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| MEDICAL HISTORY |
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| Year : 2015 | Volume
: 3
| Issue : 1 | Page : 152-154 |
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Miswak: The miracle twig
Akhter Husain, Salman Khan
Department of Orthodontics and Dentofacial Orthopaedics, Yenepoya Dental College, Yenepoya Universiy, Mangalore, Karnataka, India
| Date of Web Publication | 13-Apr-2015 |
Correspondence Address:
Prof. Dr. Akhter Husain
Department of Orthodontics and Dentofacial Orthopaedics, Yenepoya Dental College, Yenepoya Universiy, Mangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.154969
How to cite this article:
Husain A, Khan S. Miswak: The miracle twig. Arch Med Health Sci 2015;3:152-4 |
| Introduction | |  |
An oral hygiene accessory invented more than 1500 years ago when neither nylon nor toothpaste was discovered still being used among certain populations and WHO [1] has recognized its multiple benefits recently. "Miswak" is an Arabic word, which means "tooth-cleaning stick."
| Historical Perspective | | |
Archeological studies across the globe confirm that different oral hygiene measures have been tried since the dawn of time. Chew sticks, twigs, linen strips, toothpicks, feathers of birds, porcupine quills and sharp animal bones were used.
Chewing sticks used to clean teeth and mouth marks the beginning of a great evolutionary process, which began about 3500 BC by the Babylonians and today it has evolved in to the modern toothbrush. [2] A number of plant species are used to make chewing sticks, but the most popular one is Salvadora persica, these have been in use across South America, Africa, Asia and the Middle Eastern parts of the world. [3]
These sticks are popular among different cultures and languages by different names: "miswak" in Arabic, "qisa" in Aramaic, ''qesam'' in Hebrew, "mastic" in Latin and "Koyoji" in Japanese. [4] S. persica tree from which the miswak is produced is known as arak in Arabic and peelu in Urdu. The popularity of miswak became significantly widespread under the influence of Islamic culture.
Salvadora persica is a tree which is small and gives out fibrous branches, these branches are used as miswaks because they have a very aromatic fragrance and a sharp taste. These trees develop drunks that are twisted and have splintered barks with long elliptical leaves. The flowers produced by them are green to yellowish in color which are small and bear scarlet fruits. They tolerate extreme weathers very well; these grow abundantly in deserts as well as in wet lands, coastal areas and by the riverside.
There are around 182 species of plant from which a miswak can be prepared, but the popular choice is S. persica all over the world. [5] The twigs, stems and roots of this plant have been used extensively for oral hygiene measures and also smaller sticks are being used as toothpicks.
In India, these trees are found in large areas of Rajasthan but they have an extensive geographic distribution ranging from Nepal, Pakistan, Malaysia, Iran, Saudi Arabia, Iraq at the east and Mauritania to Egypt in the west and from North Africa through Ethiopia, Sudan and Central Africa to Southwestern Africa. [2]
The miswak benefits dental health in general and oral hygiene in specific by a combination of its mechanical action and pharmacological properties.
The following are a range of benefits obtained by the miswak: It contains fluorides that are helpful in fighting against caries [6] and a repeated action of chewing the mistake produces anticariogenic effect by releasing fresh sap in the oral cavity. [7] Moderate concentrations of silica and sulfur along with small quantities of tannins [8] and higher concentrations of sodium chloride help it achieve a dentifrice like effect. [9] Tissue healing and repair was found due to Vitamin C. [7] A thin resin layer is formed on the enamel which helps is protecting against caries. [10] Presence of an essential oils give out a mild pungent taste which helps in stimulating the flow of saliva behaving as a buffering agent and calculus formation is retarded by high concentrations of chloride. [8] Enamel remineralization was found to be enhanced in chewing sticks due to saturation of calcium in saliva. [11] The mechanical intervention is basically by an abrasive in the form of silica which helps is removing plaque and stains from teeth surfaceswhereas tannins helps is reducing clinically detecof cleansing gives a satisfactory result gingivitis by inhibiting the action of glucosyltransferase. [12]
Apart from being the cleaning aid for tooth and tongue, it as effective functional jaw exerciser following any trauma to the jaws or the temporomandibular joint. It prevents deleterious habits such as thumb sucking in children and smoking in adults and aids in the development of the dentition while the eruption stage. [13] It is found to elevate the appetite and aid in the regulation of peristaltic movement of the gastrointestinal tract. [14]
The Wrigleys company conducted a study, which found that mints with miswak extracts added were 20 times more effective in killing bacteria than ordinary mints, which was published in 2007 by Journal of Agriculture and Food Chemistry, it showed that in 30 min 60% of bacteria was killed when compared to a meagre 3.4% among ordinary mints.
