A review on phytochemical and pharmacological investigations of miswak (Salvadora persica Linn)

Persicaline, an alkaloid from Salvadora persica, inhibits proliferation and induces apoptosis and cell-cycle arrest in MCF-7 cells

Cancer is the second largest cause of mortality worldwide. Many natural bioactive chemicals generated from plants have favorable impacts on health, including cancer chemoprevention, compared to their manufactured counterparts. Persicaline, a novel sulfur-containing imidazoline alkaloid derived from Salvadora persica, has been shown to display promising antioxidant activity. In this study, the antiproliferative activity of persicaline was tested against different cancer cells using (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay. The cell death mode and cell-cycle arrest were examined using flow cytometry analysis. In addition, the proapoptotic and molecular mechanism effects of persicaline against mammary MCF-7 cell line were explored. Furthermore, the impact of persicaline on apoptotic genes markers, generation of reactive oxygen species (ROS), and mitochondrial membrane potential were monitored. It was found that persicaline inhibits cell proliferation in a dose-dependent manner. Persicaline-treated MCF-7 cells also showed initiation of apoptotic events and G1 cell-cycle arrest. In addition, persicaline treatment led to an increase in ROS generation, Bax and caspase upregulation while the Bcl-2 was downregulated. Hence, for the first time, this study showed that persicaline causes G1 phase arrest and apoptosis induction in MCF-7 cells. Increased proapoptotic genes and ROS levels were required for the antiproliferative and apoptotic effects of persicaline.

Biocompatibility and Antibacterial Action of Salvadora persica Extract as Intracanal Medication (In Vitro and Ex Vivo Experiment)

This study aimed to test the biocompatibility and antibacterial properties of Salvadora persica (S. persica) extract, a natural product, as an intracanal medication in comparison with calcium hydroxide (Metapaste, META BIOMED, Cheongju, Korea). The pH values of both materials were tested. The biocompatibility of S. persica extract and Metapaste was determined using light microscopy and MTT assays. The antibacterial action was tested using the zone of bacterial inhibition on four common bacterial species. In addition, intracanal medication was administered using 68 extracted single-rooted teeth contaminated with Enterococcus faecalis (E. faecalis), and the percentage reduction in colony count (% RCC) at 1, 3, and 7 days was measured. The extension of activity for both materials was assessed using histological sections and scanning electron microscopy. S. persica was found to be acidic in nature. Both materials showed significantly lower cell viability than the positive control cells on days 1 and 3 but not on day 7. S. persica showed better antibacterial effects against E. faecalis and S. mutans. S. persica extract showed 97.6%, 98.9%, and 99.3% RCC values at 1, 3, and 7 days, respectively, which are comparable to those of Metapaste. S. persica herbal extract is a promising material that can be utilized as an intracanal medication, but its use requires further research.

De-novo fabrication of sunlight irradiated silver nanoparticles and their efficacy against E. coli and S. epidermidis

Silver nanoparticles (AgNPs) gained significant attention due to their activity against microbial pathogens, cancer cells, and viral particles etc. Traditional fabrication methods require hazardous chemicals as reducing agents and their usage and disposal pose a significant hazard to environmental ecosystem. Here, a de novo, robust, cost effective and an eco-friendly method is reported to fabricate AgNPs irradiated with sunlight (SL) while using Salvadora persica root extract (SPE) as reducing agent. Sunlight (SL) irradiated S. persica silver nanoparticles (SpNPs) i.e., SL-SpNPs were characterized using multiple techniques and their antibacterial efficacy was evaluated. The SL-SpNPs were synthesized in 10 min. Field emission scanning electron microscopy (FE-SEM) and transmission electron microscopy (TEM) analysis revealed their spherical morphology with a size range of 4.5-39.7 nm, while surface plasmon resonance (SPR) peaked at 425 nm. Fourier transform infrared spectroscopy (FTIR) analysis suggested that the reduction of SL-SpNPs was due to the presence of phytochemicals in the SPE. Furthermore, X-ray powder diffraction (P-XRD) pattern depicted the crystal structure of SL-SpNPs, hence proving the presence of AgNPs. Further the antibacterial studies were carried out against Escherichia coli (ATCC 11229) and Staphylococcus epidermidis (ATCC 12228) using Kirby Bauer method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for E. coli were determined to be 1.5 μg/mL and 3.0 μg/mL respectively while MIC and MBC values for S. epidermidis were found to be 12.5 μg/mL and 25 μg/mL respectively. The solar irradiation-based fabrication method and resulting SL-SpNPs can find their utility in many biomedical and environmental applications.

