Themiswak is ateeth-cleaning twig made from theSalvadora persica tree. The miswak's properties have been described as follows: "Apart from their antibacterial activity which may help control the formation and activity of dental plaque, they can be used effectively as a natural toothbrush for teeth cleaning. Such sticks are effective, inexpensive, common, available, and contain many medical properties".[1]
Themiswak orsiwak is predominantly used inMuslim-inhabited areas.[citation needed] It is commonly used in theArabian Peninsula, theHorn of Africa,North Africa, parts of theSahel, theIndian subcontinent, andCentral Asia.
The oral hygiene practice using herbal sticks exists in many parts of the world since ancient time:ancient India,ancient Greece (mentioned byAlciphron,ancient Rome,ancient Israel (mentioned inTalmud),Eastern Asia (mentioned in theGospel of Buddhism),[2] etc.
The sticks made ofSalvadora persica tree are calledmiswak,siwak orarak inArabic,[3]koyoji inJapanese,qesam orqesem inHebrew,[3]qisa inAramaic,mastic inLatin,[4]sotio orsothiou inWolof of Senegal,[5][6]siwahewal (pluralsiwakejé) in Northern NigeriaFulani.[7]
The term miswak should not be confused with the same term used inMaghreb[8] which inMaghrebi Arabic also refers to a completely different instrument made from walnut wood (Juglans regia L., common walnut), both a toothbrush and a toothpick,[8] also used to clean teeth and gums inMorocco,[3]Algeria,[9][10]Tunisia,[11] andLibya.[12]
As far back as antiquity, people began to practice oral hygiene by using fibrous chewable sticks, such as siwak, as toothbrushes. The stick contains cleaners, disinfectants and evenfluorides. It is recommended in the collection of medical knowledge of theAncient Indian surgeon (ca. 500 BC)Sushruta, known as a pioneer ofanesthesia, which he practiced in particular withIndian hemp.[13] Siwak is also mentioned in the ancient Indian book of theLaws of Manu (Sanskrit:मनुस्मृति,manusmṛti) around theChristian era.[citation needed] In the Islamic world,Muhammad is said to have used it regularly, according to laterHadîth literature.[14]
TheWorld Health Organization (WHO) recommended the use of themiswak in 1986, but in 2000, an international consensus report onoral hygiene concluded that further research was needed to document the effect of themiswak.[15] Some of this further research has been done on a population of 203, and concluded, "that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users".[16] Yet another comparative study conducted on a sampling of 480 Saudi Arabian adults found that "the level of need for periodontal care in the sample chosen is low when compared with the findings of similar studies undertaken in other countries. The frequent use of the 'Miswak' was associated with a lower need for treatment".[17]
Studies indicate that Salvadora persica extract exhibits low antimicrobial activity compared to other oral disinfectants and anti-plaque agents liketriclosan andchlorhexidine gluconate.[18]
Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity.[18]
However, the benefits of triclosan were discounted by theUnited States Food and Drug Administration in 2016 and its safety is uncertain as a hygiene product ingredient.[19] Chlorhexidine gluconate was also linked to serious allergic reactions, albeit rarely.[20]
Salvadorine and benzylisothiocyanate appear to be responsible for the antibacterial activity of Miswak. The plant also contains insolublefluoride in high concentration, calcium,salicylic acid, and someantioxidants of unclear function.[21]
The use of themiswak is frequently advocated in thehadith (the traditions relating to the life of Prophet Muhammad). Situations where themiswak is recommended to be used include before or duringwudu (ablution), before going to the mosque, before entering one's house, before and after going on a journey, on Fridays,[22] before sleeping and after waking up, when experiencing hunger or thirst and before entering any good gathering.[citation needed]
In addition to strengthening thegums, preventingtooth decay and eliminatingtoothaches, themiswak is said to halt further decay that has already set in. Furthermore, it is reputed to create a fragrance in the mouth, eliminatebad breath, improve sensitivity of taste-buds and promote cleaner teeth.[citation needed]
It is often mentioned that theIslamic prophetMuhammad recommended themiswak's use.[23] He is quoted in varioushadith extolling its virtues:[24][25]
Were it not that I might over-burden the Believers I would have ordered them to use Siwak (Miswak) at the time of every Prayer.[26]
Four things are from among the practices of the Prophets: Circumcision, Perfume, Miswak, and Marriage.[26]
Make a regular practice of Miswak for verily it is the purification for the mouth and a means of the pleasure of the Lord.[26]
Use the Miswaak, for verily, it purifies the mouth, and it is a Pleasure for the Lord. Jib-ra-eel (A.S.) exhorted me so much to use the Miswaak that I feared that its use would be decreed obligatory upon me and upon my Ummah. If I did not fear imposing hardship on my Ummah I would have made its use obligatory upon my people. Verily, I use the Miswaak so much that I fear the front part of my mouth being peeled (by constant and abundant brushing with the Miswaak)[27]
Modern uses ofarāk wood in oral hygiene expands beyond miswak itself. Extracts containing its active components have been added tomouthwash andtoothpaste.[28] There is also a German patent for similar formulations for domesticated animals.[29]
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