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MECHANICAL AND PHYTOCHEMICAL COMPOSITION IN MISWAK

(SALVADORA PERSICA) : LITTLE THINGS BIG IMPACT

Article · May 2020

DOI: 10.35124/bca.2020.20.S1.3097

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 DOI : 10.35124/bca.2020.20.S1.3097
Biochem. Cell. Arch. Vol. 20, Supplement 1, pp. 3097-3100, 2020 www.connectjournals.com/bca ISSN 0972-5075

MECHANICAL AND PHYTOCHEMICAL COMPOSITION IN MISWAK

(SALVADORA PERSICA) : LITTLE THINGS BIG IMPACT
Huda Rashad Qaid1, Muhammad Aljunaid1, Betadion Rizki Sinaredi2, Dini Setyowati3
and Taufan Bramantoro3
1
Post Graduate Program of Oral and Dental Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia.
2
Department of Pediatric Destistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia.
3
Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Indonesia.
*e-mail : taufanbramantoro1928@gmail.com

(Received 2 March 2020, Revised 9 May 2020, Accepted 11 May 2020)

ABSTRACT : Miswak is derived from Arak tree, it is considered as a traditional toothbrush, being used since ancient times
until now-a-days due to the cultural-religious aspect and the beneficial role of it. The present review is an update on mechanical
and phytochemical composition benefits, as well as antimicrobial, anti-cariogenic, anti-plaque, anti-calculus, anti-inflammatory
and antioxidant effects of Miswak on oral health. Moreover, the study highlights the limitation in the context of various recent
experiments, clinical trials, and researches.
Key words : Miswak, Salvadora persica, oral disease, herbal medcine, communicable disease.