Exome array identifies functional exonic biomarkers for pediatric dental caries

BACKGROUND

Pediatric dental caries is common among Arab children, however we are still searching for possible genes and molecular mechanisms that influence caries development.

AIM

To identity genetic predispositions of dental caries among Saudi children with high DMFT (Decayed, Missing, and Filled Teeth).

DESIGN

This case-control study analysed putative functional exonic-variants (n = 243,345) to study the molecular genetics of pediatric caries with high dmft index, 8.75 ± 4.16 on Arab-ancestry subjects with primary dentition (n = 111; 76 cases, dmft>5 and 35 controls, dmft = 0).

RESULTS

Pediatric caries is significantly associated with single nucleotide polymorphisms (SNP) in the GRIN2B-rs4764039C (p-value = 2.03 × 10^-08) and CFH-rs1065489G (p-value = 8.26 × 10^-08) genes, even after Bonferroni correction. Irregular tooth brushing habits (p = 0.0404) and irregular dental visits (p = 0.0050) are significantly associated with caries. Functional enrichment analysis of significant genes is associated with calcium-activated chloride channel, Staphylococcus aureus infection, and N-linked glycosylation.

CONCLUSION

Genetic predispositions are found to be significantly associated with the high prevalence of pediatric caries, which is a disorder of multigene-environment interaction. The significant functional exonic variants identified can be biomarkers for the early diagnosis of pediatric dental caries in Arabs.

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.

Salvadora persica: Nature's Gift for Periodontal Health

Salvadora persica (SP) extract, displays very valuable biotherapeutic capacities such as antimicrobial, antioxidant, antiparasitic and anti-inflammatory effects. Numerous investigations have studied the pharmacologic actions of SP in oral disease therapies but its promising outcomes in periodontal health and treatment are not yet entirely described. The current study has been planned to analyze the reported effects of SP as a support to periodontal therapy to indorse regeneration and healing. In consort with clinical trials, in vitro investigations show the advantageous outcomes of SP adjunctive to periodontal treatment. Yet, comprehensive supplementary preclinical and clinical investigations at molecular and cellular levels are indispensable to reveal the exact therapeutic mechanisms of SP and its elements for periodontal health and therapy.

Salvadora persica mediated synthesis of silver nanoparticles and their antimicrobial efficacy

Silver nanoparticles (AgNPs) exhibit strong antimicrobial properties against many pathogens. Traditionally employed chemical methods for AgNPs synthesis are toxic for the environment. Here, we report a quicker, simpler, and environmentally benign process to synthesize AgNPs by using an aqueous 'root extract' of Salvadora persica (Sp) plant as a reducing agent. The synthesized Salvadora persica nano particles (SpNPs) showed significantly higher antimicrobial efficacy compared to earlier reported studies. We characterized SpNPs using UV-Vis spectroscopy, Fourier Transform Infrared Spectroscopy (FTIR), Transmission Electron Microscopy (TEM), Field Emission Scanning Electron Microscopy (FE-SEM), Dynamic Light Scattering (DLS) and X-ray powder diffraction (P-XRD). UV-Vis spectrum showed the highest absorbance at 420 nm. FTIR analysis depicts presence of bond stretching including OH- (3300 cm-1), C=N- (2100 cm-1) and NH- (1630 cm-1) which are attributed in the involvement of phenolics, proteins or nitrogenous compounds in reduction and stabilization of AgNPs. TEM, FE-SEM and DLS analysis revealed the spherical and rod nature of SpNPs and an average size of particles as 37.5 nm. XRD analysis showed the presence of the cubic structure of Ag which confirmed the synthesis of silver nanoparticles. To demonstrate antimicrobial efficacy, we evaluated SpNPs antimicrobial activity against two bacterial pathogens (Escherichia coli (ATCC 11229) and Staphylococcus epidermidis (ATCC 12228)). SpNPs showed a significantly high inhibition for both pathogens and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were found to be 0.39 µg/mL and 0.78 µg/mL for E. coli while 0.19 µg/mL and 0.39 µg/mL for S. epidermidis respectively. Further, Syto 16 staining of bacterial cells provided a supplemental confirmation of the antimicrobial efficacy as the bacterial cells treated with SpNPs stop to fluoresce compared to the untreated bacterial cells. Our highly potent SpNPs will likely have a great potential for many antimicrobial applications including wound healing, water purification, air filtering and other biomedical applications.

