Miswak – an ancient remedy for a contemporary health issue?

By Elisha Riggs and Nicky Kilpatrick

Oral health is a significant public health issue. In Australia, tooth decay in children is one of the most common reasons for hospital admission requiring a general anaesthetic for 1 to 4 year olds.

The migration of people from around the world adds complexity in understanding oral health behaviours and improving oral health outcomes. Dental services need to be coordinated and prepared to appropriately care for diverse populations. This requires an awareness of cultural differences and an understanding of traditional practices and oral health beliefs to tailor dental care.

One such oral health practice that is used in our community is miswak. Miswak is a traditional oral hygiene tool that has been used since ancient times. Essentially, miswak is a stick from a tree that is used to clean teeth. It is mostly used by Muslim communities across parts of the Middle East, Asia, the Americas and some African countries. It is typically used five times a day as part of the cleansing process associated with prayer.

To prepare for use, a miswak is soaked in water to soften it and the outer layer of bark is removed. It is then chewed on one end until it becomes frayed into a brush-like form, which is used to clean the teeth, gums and tongue. In many Middle Eastern countries, it is custom to carry a miswak in one’s pocket or tucked behind the ear.

Miswak comes from the Arak tree (Salvadora persica) which has been found to have significant antibacterial properties effective against the bacteria that cause plaque and gingivitis or gum disease. Miswak is a form of natural medicine and is popular as it is low in cost and simple to use. As the tree is not grown in Australia, the only miswaks available are dried and packaged. This is a problem for parents teaching their children to use miswak, as children would typically learn using a fresh, and much softer, one.

While there limited evidence of miswak being effective in reducing tooth decay some laboratory studies that suggest that Salvadora persica inhibits the functions of cariogenic bacteria Streptococcus mutans and Streptococcus sobrinus. It is also suggested that the antibacterial activity of the miswak may reduce the rate of dental plaque formation by inhibiting periodontal pathogens. This is important in the prevention of dental caries. However, there is mixed evidence regarding the effectiveness of miswak in the removal of plaque and the control of gingivitis compared with a Western toothbrush.

Although miswak has been customary practice for many centuries, evidence of its effectiveness as an oral hygiene tool is only recently gaining attention. The WHO Consensus Report on Oral Hygiene supports the use of miswak by stating that it may have a role to play in the promotion of oral hygiene, and warrants further evaluation of its effectiveness.

A recent qualitative study published in Ethnicity and Health reports findings from a Melbourne-based study involving refugee and migrant background mothers to explore the socio-cultural influences impacting on child oral health. By working with bicultural workers for promoting their children’s oral health in a new country. The findings demonstrated that despite mothers’ knowledge of the major causes of poor oral health – changes to their diet, there was much confusion about child oral hygiene practices. Mother’s limited oral health literacy influenced child oral health behaviours and outcomes. These findings help to determine where and how to intervene to improve child oral health.

More information:

Riggs, E., L. Gibbs, N. Kilpatrick, M. Gussy, C. van Gemert, S. Ali and E. Waters (2015). Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia. Ethnicity and Health 20(3): 241-257.

Riggs, E., C. van Gemert, M. Gussy, E. Waters and N. Kilpatrick (2012). Reflections on cultural diversity in oral health promotion and prevention. Global Health Promotion 19(1): 60-63.

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