INTRODUCTION cleaned and eliminate foul-smelling breath (Winarni et al,

Oral and dental health means safety from the pain
that affects the mouth and face, and oral diseases are
still most common amongst the widespread diseases
globally, which have critical health and economic
consequences (Dar-Odeh et al, 2019). Most of the oral
diseases are induced by dental plaque (oral biofilm), which
is the main causative factor for dental caries, gingivitis
and periodontitis. Although, these issues are considered
preventable, they persevere with a wide prevalence.
However, the essential approaches for preventing and
maintaining oral health are the mechanical and chemical
methods are to remove dental plaque (Baeshen et al,
2017).
Brushing teeth is the utmost prevalent mechanical
method that plays the most vital role to control plaque
formation. The advancement of modern toothbrushes
returns back to chewing-stick used by the Greco-Roman
thousands of years ago. Nowadays, Miswak is still used
by people in the Middle East, Asia, Africa and South
America, despite the considerable conveniences in the
use of modern toothbrushes. Furthermore, this traditional
habit persists throughout the Islamic countries due to the
religious aspect, as it has been advised by Prophet
Muhammad (Peace be Upon Him) to followers to continue
in practicing Miswak for maintaining the oral cavity
2019).
Miswak is the most common type of chewing stick
or traditional toothbrush, obtained from Arak tree
Salvadora persica (S. persica), which refers to the
Salvadoraceae family. It is an Arabic word that means
tooth cleaning chewing stick (Chauhan et al, 2020).
Miswak is mainly obtained from the small upright shrub
or from the woody roots of Arak tree. Its conventional
form, it is like a penciled stick of 15-20 cm length and 1-
1.5 cm in diameter (Savaº, 2019). It is trimmed at one
end producing an uncovered tip which is then get chewed
to form a brush (Winarni et al, 2019).The availability,
minimal price, and being preferred from distinguishable
cultural and religious purposes, making it an ideal
alternative oral hygiene tool, especially in developing
countries (Bramantoro et al, 2018).
Taking into account the over-all importance of Miswak
in the domain of oral hygiene. This review aims to provide
an up-to-date elaborated explanation and structured
assembly of studies on the use of Miswak in certain
countries in the world including significant reports of its
phytochemical constitutes and pharmacological properties
without excluding its adverse consequences on the oral
cavity by knowing the possible factor that causes the
undesirable outcomes.
3098 Huda Rashad Qaid et al
Oral benefits of miswak
Miswak chewing sticks have beneficial effects
regarding dental health care and oral hygiene, on account
of the mechanical action of its fibers as well as the
therapeutic effect of various phytochemical constituents
contained within the Miswak (Pachava et al, 2019).
Mechanical benefits
Previous investigations have established that Miswak
has high potency in comparison with toothbrush in plaque
reduction (Jassoma et al, 2019). What is more, The World
Health Organization (1987) and still recommended and
encouraging Miswak to corroborate it as an efficacious
tool for oral hygiene (Oviya et al, 2019). Miswak can be
compared with a toothbrush in that it has bristles, which
eliminate plaque mechanically. Notwithstanding, in
contrast to the toothbrush, its bristles are parallel to the
handle, which makes it more difficult to brush on buccal
and occlusal surfaces, notably with the posterior part of
the dentition (Winarni et al, 2019).
Recent study exhibit that Miswak is further efficient
than toothbrush as oral hygiene aid for the teeth (Fathy
et al, 2019). Another study investigation showed the effect
of mechanical brushing of Miswak on acrylic resin
PMMA denture base, showed that Miswak presented
the least grooves material compared to a toothbrush (Ali,
2019).
Phytochemicals benefits
Pharmacological and phytochemical investigations of
Miswak have revealed the presence of valuable natural
constituents which are ideal medicinal combinations such
as; fluoride, silicone, alkaloids, flavonoids, tannins, ascorbic
acid, tri-methylamine, chloride, resins, gums,
anthraquinones and related compounds, besides, S.
persica root contains Benzyl isothiocyanate (BIT) 90%
and benzyl nitrate 10%, which are proved to be favorable
for oral health and act as anti-carious effects, antibacterial,
anti-inflammatory, antiseptic, as well as relieve halitosis,
remineralize enamel tissues, teeth whitening, increase
salivation,and improve taste sensation. All these benefits,
unlike the toothbrushes that require toothpaste which is
manufactured in order to have all of these ingredients
(Chauhan et al, 2020; Fathy et al, 2019).
Anticariogenic and anti-plaque effect
Numerous clinical studies have stated that Miswak
has an affirmative effect on dental plaque and gingival
inflammation, an additional study reviewed that Miswak
significantly reduces plaque accumulation that causes
caries, periodontal diseases as compared to the toothbrush
(Winarni et al, 2019). Previous study showed that
Miswakeffectually frustrated dental caries in high school
students (Mustafa et al, 2016).
Miswak exhibited elevated levels of plaque pH by
increasing salivary flow, which signifies an effective role
concerning caries prevention by buffering capacity
(Pachava et al, 2019). The effectiveness of the Miswak
is also associated with the existence of benzyl
isothiocyanate, which is the principal component of
inhibiting acid production and Streptococcus mutans (S.
mutans) growth, the main aetiological pathogen of dental
caries (Sabbagh et al, 2020). Other main anti-cariogenic
component sare fluoride, it reduces the enamel solubility,
formation and reinforces of the hydroxyapatite, in addition
to its inhibitory effect against microorganism growth and
their enzyme by its cariogenic potential. Furthermore,
chewing sticks have been shown that it contains silicone,
which construes for the lower caries rate noticed amongst
the chewing-sticks continuous users. Furthermore, tannin
components form a coat over the enamel and thus protect
against tooth decay (Chauhan et al, 2020; Darul and
Putera, 2020).
Oviya et al (2019a) study proved that S. persica
exhibits antibacterial activity against oral pathogens that
cause dental caries. However, Winarni et al (2019)
declared through clearly evident from the clinical trial
and experiments that Miswak was equivalently efficient
as the traditional method of teeth-brushing on plaque
removal. other similar studies revealed notable
enhancement in plaque rate and gingival health meanwhile
Miswak was used as an adjunct to tooth brushing (El-
