Efficacy of Miswak toothpaste and mouthwash on cariogenic bacteria

Herbal medicines to prevent dental caries

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of herbs/herbal extracts to prevent or minimise tooth decay in children and adults.

Herbal Mouthrinses for Prevention of Dental Caries in Children and Adolescents: A Systematic Review

The primary aim of this study was to evaluate the effectiveness of herbal mouthrinses (HMR) on caries prevention in children and adolescents. In addition, this systematic review assessed its effectiveness in remineralization of white spot lesions, reduction of halitosis, and improving gingival and periodontal health in orthodontic patients and patients with special healthcare needs (SHCN). A comprehensive bibliographic search was conducted in PubMed, Cochrane Central, EMBASE, AMED, ProQuest, CINAHL, AYUSH, Digital Helpline for Ayurveda Research Articles (DHARA), and Clinical Trial Gov databases. A total of 3,918 titles were identified during the initial search. Of these, 32 studies were selected for quality assessment. A total of 5,038 participants from 10 countries were thus included in this review, with 22 (66.7%) studies conducted in India. All included studies were published between 2004 and 2021. Included studies investigated the effect of HMR on caries increments, which record decayed, missing, filled (DMF) [International Caries Detection and Assessment System (ICDAS)], decayed, missing, filled teeth/surfaces (DMFT/S), and incipient caries. Changes in bacterial count (Streptococcus mutans and Lactobacillus) and alterations in levels of Candida albicans from saliva or plaque samples were also reported. The effect of HMR on gingival and plaque indices among adolescents undergoing orthodontic treatment and children with SHCN was reported in two studies. The variance in the HMR formula across studies, short follow-up period, and limiting grade of evidence do not allow for conclusive evidence of the efficacy of HMR. This warrants high-quality randomized controlled trials (RCTs) with longer intervention periods involving children under 6 years to yield more conclusive results.

How to cite this article

Saikia AM, Sivasubramanian A, MS M, et al. Herbal Mouthrinses for Prevention of Dental Caries in Children and Adolescents: A Systematic Review. Int J Clin Pediatr Dent 2024;17(S-1):S100-S111.

Effectiveness of Salvadora persica toothbrush and Salvadora persica chewing stick in plaque and gingivitis control: a randomized control trial

BACKGROUND

The values of plant-based products have taken on an expanding relevance in dentistry. Salvadora persica chewing stick (miswak) has been practiced for centuries and is recommended by the World Health Organization as a customary oral hygiene tool. The therapeutic effects of S. persica chewing stick are contributed by its mechanical cleansing action, active chemicals released, or the combination of these two actions. However, the S. persica chewing stick in its natural form can be difficult to maneuver in certain parts of the mouth. This concern has inspired the innovation of the S. persica toothbrush that is designed to merge the ease of use of a toothbrush with the beneficial natural properties of S. persica preserved in its bristle. The present study aimed to compare the clinical effectiveness between S. persica toothbrush, S. persica chewing stick and the standard toothbrush in plaque and gingivitis control.

METHODS

In this single-blinded and parallel randomized controlled trial, 78 participants were randomly divided into three groups to either use (i) S. persica toothbrush (MTB); (ii) S. persica chewing stick (MCS); or (iii) standard toothbrush (STB) in a standardized manner for three weeks. Plaque Index (PI) and Periodontal Inflamed Surface Area (PISA) values, measuring plaque levels and severity of gingivitis, respectively, were evaluated at baseline, one- and three-week post-interventions.

RESULTS

The MCS group showed a significant improvement in the mean PISA values of the anterior teeth compared to the MTB and STB groups (MCS: from 16.35 ± 10.03 to 3.41 ± 1.14; MTB: from 25.20 ± 14.01 to 3.57 ± 1.19; STB: from 26.54 ± 8.64 to 6.17 ± 0.86; p < .050). All three groups reported significant improvements (p < .001) in the plaque levels and the severity of gingivitis from baseline to three weeks after the intervention.

