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CC BY 4.0 · European Journal of General Dentistry 2024; 13(03): 190-197
DOI: 10.1055/s-0044-1782185
Original Article

Periodontal Health and Microbiological Characteristics of Siwak (Chewing Stick) and Toothbrush Users: A Cross-Sectional Study

Winarni Yasmin
1   Faculty of Dentistry, Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
,
Rathna Devi Vaithilingam
2   Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
,
Nadia Halib 
3   Department of Basic Sciences, Faculty of Dentistry, Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
,
Rohazila Mohamad Hanafiah
3   Department of Basic Sciences, Faculty of Dentistry, Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
,
Haslinda Ramli
4   Department of Periodontology and Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
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Abstract

Objective Siwak is a chewing stick used to clean the teeth and oral structures. Many studies have been conducted to assess the potential use of siwak in dentistry and concluded that it can be an alternative to a toothbrush in reducing plaque and gingivitis. However, some observations have reported more periodontal attachment loss and gingival recession among siwak users. This study aimed to compare the periodontal health and oral microbial characteristics between siwak and toothbrush users.

Materials and Methods This was a cross-sectional study, and participants were recruited from the public who attended community engagement programs. They were assigned to two groups based on whether they used siwak or a toothbrush. Participants who consented were examined for periodontal health. Supragingival and subgingival plaque samples were collected for bacterial identification and quantification.

Statistical Analysis The SPSS package version 21.0 was used for data entry. Data normality was statistically tested using Kolmogorov–Smirnov and Shapiro–Wilk tests, while data comparison used either t-test or Mann–Whitney U test.

Results A total of 36 participants were included in this study. The findings revealed that the plaque scores, bleeding scores, and periodontal pocket depths between siwak and toothbrush users were comparable (p > 0.05). Both groups had no evidence of gingival recession. Most participants had bacteria with characteristics of Streptococcus spp., which were present in 12 toothbrush users and 6 siwak users.

Conclusions The periodontal health status of siwak users was comparable to that of toothbrush users. Despite this, siwak users had fewer types of bacteria than toothbrush users, suggesting that siwak may serve as an alternative device to conventional toothbrushes for oral hygiene when properly used.

Keywords

bacterial morphology - chewing stick - gingivitis - periodontal pocket - Salvadora persica