Latif Hesham and Alrumman, 2016). What is more, a
study exposed the efficacy of Miswak as an anti-
cariogenic plant by examining its effects corresponding
with the toothbrush, where cariogenic bacteria S.mutans
number was a more prominent reduction in Miswak user
in comparison with toothbrush user (Wassel and Khattab,
2017). A recent experimental study reports that Miswak
and brushing with fluoride toothpaste significantly
decreased plaque amounts between children. Also,
Miswak could change the amounts of salivary bacteria
in favour of species with less risk of causing caries to
alter the amounts of salivary bacteria in favour of species
with low risk of causing tooth decay (Sabbagh et al, 2020).
Antimicrobial effect against oral pathogens
Various bacterial species remain in the oral cavity
and subsequently get induced to cause oral diseases. The
gingival and periodontal disease process can be prevented
by the effective elimination of dental plaque. As stated
by many studies, Miswak has been described to reveal
antibacterial role, mainly on bacteria cause tooth decay
 Mechanical and phytochemical composition in miswak
and periodontal disease (Al-Dabbagh et al, 2016). The
presence of thiocyanate agent, accompanied by another
chemical such as sodium chloride, potassium chloride,
sulphur, alkaloid, saponin, tannins have a strong
antibacterial effect against several gram-negative bacteria
that cause periodontitis and gram-positive bacteria causing
dental (Niazi et al, 2016). Furthermore, S. perisca
chewing stick has antifungal efficacy due to tannin and
hexane components that present in Miswak roots were
observed potent toward Candida albicans and E.
faecalis (Chauhan et al, 2020). Likewise, benzyl
isothiocyanate has a viricidal activity against Herpes
simplex virus (Haque and Alsareii, 2015).
Anti-calculus effect
High amounts of chloride and silica components found
in Miswak along with the frequency and duration of the
mechanical action of Miswak contribute to the control of
supragingival calculus formation and removal of calculus
together with the extrinsic tooth stains. Thus, Calculus
promote and preserve dental plaque on its external
surface in the teeth consequently, it is a relevant risk
factor of the progression of attachment loss of the teeth
(Aumeeruddy et al, 2018).
Anti-inflammatory and analgesic effect
Miswak has anti inflammatory, analgesic and
astringent properties on the gum, making it an efficient
remedy for initial periodontal diseases. It is understood
that inflammation of the gingiva happens considerably
regularly during brushing teeth. However, chewing sticks
contain elements that possess a robust anti-inflammatory
impact on gingival inflammation, as well as it contains
vitamin C which helps in gingival tissue healing and repair
(Chauhan et al, 2020). Moreover, it has been noted that
patients using Miswak regularly had a low incidence of
toothache compared to toothbrush users this may be due
to the evidence suggested Miswak being affective
towards thermic stimuli corresponded to chemical ones
(Niazi et al, 2016). Likewise, the tannins component that
performs astringent or slightly ant irritant action on the
mucous membranes. Additionally, essential-volatile oils
that occupy characteristics of aroma exert, antiseptic and
analgesic actions, some of these oils are applied locally
on the irritated gingiva, mucous membranes or carious
teeth to relieve the pain (Haque and Alsareii, 2015).
Antioxidant
Antioxidants assist the body to defend itself against
different kinds of oxidative damage induced by reactive
oxygen species, which are correlated with the diversity
of ailments including chronic inflammatory diseases like
periodontal disease (Aumeeruddy et al, 2018). From
3099
scientific research of Miswak root, it has been exhibited
great antioxidant activity. The antioxidant capability of
Miswak was further associated with the existence of
phenolic contents, flavonoids antioxidant enzymes,
peroxidase, polyphenol oxidase and catalase. This
synergistic effects between enzymes and antioxidant
compounds make the Miswak is a reliable choice for
cleansing teeth and oral hygiene (Ibrahim et al, 2015).
Through these several benefits, a recent study
described that Miswak users stated good periodontal
health, reduced gingival bleeding, and interproximal loss
of bone in comparison with toothbrush users. The
relatively low score of gingival indices when observed in
Miswak users, as a consequence of these properties
Miswak may positively contribute to dental welfare
(Jassoma et al, 2019; Niazi et al, 2016).
Limitations of miswak
Although, Miswak is considered as a low cost, and
reasonable approach, together with its valuable
pharmacological properties of maintaining good oral.
Some disadvantages are correlated with it is practice.
The form of Miswak bristles lies in the long axis of the
stick, which makes it hard for users to brush and reach
the interdental space and lingual surface. Therefore, it
might not be feasible for users to accurately and easily
accessible to all dental surfaces (Haque and Alsareii,
2015). Another drawback reported is relevant to the
routine practice of Miswak for a continuous period to
the anterior teeth, claimed that excessive brushing could
compromise the aesthetic teeth surfaces and result in
severe attrition (Saleh, 2017). Besides that when Miswak
used dry without softening it, it may adversely affect the
gingiva and teeth. Despite the robust properties and no
cytotoxicity effect proven by previous studies regarding
fresh Miswak, there is atoxic effect for the oral cavity
showedwhen used after time again (Albabtain et al,
2017). These disadvantages can be defeated by
perception and knowledge by adjusting the appropriate
technique and method of how to use Miswak without the
negative impact of it, as it is an oral hygienic tool with a
sensitive technique.
CONCLUSION
Sherds of evidence revealed that Miswak is a
valuable tool for maintaining oral health. This review high
spot numerous valuable impacts of S. persica on
maintaining oral health and oral disease prevention and
enhancement, due to its excellent mechanical efficiency
in plaque removing, and its wide range of the biological
and phytochemical properties. As well as the use of
Miswak is correlated with cultural, and religious aspects.
 3100 Huda Rashad Qaid et al
Consequently, using Miswak should be encouraged and
recommended due to its numerous therapeutic outcomes
on oral health based on scientific investigation and
studies.It is predicted by the end of this review to reveal
more new approaches to research over again and
encourage more studies to fill the gaps in this research.
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