Pretreatment with Salvadora persica L. (Miswak) aqueous extract alleviates paracetamol-induced hepatotoxicity, nephrotoxicity, and hematological toxicity in male mice

Background and Aim:

Paracetamol (PCM) ingestion is one of the most frequent global causes of toxicity. Salvadora persica L. is a plant that among many other effects exhibits potent antioxidant, anti-inflammatory, antimicrobial, and anticancer effects. In this study, we investigated the possible protective effect of S. persica aqueous extract in the PCM overdose-induced liver and kidney injury and hematological changes in a mice model.

Materials and Methods:

Mice were given PCM with and without S. persica pretreatment. Blood cell counts and liver and kidney function biomarkers were measured. Liver and kidney samples were histologically examined.

Results:

A single overdose of PCM caused significant elevations of alanine and aspartate transaminases, alkaline phosphate, bilirubin, urea, uric acid, and creatinine compared with the control group. In addition, PCM toxicity significantly lowered red blood cell count but insignificantly increased both white blood cell and platelet counts in comparison to the control mice. Pretreatment with S. persica significantly prevented PCM-induced changes in hepatic and renal biomarkers. S. persica also caused marked reversal of hematological changes. Histologically, the liver and kidney showed inflammation and necrosis after PCM treatment, which were significantly reduced in mice pretreated with S. persica.

Conclusion:

Taken together, S. persica significantly inhibited PCM-induced renal, hepatic, and hematological toxicity, pointing to its possible use in the treatment of liver and renal disorders.

Anti-Oral Pathogens of Tecoma stans (L.) and Cassia javanica (L.) Flower Volatile Oils in Comparison with Chlorhexidine in Accordance with Their Folk Medicinal Uses

Background and Objectives: Teeth decay and plaque are complicated problems created by oral pathogens. Tecoma stans (L.) and Cassia javanica (L.) are two ornamental evergreen plants widely distributed in Egypt. These plants are traditionally used for oral hygienic purposes. This study aims to elucidate the volatile oil constituents obtained from the flowers of these plants and evaluate the antimicrobial activity of these volatile oils against specific oral pathogens in comparison to chlorhexidine. Materials and Methods: The flowers obtained from both plants were extracted by n-hexane. GC-MS spectrometry was used to identify the constituents. Minimum inhibitory concentrations (MICs) were measured using tetrazolium salt (2,3-bis[2-methyloxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide) (XTT). Results: GC-MS analysis revealed the presence of 32 and 29 compounds, representing 100% of the volatile constituents of Tecoma stans and Cassia javanica, respectively. The GC-MS analysis showed more than 60% of the volatile oil constituents are represented in both plants with different proportions. Chlorhexidine exerted stronger activity than tested plants against all microorganisms. Cassia javanica flower extract was more active against all tested microorganisms than Tecoma stans. Of note was the effect on Streptococcus mutans, which was inhibited by 100% at 12.5 and 25 µg/mL of Cassia javanica and Tecoma stans, respectively. The growth of Lactobacillus acidophilus was also completely inhibited by 25 µg/mL of the Cassia javanica extract. MIC90 and MIC were also calculated, which revealed the superiority of Cassia javanica over Tecoma stans against all tested oral pathogens. Conclusion: Cassia javanica flower volatile oils showed a potential anti-oral pathogen activity at relatively low concentrations. Also, Cassia javanica and Tecoma stans demonstrated a strong activity against tooth decay's notorious bacteria Streptococcus mutans. Both plants can be potential substituents to chlorhexidine. Formulating the constituents of these plants in toothpastes and mouthwashes as anti-oral pathogen preparations can be an interesting future plan.