CONCLUSIONS

Following correct techniques, S. persica toothbrush and chewing sticks are as effective as the standard toothbrush in plaque control and gingival health, which represent the reputed anti-plaque and anti-gingivitis properties of S. persica.

TRIAL REGISTRATION

This clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04650685 (25/11/2020).

Antibacterial Effect of Miswak herbal toothpaste Compared to Fluoride Toothpaste in High Caries Risk Patients: Randomized Clinical Trial

Background

Modern toothbrushes origin can be traced to plant-derived chewing sticks, which were documented to be used Babylonians as early as 3500 BC. Chewing sticks are routinely used for cleaning teeth in Asia, Africa, South America, and the Middle East. The aim of the current study was to evaluate the antibacterial effect of miswak herbal toothpaste compared to fluoride toothpaste using a normal toothbrush, against Streptococcus mutans in high caries risk patients.

Material and Methods

A total of 32 participants were recruited to the current clinical trial using convenience sampling randomly either to miswak or fluoride toothpastes groups (n=16). The bacterial count represented as colony-forming units per milliliter (CFU/ml) was assessed at baseline and after 1 week, 1 month and 3 months. Moreover, the ion release for silicone, calcium, phosphorus, and fluoride from both toothpastes was analyzed in addition to the pH of both toothpastes and their supernatants. Intergroup comparison was performed using independent t test, while intragroup comparison was performed using repeated measures ANOVA followed by tukey post-hoc test and paired t test when appropriate.

Results

There was no statistically significant difference between both toothpastes for the S. mutans count within each follow up period, however the bacterial count significantly decreased over time in both groups. Signal Fluoride toothpaste exhibited statistically significant higher ion release when compared to the Dabur Miswak toothpaste. There was no statistically significant difference between either toothpastes regarding pH (P = 0.5368), while comparison between supernatants of toothpastes have shown statistically significant difference (P = 0.0194), with a higher pH in miswak toothpaste.

Conclusions

Miswak herbal toothpaste possesses a potent antibacterial effect, yet its remineralization potential is questionable due to its inferior ion release that will affect the ion substantivity in saliva, which is an important factor in remineralization. Key words:High caries risk, Miswak, Fluoride, Antibacterial, Streptococcus mutans.

Effect of Salvadora persica Extract (Miswak) on the Dentinal Tubules of Sound Root Dentin: Scanning Electron Microscope Study

BACKGROUND/PURPOSE

Root dentin is vulnerable to a higher risk of demineralization than coronal enamel. This study aimed to evaluate the effect of miswak extract on the dentinal tubules of sound root dentin.

MATERIALS AND METHODS

Twenty bovine root dentin blocks, approximately 2 mm × 3 mm × 3 mm (width × length × depth) in dimensions, were prepared from freshly extracted sound bovine incisors. The sample was divided into two groups: control and miswak group. The control group had sound root dentin block and the miswak test group was treated with miswak extract 20% for 24 h. The two groups of all specimens were subjected to ultrasonication for 10 min. Scanning electron microscope images were analyzed for surface typography.

RESULTS

Fifty percent of the control group had surface particles (SPs), while the other 50% had no SPs. For the dentinal tubules, all (100%) the control group had a mixture of opened and partially opened dentinal tubules. On the other hand, for the miswak group, all (100%) the sample had SPs and blocked dentinal tubules.

CONCLUSION

Miswak showed total blocking of the dentinal tubules compared to the control group. This might indicate that miswak has a role in reducing dentinal hypersensitivity of exposed root dentin.

Beneficial Role of Antioxidant Secondary Metabolites from Medicinal Plants in Maintaining Oral Health

Plant-derived phytochemicals have been touted as viable substitutes in a variety of diseases. All over the world, dentists have turned to natural remedies for dental cure due to the negative possessions of certain antibacterial mediators used in dentistry. Antimicrobial and other drugs are currently in use, but they show some side effects. Since ancient times, antioxidant EOs have been used for different ailments and have grown in popularity over time. Several in vitro, in vivo, and clinical trials have shown the safety and effectiveness of antioxidant essential oils (EOs) in oral health obtained from medicinal plants. The current review of literature provides a summary of secondary metabolites, more specifically EOs from 20 most commonly used medicinal plants and their applications in maintaining oral health. Dental caries and periodontal diseases are the most common and preventable global infectious diseases, with diseases of the oral cavity being considered major diseases affecting a person's health. Several clinical studies have shown a connection between oral diseases and oral microbiota. This review discusses the role of antioxidant secondary metabolites in inhibiting the growth of oral pathogens and reducing the formation of dental plaque, and as well as reducing the symptoms of oral diseases. This review article contributes a basic outline of essential oils and their healing actions.

