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Title Effectiveness of the Miswak (Chewing stick) on plaque reduction and gingival health
Clinical Question In young adults, what is the efficacy of the Miswak (chewing stick) for plaque microbial reduction and gingival health in comparison to a toothbrush?
Clinical Bottom Line There is some evidence to show that use of a Miswak is actually more effective than a toothbrush in reducing plaque and gingivitis when patients are instructed in its proper use. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15643758Al-Otaibi/200315 healthy Saudi Arabian male volunteers aged 21 to 36 yearsRandomized Controlled Trial (Crossover)
Key resultsThis study concluded that the use of Miswak had resulted in higher reductions of plaque (p<0.001) and gingival (p<0.01) indices than toothbrushing. There was also support of this with image analysis, which showed a higher plaque reduction for the Miswak versus the toothbrush (p<0.05).
Evidence Search PubMed was searched using the following keywords: "Toothbrushing"[Mesh] AND ((chewing AND stick) OR miswak) ...view in PubMed
Comments on
The Evidence
Baseline measures were taken of gingival indices and digital photographs of the plaque distributions amongst the participants, which were the Turesky modified Quigley-Hein and Loe-Silness gingival indices. All the patients had received professional tooth cleanings before initial baseline measurements were taken as well as three weeks after the trials of their usage of either the Miswak or toothbrush. The low number of participants in this study certainly limits the strength of its findings.
Applicability These findings apply to healthy, young adult males, particularly in the Middle East and other areas where the Miswak is commonly used.
Specialty/Discipline (Public Health) (General Dentistry) (Dental Hygiene)
Keywords Miswak; chewing stick; gingivitis; plaque; toothbrushing
ID# 508
Date of submission: 01/08/2010spacer
E-mail FrancisJ@uthscsa.edu
Author Mohammad Arsalan Khan
Co-author(s) J. Christian Francis
Co-author(s) e-mail
Faculty mentor/Co-author Kenneth Kalkwarf, DDS
Faculty mentor/Co-author e-mail KALKWARF@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Clarian Lannom (San Antonio, Texas) on 04/18/2012
A PubMed search on this topic was completed in April 2012. The publication in CAT is the most recent and of the highest level of evidence related to the clinical question. A double blind RCT: PubMed ID 21798329 which included 68 patients was published in 2011. Although it did not compare chewing Miswak to using a toothbrush, it did further document the benefit of chewing Miswak to reduce plaque and gingivitis.

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