Publication History

Article published online:
29 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Chaurasia A, Patil R, Nagar A. Miswak in oral cavity: an update. J Oral Biol Craniofac Res 2013; 3 (02) 98-101
    CrossrefPubMedSearch in Google Scholar
  • 2 Wu CD, Darout IA, Skaug N. Chewing sticks: timeless natural toothbrushes for oral cleansing. J Periodontal Res 2001; 36 (05) 275-284
    CrossrefPubMedSearch in Google Scholar
  • 3 Kumar S, Rani C, Mangal M. A critical review on Salvadora persica: an important medicinal plant of arid zone. Int J Phytomed 2012; 4: 292-303
    Search in Google Scholar
  • 4 Sher H, Al-Yemeni MN, Masrahi YS, Shah AH. Ethnomedicinal and ethnoecological evaluation of Salvadora persica L.: a threatened medicinal plant in Arabian peninsula. J Med Plants Res 2010; 4: 1209-1215
    Search in Google Scholar
  • 5 Cheema S, Maisonneuve P, Al-Thani MH. et al. Oral health behavior and factors associated with poor oral status in Qatar: results from a national health survey. J Public Health Dent 2017; 77 (04) 308-316
    CrossrefPubMedSearch in Google Scholar
  • 6 Saleh M. , Nurhaeni, Sainuddin O. et al. Effect stick of miswak on periodontal reccesion to Jama'ah Tabligh Kerung Kerung Kota Makassar, Indonesia. J Kesehatan Tasikmalaya 2017; 3 (01) 1-3
    Search in Google Scholar
  • 7 Ekowmenhenhen UI, Wright KO, Uti GO, Sofola OO. Comparison of oral health status of adults in rural urban communities in Lagos, Nigeria. UNILAG J Med Sci Technol 2019; 7 (01) 97-112
    Search in Google Scholar
  • 8 Hotchandani SS, Harjani PR, Punjabi SK. et al. Understanding, oral hygiene practices, behaviors and myths to deal with toothache in rural areas. J Univ Med Dent Coll 2022; 13 (01) 316-319
    Search in Google Scholar
  • 9 Darout IA, Mubarky AY, Abduh MA. Oral health related knowledge and behavior among secondary school students in Jazan Region, Kingdom of Saudi Arabia. Am J Health Res 2016; 4 (05) 138-142
    CrossrefSearch in Google Scholar
  • 10 Ramli H, Mohd-Dom TN, Mohd-Said S. Clinical benefits and adverse effects of siwak (S. persica) use on periodontal health: a scoping review of literature. BMC Oral Health 2021; 21: 618
    CrossrefPubMedSearch in Google Scholar
  • 11 Shetty R, Shetty S, BM Sachin, Amirisetty R, Agrawal A. Comparative study to assess the effect of chewing stick and toothbrush on oral hygiene and periodontal status among Indian population. Int J Public Health Dent 2010; 1 (01) 6-12
    Search in Google Scholar
  • 12 Patel PV, Shruthi S, Kumar S. Clinical effect of miswak as an adjunct to tooth brushing on gingivitis. J Indian Soc Periodontol 2012; 16 (01) 84-88
    CrossrefPubMedSearch in Google Scholar
  • 13 Rifaey N, AlAdwani M, Karched M, Baskaradoss JK. A clinical investigation into the efficacy of miswak chewing sticks as an oral hygiene aid: a crossover randomized trial. Int J Dent Hyg 2021; 19 (02) 223-230
    CrossrefPubMedSearch in Google Scholar
  • 14 Khawaja SH, Soomro SN, Ali K. Clinical effects of miswak and tooth brushing on gingivitis. Med Forum 2019; 30 (11) 141-144
    Search in Google Scholar
  • 15 Ramadan A, Alshenqiti M. Periodontal status of habitual adult users of miswak sticks or toothbrushes among a population in Al-Madinah Al-Munawara. Int J Med Dev Countries 2021; 5 (03) 865-869
    CrossrefSearch in Google Scholar
  • 16 Nordin A, Bin Saim A, Ramli R, Abdul Hamid A, Mohd Nasri NW, Bt Hj Idrus R. Miswak and oral health: an evidence-based review. Saudi J Biol Sci 2020; 27 (07) 1801-1810
    CrossrefPubMedSearch in Google Scholar
  • 17 Sofrata A, Santangelo EM, Azeem M, Borg-Karlson AK, Gustafsson A, Pütsep K. Benzyl isothiocyanate, a major component from the roots of Salvadora persica is highly active against gram-negative bacteria. PLoS One 2011; 6 (08) e23045
    CrossrefPubMedSearch in Google Scholar
  • 18 Khan M, Alkhathlan HZ, Khan ST. Antibiotic and antibiofilm activities of Salvadora persica L. Essential oils against Streptococcus mutans: a detailed comparative study with chlorhexidine digluconate. Pathogens 2020; 9 (01) 1-16
    CrossrefPubMedSearch in Google Scholar
  • 19 Al-Otaibi M, Al-Harthy M, Söder B, Gustafsson A, Angmar-Månsson B. Comparative effect of chewing sticks and toothbrushing on plaque removal and gingival health. Oral Health Prev Dent 2003; 1 (04) 301-307
    PubMedSearch in Google Scholar
  • 20 Darout IA, Skaug N. Comparative oral health status of an adult Sudanese population using miswak or toothbrush regularly. Saudi Dent J 2004; 16 (01) 29-38