The effectiveness of Salvadora persica stick on the colonization of oral pathogens in mechanically ventilated patients in the intensive care unit (ICU): A pilot study

OBJECTIVE

To evaluate the effectiveness of antibacterial Salvadora persica stick on the colonization of oral pathogens in patients with mechanical ventilation.

METHOD

This research is quasi-experimental research with pre-test-post-test design. Oral care was administered every 12h on patients who required mechanical ventilation for less than 24h. The colonization of oral pathogen assessment was conducted with swab oral treatment before and 48h after mechanical ventilation. The data obtained were analyzed with a paired t-test.

RESULTS

The results of this research showed that the antibacterial effect of S. persica stick was significant in preventing the increase in the amount of oral pathogen colonization in mechanically ventilated patients (p<0.05). The colonization of oral pathogens decreased from 48×10⁶CFU/ml to 14×10⁶CFU/ml.

CONCLUSION

Oral care with S. persica can serve as a complementary therapy for patients with mechanical ventilation.

Comparative Evaluation of the Effectiveness of 40% Miswak Mouthwash and 0.12% Chlorhexidine Mouthwash in Treating Gingivitis: A Blinded, Randomised Clinical Trial

PURPOSE

To assess the effectiveness of a 40% miswak compared to a 0.12% chlorhexidine mouthwash.

MATERIALS AND METHODS

A total of 60 patients aged 20-55 years who attended the Periodontics Clinics at the College of Dentistry, Al-Iraqia University, Baghdad, Iraq, were allocated into 2 groups to use either 40% miswak mouthwash or 0.12% chlorhexidine gluconate Kin Gingival (Laboratorios KIN) twice daily for 2 months. Gingival, bleeding, and plaque indices were assessed.

RESULTS

There were statistically significant differences between the effectiveness of miswak and chlorhexidine mouthwashes in terms of gingivitis. The means of gingival, bleeding, and plaque indices using miswak mouthwash were 1.2, 0.4, and 0.53, respectively, i.e. indicating lower effectiveness, than when 0.12% chlorhexidine mouthwash was used (0.87, 0.43, 0.23, respectively).

CONCLUSION

Miswak mouthwash is a good oral hygiene agent especially for long-term use even if its efficacy is lower than chlorhexidine mouthwash.

Khat Chewing Induces a Floral Shift in Dental Material-Associated Microbiota: A Preliminary Study

Background

The habit of khat (Catha Edulis Forskal) chewing is widely practiced in the southern regions of Saudi Arabia, Yemen, and East Africa. This social habit has tremendous effects on oral and general health of khat chewers. Khat may affect bacterial species in plaque biofilms on oral rehabilitation materials. This preliminary case-controlled study aimed to assess and compare the effect of khat chewing on bacterial biodiversity between non-khat chewers (NKC) and khat chewers (KC) in oral biofilms on oral rehabilitation materials using polymerase chain reaction (PCR).

Material/Methods

Fifty participants were organized into 2 equal groups of NKC and KC, each containing 5 subgroups related to filling material type. Some participants had amalgam (A) or composite (C) restorations, while others had feldspathic porcelain (FP), nickel chromium (NC), and zirconia ceramic (ZC) crowns or bridges. Oral biofilm samples were collected from all participants, DNA was extracted, and samples were subjected to PCR. Bacterial species were then identified and counted. PCR products were sequenced to detect similarity. Partial 16S rRNA gene sequences of the current study samples were compared with 16S rRNA gene sequences from GenBank using BLAST on the National Center for Biotechnology Information website.

