Miswak: a potential alternative to standard tooth-brushing?

A summary of: Yasmin, W. et al: “Miswak: The underutilized device and future challenges”. Vol.11(2), pp. 6-11 , October (2019) https://doi.org/10.5897/JDOH2019.0240

What is Miswak?

Miswak also known as Siwak is a (bark) stick from the Salvadora Persica plant used as an alternative toothbrushing tool. ”Miswak” in Arabic means “stick to brush your teeth”. It has been around for approximately 7,000 years and is still used by specific populations today, most commonly among Muslims. This is because in Islam it is believed that prophet Muhammad used the S. Persica plant; therefore, allowing it to be a suitable tree used to produce the Miswak.

Today many in Saudi Arabia, Asia, and Africa use Miswak because it is also cost effective and easy to use. Moreover, the World Health Organisation recommends Miswak use based on its many oral-health benefits. A clinical experimental study at Karolinska Institute found Miswak to be as effective in reducing the accumulation of plaque as your standard toothbrush would, suggesting it can be a suitable replacement. 

Miswak use 

Miswak comes in forms of small stems. Around 2 cm of bark off one end of the stick needs to be removed and chewed until it becomes like a toothbrush head with bristles, This then softens, allowing you to clean your mouth. It is also recommended to soak the Miswak in water to further soften the bark allowing you to bite down and form the brush-like head. After using the head several times, you could cut away the end and reveal a new head of bark or replace the Miswak.

Techniques for Miswak grip recommended by scholars include the five-finger grip, three-finger grip and even pen-grasp technique. These methods intend to ensure that all parts of the oral cavity can be reached with ease. Both vertical and horizontal movements can be used when brushing. It is recommended to brush away from the gingival margin.

Today S. Persica/miswak extract has been modified and added in: 

  • Mouth wash (less effective than chlorhexidine in prevention plaque accumulation)
  • Endodontic irrigation (limits levels aerobic and anaerobic bacteria during an RCT)
  • Tooth whitening (crystal content act as natural abrasive removing extrinsic stains) 
  • Toothpaste (more effective plaque removal than Oral- B toothpaste- Hattab 1997)
  • DNA testing

Benefits of Miswak

S.Persica contains anti-plaque and anti-bacterial substances which act against certain types of cariogenic bacteria in the mouth. The main targets of miswak include Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Haemophilus influenzae. S. Persica substances also inhibit growth and production of acidic bacteria. In relation to plaque removal, studies found a 75% reduction of plaque after 8 days of miswak usage.

Periodontal pockets and gingival bleeding

Even though the use of Miswak didn’t result in significantly different gingival indexes or bleeding scores in comparison to standard toothbrushes, Miswak use does present with patients of better periodontal status than toothbrush users.

Gingival Recession and Miswak

The use of Miswak could result in a high prevalence of gingival recession. In most cases it is due to mechanical trauma from incorrect use.


In conclusion, this review of Miswak-use in modern day dentistry suggests Miswak can effectively and exclusively replace the standard toothbrush based on its ability to significantly reduce plaque accumulation and gum inflammation if used appropriately. However, further research must be done in relation to the technique of using Miswak and its benefits in relation to the oral cavity. 

Research Summary Written by: Anna-Maria Sturki, University of Manchester – BDS3

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