    Search in Google Scholar
  • 21 Darout IA, Christy AA, Skaug N. Identification and quantification of some potentially antimicrobial anionic components in miswak extract. Indian J Pharmacol 2000; 32 (01) 11-14
    Search in Google Scholar
  • 22 Socransky SS, Haffajee AD, Smith C. et al. Use of checkerboard DNA-DNA hybridization to study complex microbial ecosystems. Oral Microbiol Immunol 2004; 19 (06) 352-362
    CrossrefPubMedSearch in Google Scholar
  • 23 Katsoulis J, Lang NP, Persson GR. Proportional distribution of the red complex and its individual pathogens after sample storage using the checkerboard DNA-DNA hybridization technique. J Clin Periodontol 2005; 32 (06) 628-633
    CrossrefPubMedSearch in Google Scholar
  • 24 Olson JC, Cuff CF, Lukomski S. et al. Use of 16S ribosomal RNA gene analyses to characterize the bacterial signature associated with poor oral health in West Virginia. BMC Oral Health 2011; 11 (07) 7
    CrossrefPubMedSearch in Google Scholar
  • 25 Tankeshwar A. Colony morphology of bacteria. Microbeonline. 2013 . Accessed February 14, 2024 at: https://microbeonline.com/colony-morphology-bacteria-describe-bacterial-colonies/
    PubMedSearch in Google Scholar
  • 26 Valkenburg C, Slot DE, Bakker EWP, Van der Weijden FA. Does dentifrice use help to remove plaque? a systematic review. J Clin Periodontol 2016; 43 (12) 1050-1058
    CrossrefPubMedSearch in Google Scholar
  • 27 Ramli H, Nor Aripin KN, Mohd Said S, Mohamad Hanafiah R, Mohd Dom TN. The effectiveness of miswak (Salvadora persica L. and Azadirachta indica A.Juss.) practices in reducing plaque and gingivitis among adults: a systematic review and meta-analysis. J Ethnopharmacol 2022; 298: 115598
    CrossrefPubMedSearch in Google Scholar
  • 28 Johnson JS, Spakowicz DJ, Hong BY. et al. Evaluation of 16S rRNA gene sequencing for species and strain-level microbiome analysis. Nat Commun 2019; 10: 5029
    CrossrefPubMedSearch in Google Scholar
  • 29 Karki G. Genus Streptococcus: habitat, morphology, culture and biochemical characteristic. Online Biology Notes. 2017 . Accessed February 14, 2024 at: https://www.onlinebiologynotes.com/genus-streptococcus-habitat-morphology-culture-biochemical-characteristics/
    PubMedSearch in Google Scholar
  • 30 Sofrata AH, Claesson RL, Lingström PK, Gustafsson AK. Strong antibacterial effect of miswak against oral microorganisms associated with periodontitis and caries. J Periodontol 2008; 79 (08) 1474-1479
    CrossrefPubMedSearch in Google Scholar
  • 31 Zaenab, Mardiastuti HW, Anny VP, Logawa B. Uji Antibakteri Siwak (Salvadora Persica Linn.) Terhadap Streptococcus mutans (ATC31987) Dan Bacteroides melaninogenicus . Makara Seri Kesehatan 2004; 8 (02) 37-40
    Search in Google Scholar
  • 32 Wolf HF. Microbiology: biofilm plaque formation on tooth and root surfaces. In: Wolfe HF, Rateitschak KH. eds. Periodontology. Stuttgart: Georg Thieme Verlag KG; 2006: 24-30
    Search in Google Scholar
  • 33 Vyawahare SS, Kamble KD, Waghmare VD, Kamble LH. Characterization of actinomycetes for some industrially important enzymes. Trends Biotechnol Res 2013; 2 (02) 1-6
    Search in Google Scholar
  • 34 Minic I, Pejcic A. Pathogenesis of Aggregatibacter actinomycetemcomitans in periodontitis. Scient Arch Dent Sci 2019; 2 (04) 17-21
    Search in Google Scholar
  • 35 How KY, Song KP, Chan KG. Porphyromonas gingivalis: an overview of periodontopathic pathogen below the gum line. Front Microbiol 2016; 7: 53-67
    PubMedSearch in Google Scholar
  • 36 Jones MJ, Miller JN, George WL. Microbiological and biochemical characterization of spirochetes isolated from the feces of homosexual males. J Clin Microbiol 1986; 24 (06) 1071-1074
    CrossrefPubMedSearch in Google Scholar
  • 37 Albabtain R, Azeem M, Wondimu Z, Lindberg T, Borg-Karlson AK, Gustafsson A. Investigations of a possible chemical effect of Salvadora persica chewing sticks. Evid Based Complement Altern Med 2017; 2017: 2576548
    CrossrefPubMedSearch in Google Scholar
  • 38 Ramli H, Baharudin Z, Mohamad Hanafiah R. Antibacterial activity of bioactive compound in Salvadora persica (chewing stick) against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans . ASM Sci J 2022; 17: 1-8
    CrossrefSearch in Google Scholar
  • 39 Siddeeqh S, Parida A, Jose M, Pai V. Estimation of antimicrobial properties of aqueous and alcoholic extracts of Salvadora persica (miswak) on oral microbial pathogens: an invitro study. J Clin Diagn Res 2016; 10 (09) FC13-FC16
    PubMedSearch in Google Scholar