Results

The Streptococcus sp. was the most common bacterial species among our participants (40; 80%), followed by Lactobacillus and Veillonella spp., accounting for 12% (6) and 8% (4), respectively. Streptococcus sp. was observed equally among NKC and KC, but Lactobacillus and Veillonella spp. were higher in KC and NKC, respectively. Lactobacillus was associated mainly with prosthetic materials, and Streptococcus was found among all examined dental restorative materials.

Conclusions

This research concluded that khat chewing significantly affects bacterial biodiversity in oral biofilms in the presence of different restorative and prosthetic dental materials.

Dental caries and hypoplastic amelogenesis imperfecta: Clinical, structural, biochemical and molecular approaches

AIM

The aim of this study was to explore the caries features in hypoplastic Amelogenesis Imperfecta (AI) patients.

MATERIALS AND METHODS

A cross-sectional study was performed including 28 patients, 14 with hypoplastic AI and 14 controls for whom Decayed (D), Missed (M) and Filled (F) Teeth (T) were checked for a DMFT index evaluation. Twenty-eight saliva samples, 4 bacterial plaques and 19 teeth were used. Decayed teeth were observed under polarized light and scanning electron microscopy. Salivary pH was measured and saliva bacterial strains were biochemically identified and confirmed by PCR. Bacterial adhesions to tooth surfaces were observed by Scanning Electron Microscopy (SEM) and evaluated by colony enumeration after in vitro culture of Streptococcus mutans and Lactobacillus casei with dental fragments.

RESULTS

DMFT indexes were significantly lower in AI patients (mean DMFT = 0.8) compared to controls (mean DMFT = 2.9). Decayed teeth revealed sclerotic, demineralized, invaded and disintegrated zones in dentine. Dental plaques were rich with filamentous bacteria in AI patients. Oral microbiotome of the saliva showed a low rate of Streptococci and a significant high level of Bacillus spp, Enterococcus faecalis and Enterococcus faecium in AI patients. In vitro study showed a significant high adhesion of Lactobacillus casei and a weak adhesion of Streptococcus mutans on AI dental hard tissues.

CONCLUSION

Our study showed that hypoplastic AI patients have (i) a low DMFT index, (ii) an alkaline pH of saliva enriched with Bacillus spp, Enterococcus faecalis and Enterococcus faecium and (iii) dental tissues more easily invaded by Lactobacilli than Streptococci. The combination of these bacteria seems to give AI patients protection against dental caries.

The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic review and meta-analysis

BACKGROUND

The plant Salvadora persica (miswak) has a long history of use in oral hygiene. Associations between the use of Salvadora persica and decreased oral bacteria numbers and plaque scores have been reported. This systematic review and meta-analysis assessed the ability of Salvadora persica mouthrinses to reduce plaque/cariogenic bacteria, in comparison to that of chlorhexidine and/or placebo rinses.

METHODS

A comprehensive literature search for clinical trials reporting the use of Salvadora persica rinses as an antibacterial and/or antiplaque agent in comparison with chlorhexidine and/or placebo rinses was conducted, with no restriction to language. MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, Wiley Online Library, ScienceDirect, and Google Scholar databases were searched to include all articles published up to December 2018. Based on inclusion/exclusion criteria, data were extracted from the identified reports by two independent reviewers. The primary and secondary outcomes measured from the eligible studies were mean plaque scores and mean cariogenic bacterial counts, respectively. Risk of bias of these studies was assessed. A statistical test of homogeneity was used to determine if the results of the separate studies could be combined. Based on the chi-square test, an inconsistency coefficient was computed (I2 statistic). Sensitivity analyses using subgroups and homogeneity evaluation were conducted.

