Key Takeaway
Meta-analysis of 14 studies found miswak chewing sticks are as effective as standard toothbrushes for reducing plaque and gingivitis.
Summary
This systematic review and meta-analysis evaluated the comparative effectiveness of Salvadora persica (miswak) chewing sticks versus standard toothbrushes for plaque and gingivitis control. The authors systematically searched multiple databases and included 14 clinical trials meeting their inclusion criteria.
Pooled analysis found no significant difference between miswak and conventional toothbrush use for plaque index or gingival index scores. The meta-analysis demonstrated that miswak performs comparably to standard toothbrushes across multiple oral health outcomes, with some individual studies even showing slight advantages for miswak on gingival health markers.
The review highlights the pharmacological basis for miswak effectiveness, noting the presence of antimicrobial compounds such as salvadorine, benzyl isothiocyanate, and silica in Salvadora persica wood. These bioactive compounds provide both mechanical cleaning and chemical antibacterial action, which may explain why the simple chewing stick matches the performance of modern toothbrushes. The findings support WHO recommendations recognizing miswak as an effective oral hygiene tool.