Antibacterial activity of aqueous and methanol extracts of selected species used in livestock health management

CONTEXT

Salvadora persica L. (Salvadoraceae), Colophospermum mopane (J.Kirk ex Benth.) J. Léonard (Leguminosae) and Dichrostachys cinerea (L.) Wight & Arn. (Leguminosae) crude extracts are used by local farmers against many livestock infections with little or no side effects usually associated with synthetic antimicrobials. However, their efficacy has rarely been tested.

OBJECTIVE

These plants were tested for potential antibacterial activity against clinical isolates of Staphylococcus aureus ATCC33862 and Escherichia coli ATCC25922. Minimal inhibitory concentrations (MIC) of the crude plant extracts were determined.

MATERIALS AND METHODS

Aqueous and methanol extraction of 100 g each of the bark of C. mopane, roots of D. cinerea and leaves of S. persica was done by placing the samples in 250 mL of either water or methanol. Nutrient broth was used as growth medium for the bacteria, and McFarland standard for bacterial standardization. 2,3,5-Triphenyltetrazoliumchloride (TTC) was the indicator salt. Each of the aqueous and methanol extracts (100 μL) was tested. Gentamycin and ampicillin were the controls.

RESULTS

MIC of aqueous extracts ranged from 1.03-14.6 mg/mL against S. aureus, and from 12.1-34.3 mg/mL against E. coli. Methanol extracts ranged between 5.31 and 9.64 mg/mL against S. aureus, and between 7.86 and 13.6 mg/mL against E. coli. Aqueous and methanol extracts of S. persica were significantly higher (p < 0.05) than C. mopane and D. cinerea.

DISCUSSION AND CONCLUSION

Colophospermum mopane, S. persica and D. cinerea exhibited antibacterial activity, with methanol extracts performing better than aqueous extracts, justifying use as ethnoveterinary medicine. Further study to isolate the active components should be pursued.

Antioxidant Activities, Metabolic Profiling, Proximate Analysis, Mineral Nutrient Composition of Salvadora persica Fruit Unravel a Potential Functional Food and a Natural Source of Pharmaceuticals

Salvadora persica is a medicinally important plant mainly used in oral hygiene. However, little attention has been given towards the nutritional prominence of this plant. This study encloses the proximate and mineral nutrient contents, amino acid composition, metabolite profiling and antioxidant potential of S. persica fruit. The ripen fruit contained substantial amount of sugars, mineral nutrients, carotenoids, polyphenols and flavonoids. The metabolic profiling of the fruit extract by GC-MS revealed a total of 22 metabolites comprising of sugars, sugar alcohols, organic acids, organic base, and aromatic silica compound. The identified metabolites have been previously reported to have potential antioxidant, antimicrobial, anti-hyperglycemic, and antitumor properties. The GC-MS analysis indicated high glucose and glucopyranose (247.62 and 42.90 mg g-1 FW respectively) contents in fruit of S. persica. The fruit extract demonstrated a significantly higher antioxidant and ROS scavenging properties along with high contents of mineral nutrients and essential amino acids. HPLC analysis revealed presence of essential and non-essential amino acid required for healthy body metabolism. The cysteine was found to be in highest amount (733.69 mg 100 g-1 DW) among all amino acids quantified. Specifically, compared to similar medicinal plants, previously reported as a source of non-conventional food and with some of the commercially important fruits, S. persica fruit appears to be a potential source of essential mineral nutrients, amino acids, vitamins (ascorbic acid and carotenoid) and pharmaceutically important metabolites contributing towards fulfilling the recommended daily requirement of these for a healthy human being. This is the first report establishing importance of S. persica fruit as nutraceuticals. The data presented here proposed that fruit of S. persica may be used as functional food or reinvigorating ingredient for processed food to reduce deficiency of nutrients among the vulnerable population group. The phytochemicals identified from S. persica fruit may be used as natural source for pharmaceutical preparations.