RESULTS

A total of 1135 potentially eligible articles were identified, of which 19 were eventually included in the qualitative analysis whereas 18 were included in the quantitative meta-analysis. The meta-analysis showed that Salvadora persica rinses exhibited strong antiplaque effects (P < 0.00001, MD: 0.46, and 95% CI: 0.29 to 0.63). In addition, it had statistically significant anti-streptococcal (P < 0.0001, MD: -1.42, and 95% CI: -2.08 to - 0.76) and anti-lactobacilli effects (P < 0.00001, MD: -1.12, and 95% CI: -1.45 to - 0.79) when compared to placebo. However, its effects were inferior compared to those by chlorhexidine rinse (P = 0.04, MD: 0.19, and 95% CI: 0.01 to 0.37). Subgroup analyses yielded results similar to those prior to subgrouping.

CONCLUSION

The use of Salvadora persica extract was associated with a significant reduction in the plaque score and cariogenic bacterial count. Although, this reduction was lower than that achieved with the gold standard chlorhexidine mouthwash, Salvadora persica-containing rinse could be considered as a suitable oral hygiene alternative for use in individuals of all ages, socioeconomic backgrounds, and health conditions especially as a long-term measure due to its efficacy, safety, availability, cost-effectiveness, and ease of use.

Use of Oral Cleaning Devices and Their Perceived Benefits among Malaysians in Kuala Lumpur and Johor Bahru: An Exploratory Structured Approach

Background and Objectives

Various devices have been used to maintain oral hygiene. These include toothbrush and toothpaste, mouthwash, dental floss, miswak, and toothpick. This study attempts to investigate the use of various oral cleaning devices and their perceived benefits among Malaysians.

Methods

A quantitative cross-sectional study conducted in two different cities of Malaysia. A convenience sampling approach was adopted. A total of 787 participants agreed to participate in the current research. A validated questionnaire translated into national language was used for data collection.

Statistical Analysis Used

Data analysis was performed using Statistical Package for Social Sciences version 20.

Results

About 302 respondents were in the age range of 18 - 25 years old (38.4%). There were marginally more females (55.7%) than males (44.3%). Although 99.9% of the participants used a toothbrush, a significant majority (n = 590, 75%) used more than a single device to maintain their oral hygiene. Only 311 respondents knew that toothpicks were inappropriate to use to remove food between teeth and gums, while a majority (n = 592, 75.2%) did not realize that some mouthwashes can stain the teeth. Less than half (42.1%) knew that improper use of miswak might harm the teeth.

Conclusions

Although their oral hygiene behaviors are relatively at a higher level, their perceived oral health benefits did not compare well.

Comparison of Fluoridated Miswak and Toothbrushing with Fluoridated Toothpaste on Plaque Removal and Fluoride Release

INTRODUCTION

Dental caries and periodontal diseases are all induced by oral biofilm (dental plaque). This study was conducted to evaluate if fluoride-impregnated miswak is as effective in plaque removal and fluoride release as toothbrushing with fluoride toothpaste.

MATERIALS AND METHODS

This single-blind, randomized, crossover study was conducted at the Department of Cariology, University of Gothenburg, Gothenburg, Sweden, from February 2010 to January 2011. Fifteen healthy subjects participated in this study. The participants were instructed to use the following: (1) 0.5% NaF-impregnated miswak, (2) nonfluoridated miswak, (3) toothbrush with nonfluoride toothpaste, and (4) toothbrush with 1450 ppm fluoride toothpaste. Each method was used twice a day for 1 week after which plaque amount and fluoride concentration in resting saliva were measured. There was a 1-week washout period between each method.

RESULTS

No significant difference between miswak and tooth-brushing was found regarding plaque removal on buccal and lingual surfaces. A somewhat higher fluoride concentration in resting saliva was found after using impregnated miswak when compared with toothbrushing with fluoride toothpaste (p < 0.05).

CONCLUSION

Miswak and toothbrushing showed the same plaque removing effect on buccal and lingual surfaces. Miswak impregnated with 0.5% NaF resulted in a higher concentration of fluoride in saliva than brushing with 1450 ppm fluoride toothpaste.

CLINICAL SIGNIFICANCE

Miswak impregnated with 0.5% NaF and toothbrushing results in comparable plaque removal and about the same fluoride concentration in saliva even it was somewhat higher for impregnated miswak.