Swedish researchers did a culture study where miswak pieces suspended in a petridish were able to kill periodontal disease causing bacteria without contacting them, this study suggested presence of antibiotic in gaseous form to explain the phenomenon, which was published in august issue of Journal of Periodontology (2008).
Today several major oral health care companies have commercially available mouthwashes and toothpastes containing miswak extracts. A few are Miswak ® , Pakistan, Indonesia Fluoroswak ® , Dentacare Miswak Plus ® , Saudi Arabia, Quali-Meswak toothpaste ® , Switzerland, Sarkan toothpaste ® , UK, Siwak-F ® toothpaste, Epident toothpaste ® , Egypt.
| Role of Miswak in India | | |
Oral health care resources remain limited in developing countries like India; higher ratio pertaining to rural India. There is an inherent need to explore any easily available and inexpensive cleaning aids, which are traditional to the society as this move is supported and encouraged by the WHO. [1]
Highly acclaimed Indian medicine books such as Susrutha Samhita and Charaka Samhita that herbal chewing sticks are excellent oral hygiene aid tool. [1]
The use of miswak, neem, banyan and mango sticks are among the popular oral hygiene aids that are used in India and a study was done in South India comparing these four sticks, which concluded stating miswak being the more superior in antimicrobial activity among these chewing sticks. [15]
| How to Use It | | |
One end of the bark is either trimmed or chewed off by about 1 cm. The exposed end is then chewed upon until the twigs form in to bristles, and these are used to brush without toothpaste. Every few days the wearing away bristles may be cut off and repeat peeling the bark and starting fresh. The miswak requires to be moistened by water or preferably rose water when it becomes dry. Usually miswak is about 15 cm in length and thickness resembles a finger.
There are two grips to miswak, palm-grip (five-finger) or pen-grip (three-finger). Both are done to exercise a firm controlled movement of miswak intramurally and to enhance reachability to all areas of the oral cavity with ease.
The direction of miswak should be directed away starting at gingival margins of the teeth on both lingual and buccal surfaces. Antero-posterior scrubbing action is used on the occlusal surfaces. One must be careful to avoid damage to the soft tissues of the oral cavity and generally about 5 min of cleansing gives a satisfactory result[Figure 1]. | Figure 1: The Miswak-Salvadora persica (Photographer: Dr. Akhter Husain Location: Department of Orthodontics, Yenepoya University)
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The cleaning of the tongue is an important use of miswak; it helps in fighting halitosis and effectively removing the white coat that develops on the dorsum of the tongue. This is usually done by the brush end of the miswak, but results are shown to be significantly pronounced when a stick is broken into V-shape and used in a scraping action across the tongue.
| Islamic Perspective | | |
Oral hygiene is highly valued in the religion of Islam; cleanliness is regarded as a sign of faith. Oral hygiene measures involving the cleaning of teeth were a popular practice among the prophets. In fact, cleaning the teeth using a miswak is a sunnah (a practice of Prophet Muhammad) and has an aspect pertaining to worship which was introduced more than 1400 years ago. He strongly advocated the use of miswak throughout the day; before performing prayers (5 times a day), having meals, social gatherings and before going to bed. Islam introduced basic oral hygiene as a means of pleasing the god and deemed it a religious practice. It teaches the significance of having a clean body, clear mind and a pure soul. Several popular quotations are found regarding the use of miswak in oral hygiene measures from the collection of sayings by Prophet Muhammad. One such saying is Prophet Muhammad, said: "Siwak purifies the mouth and pleases Allah and said: Were it not to be a hardship on my community, I would have ordered them to use Siwak for every ablution."