"Miswak" Based Green Synthesis of Silver Nanoparticles: Evaluation and Comparison of Their Microbicidal Activities with the Chemical Synthesis

Microbicidal potential of silver nanoparticles (Ag-NPs) can be drastically improved by improving their solubility or wettability in the aqueous medium. In the present study, we report the synthesis of both green and chemical synthesis of Ag-NPs, and evaluate the effect of the dispersion qualities of as-prepared Ag-NPs from both methods on their antimicrobial activities. The green synthesis of Ag-NPs is carried out by using an aqueous solution of readily available Salvadora persica L. root extract (RE) as a bioreductant. The formation of highly crystalline Ag-NPs was established by various analytical and microscopic techniques. The rich phenolic contents of S. persica L. RE (Miswak) not only promoted the reduction and formation of NPs but they also facilitated the stabilization of the Ag-NPs, which was established by Fourier transform infrared spectroscopy (FT-IR) analysis. Furthermore, the influence of the volume of the RE on the size and the dispersion qualities of the NPs was also evaluated. It was revealed that with increasing the volume of RE the size of the NPs was deteriorated, whereas at lower concentrations of RE smaller size and less aggregated NPs were obtained. During this study, the antimicrobial activities of both chemically and green synthesized Ag-NPs, along with the aqueous RE of S. persica L., were evaluated against various microorganisms. It was observed that the green synthesized Ag-NPs exhibit comparable or slightly higher antibacterial activities than the chemically obtained Ag-NPs.

Effects of extracts of Salvadora persica on proliferation and viability of human dental pulp stem cells

OBJECTIVES

Efficacy of an ideal antimicrobial agent depends on its ability to eliminate microorganisms while causing minimal toxicity to host cells. The purpose of this study was to assess the effect of ethanolic and water extracts of Salvadora persica (SP) on proliferation and viability of human dental pulp stem cells (hDPSCs).

MATERIALS AND METHODS

In this in-vitro study, the effects of seven concentrations of ethanolic and water extracts of SP (ranging from 5.75 mg/ml to 0.08 mg/ml) on hDPSCs were evaluated using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay. The results were analyzed using one-way ANOVA and Tukey's post-hoc test. P < 0.05 was considered statistically significant.

RESULTS

Water extract of SP only had cytotoxic effect at 5.75 mg/ml concentration; and caused significant cell proliferation at 1.43-0.08 mg/ml concentrations at 24 h (P < 0.05). At 48 h, only 0.17 and 0.08 mg/ml concentrations caused significant cell proliferation (P < 0.05). Ethanolic extract of SP at 5.75-1.43 mg/ml concentrations showed severe cytotoxic effects at 24 and 48 h. Other concentrations had no significant effects on cells (P > 0.05).

CONCLUSION

The highest concentrations of both water and ethanolic extracts of SP had cytotoxic effects on hDPSCs. Water extract of SP has favorable effects on cell proliferation at specific concentrations in a time-dependent manner.

Looking Islam in the Teeth: The Social Life of a Somali Toothbrush

The Arabic miswak (Somali, adayge) is a tooth-cleaning stick from the Salvadora persica plant. In this article, we trace the social life of a "thing," examining meanings inscribed in the stick brush, drawing on interviews with 82 Somali refugees in Massachusetts and an analysis of local and transnational science and marketing. The miswak toothbrush symbolizes relationships to nature, homeland culture, global Islam, globalizing dental medicine, and the divine as it intersects with the lives of producers, marketers, distributors, and users, creating hybrid cultural forms in new contexts.

Efficacy of miswak on oral pathogens

The oral cavity harbors a diverse and abundant number of complex oral pathogens causing different oral diseases. The development of dental caries and periodontal diseases has been found to be closely associated with various gram positive and gram negative microrganisms. Miswak, a natural toothbrush, has been documented as a potent antibacterial aid and its use is encouraged in different countries because of its good taste, texture, availability, cost and beneficial effect on teeth and supporting tissues. Different researches have been carried out to evaluate the antimicrobial effects of Miswak. This review encompasses the efficacy of Miswak on suppression of oral pathogens with respect to conducted on fungi as well as cariogenic, periodontal and endodontic bacteria.

