Summary
Dr. Mark Burhenne dedicates an entire episode to miswak after a listener named Sari asks about this traditional chewing stick. Dr. B shares his personal experience traveling to central Nigeria where he observed chewing stick use firsthand, and explains the science behind Salvadora persica, the plant from which miswak is made. He discusses how studies from Saudi Arabia and India show that chewing miswak produces results virtually identical to conventional toothbrushing for oral hygiene. Dr. Burhenne also tells a fascinating detective story from his time in Nigeria, where he discovered that a village experiencing high decay rates was actually chewing on a plant closely related to sugar cane rather than true miswak, since the miswak tree couldn't grow at their 7,000-foot elevation. He cautions against concentrated miswak extracts in modern toothpaste products, noting that the natural chewing action combined with the mild bactericidal properties of Salvadora persica is what makes miswak effective, not synthesized versions of its compounds.
Key Points
- Miswak is a chewing stick made from Salvadora persica bark, used for over 7,000 years across the Mediterranean, Middle East, Africa, and South Asia
- Studies from Saudi Arabia and India show miswak produces virtually identical oral hygiene results compared to conventional toothbrushing
- Chewing on miswak stimulates saliva production, which buffers acids after meals
- Dr. Burhenne warns against concentrated Salvadora persica in modern toothpaste products, as extraction changes its effectiveness
- The natural chewing action plus mild bactericidal properties is what makes miswak work
- In Nigeria, a village had high decay rates because they were unknowingly chewing on a sugar cane relative instead of true miswak
- Dr. Burhenne recommends hydroxyapatite as the one modern toothpaste ingredient he endorses
Key Moments
Studies show miswak matches conventional toothbrushing
Dr. Burhenne explains that studies from Saudi Arabia and India show subjects who chew miswak achieve virtually identical oral hygiene results compared to those who brush conventionally, and that chewing on the stick produces saliva which buffers acids after meals.
"So the studies show that populations or the subjects that chew on this chewing stick, the mizwak, as opposed to people that brush the subjects that brush in the study there, the results are virtually the same. Both work very, very well."
Salvadora persica — the active compound in miswak bark
Dr. Burhenne identifies the active substance in miswak as Salvadora persica and notes that while U.S. researchers have never studied it, research from Saudi Arabia and India validates its effectiveness.
"That's the substance that is in the meswak tree, in the bark. And if used naturally, there are studies. And again, these studies are not in the U.S. No one in the U.S. has ever heard of it. They wouldn't even think of studying this. These studies are from Saudi Arabia and India, just like the tea tree oil studies are as well, mostly from India."
Warning against concentrated miswak in modern products
Dr. Burhenne cautions that when companies extract and concentrate Salvadora persica into toothpaste, the results differ from natural miswak chewing. He warns that concentrated essential oils can harm the oral microbiome.
"And they've concentrated it or they've synthesized it and they put it into toothpaste. That's a different story altogether."
The Nigeria chewing stick mystery — wrong plant, high decay
Dr. Burhenne shares his detective story from central Nigeria, where a village had high tooth decay despite using chewing sticks. He discovered they were chewing a plant related to sugar cane rather than true miswak, which likely couldn't grow at their 7,000-foot elevation.
"So finally, I narrowed it down potentially to their chew stick. And I chewed on it. It tasted very sweet. And so I sent it up to Denmark to have it analyzed. And it turns out that the plant they were chewing on was a plant that was very closely related to the sugar cane plant."