These are certain Islamic etiquettes of using a miswak:
- It should be a straight, clean, smooth twig, which isn't too hard spanning about 8 inches in length and thickness similar to the forefinger.
- It should be washed well before and after use, preferably with rose water and should not be sucked upon.
- It should be stored vertically while not in use, shouldn't be used in toilet and using of both ends should be avoided.
- Each section of the mouth should be brushed at least thrice, and very importantly it should not be taken from any unknown tree as it can be poisonous or harmful.
| Conclusion | | |
To add all this that has been said and analyzed about miswak, a thing to ponder is that it is a natural stick, eco-friendly, inexpensive with nothing left to litter providing so many beneficial effects without the need of a toothpaste and a natures simple way of providing us fluoride. Only with real-time use can we truly experience its miracle that exists for more than a century now.
| References | | |
| 1. | Prevention methods and programmes for oral diseases. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1984;713:1-46.  |
| 2. | Wu CD, Darout IA, Skaug N. Chewing sticks: Timeless natural toothbrushes for oral cleansing. J Periodontal Res 2001;36:275-84. |
| 3. | Elvin-Lewis M. Plants used for teeth cleaning throughout the world. J Prev Dent 1980;6:61-70. |
| 4. | Bos G. The miswãk, an aspect of dental care in Islam. Med Hist 1993;37:68-79. |
| 5. | Elvin-Lewis M. The therapeutic potential of plants used in dental folk medicine. Odontostomatol Trop 1982;5:107-17. |
| 6. | Char D, Dogao A, Dogan M. SEM, XRF, and EMPA evaluation of Middle Eastern toothbrush '' Salvadora persica''. J Electron Microsc Technol 1987;5:145. |
| 7. | Almas K, al-Lafi TR. The natural toothbrush. World Health Forum 1995;16:206-10. |
| 8. | Akhtar MS, Ajmal M. Significance of chewing-sticks (miswaks) in oral hygiene from a pharmacological view-point. J Pak Med Assoc 1981;31:89-95. |
| 9. | Dorner W. Active substances from African and Asian natural tooth brushes. Chem Rundsch 1981;34:50. |
| 10. | Al lafi T, Ababneh H. The effect of the extract of the miswak (chewing sticks) used in Jordan and the Middle East on oral bacteria. Int Dent J 1995;45:218-22. |
| 11. | Gazi MI, Davies TJ, al-Bagieh N, Cox SW. The immediate- and medium-term effects of Meswak on the composition of mixed saliva. J Clin Periodontol 1992;19:113-7. |
| 12. | Gazi MI, Davies TJ, al-Bagieh N, Cox SW. The immediate- and medium-term effects of Meswak on the composition of mixed saliva. J Clin Periodontol 1992;19:113-7. |
| 13. | Almas K. Miswak (chewing stick) and its role in oral health. Postgrad Dent 1993;3:214-8. Gazi MI, Davies TJ, al-Bagieh N, Cox SW. The immediate-and medium-term effects of Meswak on the composition of mixed saliva. J Clin Periodontol 1992;19:113-7. |
| 14. | al-Khateeb TL, O'Mullane DM, Whelton H, Sulaiman MI. Periodontal treatment needs among Saudi Arabian adults and their relationship to the use of the Miswak. Community Dent Health 1991;8:323-8. |
| 15. | Elangovan A, Muranga J, Joseph E. Comparative evaluation of the antimicrobial efficacy of four chewing sticks commonly used in South India: An in vitro study. Indian J Dent Res 2012;23:840. [ PUBMED]  |
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