Salinity-induced modulation of growth and antioxidant activity in the callus cultures of miswak (Salvadora persica)

Miswak (Salvadora persica Linn.) is a medium-sized tree, desert facultative halophytic plant. Besides edible fruits and non-edible seed oil, the plant contains several bioactive compounds like alkaloids, tannins, saponins and sterols related to food and cosmetic industries. In the present study, physiological responses and antioxidant potential under salinity stress were investigated in callus cultures of S. persica to evaluate its use as a source of antioxidant. The callus cultures were grown on MS medium supplemented with 0.5 mg/l each of 2,4,5-T and BAP, which could be established successfully by regular subcultures of slow growing callus on this medium for several months. Increased dry weight, soluble proteins, proline, soluble carbohydrates and CAT activity were recorded under NaCl stress in comparison to control cultures. The DPPH and FRAP antioxidant activities were gradually elevated in NaCl-treated callus, whereas SOD quenching was recorded maximum at 200 mM. A significant correlation between antioxidant capacity and phenol content was observed, indicating that phenolic compounds are the major contributors to the antioxidant potential in S. persica. These findings suggest that increased salinity stress caused elevated antioxidant potentials and the plants grown in such conditions may serve as potential source of antioxidant.

In vitro antimicrobial comparison of chlorhexidine, persica mouthwash and miswak extract

AIM

Herbal mouthwashes, such as persica (Salvadora persica, mint and yarrow extracts) and miswak extract have been shown to decrease gingival inflammation and plaque accumulation. The aim of this study was to compare the antimicrobial activities of persica and miswak extract with the conventional mouthwash chlorhexidine against Streptococcus salivarius, Streptococcus sanguis, Lactobacillus vulgaris and Candida albicans.

MATERIALS AND METHODS

In this in vitro study, blood-agar culture (Merk, Germany) was used to grow the streptococcus strains, saburd-dextrose culture (Merk, Germany) was used to grow C. albicans and MRS-agar was used to grow L. vulgaris. Various concentrations of these substances (0.1, 0.05 and 0.025% of miswak extract, 0.1, 0.05, 0.025 and 0.0125% of persica, 0.2, 0.1, 0.05 and 0.025% of chlorhexidine) were added to paper disks, separately, inserted into culture plates and transferred into the incubator. The inhibition zone around each disk was measured after 24 hours and the data was analyzed by the Kruskal-Wallis test.

RESULTS

Chlorhexidine possessed antibacterial activity at all concentrations tested. It was more effective than persica and miswak at all concentrations on S. salivarius (p = 0.022 for 0.1%, 0.009 for 0.05 and 0.025%). It had greater effect than the other two tested material on S.sanguis only at concentration 0.01%. Chlorhexidine was the most effective against S.salivarius; persica was the most effective against Lactobacillus (p = 0.005) and the least effective against S. salivarius; and miswak extract was the most effective against S. salivarius and S. sanguis at concentrations 0.1 and 0.05% (p = 0.005) and ineffective against L. vulgaris. None of these mouthwashes were effective against C. albicans.

CONCLUSION

This study revealed that chlorhexidine remains the gold standard as an antimicrobial agent, although herbal based mouthwashes do have marginal antimicrobial activities. It is necessary to conduct more clinical and microbiological studies focusing on periodontal pathogens and anaerobic microorganisms.

CLINICAL SIGNIFICANCE

Mechanical plaque control is the main way for periodontal disease prevention and mouthrinses are used to improve its efficacy. Based on the results of this study, chlorhexidine has the most antibacterial effect and although persica mouthwash and miswak are routinely used in some Asian countries their antibacterial efficacies are suspected.

A review on miswak (Salvadora persica) and its effect on various aspects of oral health

Plants have been used for centuries to improve dental health and to promote oral hygiene, and this practice persists in several communities throughout the world. "Miswak" is an Arabic word meaning "tooth-cleaning stick," and Salvadora persica miswak has a wide geographic distribution. It was used by ancient Arabs to whiten and polish the teeth. This review discusses the history and chemical composition of S. persica miswak and its influence on oral health, including the advantages and disadvantages of its use.