Miswak (Salvadora Persica) Versus a Toothbrush in Plaque Removal

Effectiveness of a 45°-Cut Miswak (Salvadora Persica) Versus a Toothbrush in Plaque Removal Among Children: A Randomized Split-Mouth Clinical Trial

The study investigates the effectiveness of a 45°-cut miswak for plaque removal compared to a toothbrush in children and assesses their preferences for these tools. Conducted at King Abdulaziz University Dental Hospital, it employs a split-mouth randomized controlled trial design to measure plaque levels and gather feedback through a questionnaire.

Study Overview

• Status: Completed
• Conditions: Dental Caries; Dental Plaque Accumulation
• Intervention / Treatment: Other: Miswak; Other: Toothbrush

Detailed Description

Miswak provides both mechanical and chemical cleaning. Its fibrous structure enables mechanical removal of debris from tooth surfaces and interdental areas, while naturally occurring compounds (e.g., fluoride, silica, and calcium) may contribute to its anticariogenic effects. Studies have reported that miswak exhibits antibacterial, antifungal, antiviral, anti-cariogenic, and antioxidant effects, and molecular docking studies have suggested potential anti-COVID-19 activity.

One of the studies has shown that miswak can reduce oral bacterial load, in some cases more effectively than conventional toothpaste particularly against Streptococcus mutans and Lactobacilli, key contributors to dental caries. Miswak-based toothpaste and mouthwash have also been associated with significant reductions in plaque levels and improved gingival health, suggesting that miswak could be a viable and affordable oral hygiene option, especially for children in underserved or resource-limited communities

Methods:

This research employs a split-mouth randomized controlled trial (RCT) design that compared the effectiveness of a 45-degree cut Miswak stick versus a manual toothbrush in reducing dental plaque among children aged 6 to 14 years. The study focused on evaluating intra-individual differences in plaque accumulation by assigning each child to use Miswak on one side of the mouth and a toothbrush on the opposite side. This split-mouth approach aims to minimize variability and enhance statistical reliability.

This design supported intra-individual comparison and enhanced the study's internal validity.

• Group A (n=36) used a manual toothbrush on the left upper and lower quadrants and a 45-degree cut Miswak on the right quadrants.
• Group B (n=36) followed the reverse assignment, using the toothbrush on the right and Miswak on the left

• Study Type: Interventional
• Enrollment (Actual): 82
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Saudi Arabia
  • Jeddah, Saudi Arabia
    • King Abdulaziz University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion criteria included:

• Healthy children aged 6 to 14 years.
• Children who their parents/legal guardians have approved and signed the consent form, which ensures that the participants are within the target age range and are healthy, which helps to control variables that could affect oral hygiene outcomes.

Exclusion Criteria:

• Unhealthy children
• Children whose ages are below 6 years or above 14 years
• Children with orthodontic brackets because it can affect oral hygiene practices and outcomes, excluding these participants ensures a more homogeneous sample.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention (Miswak); This arm introduces a 45° miswak technique, which aligns with the modified Bass method by angling the miswak fibers at 45° toward the gingival margin	Other: Miswak; Miswak is a traditional oral hygiene tool made from the twigs of the Salvadora persica tree. It's used for cleaning teeth and has natural antibacterial properties. Miswak is popular in many cultures, particularly in the Middle East and parts of Africa, and is valued for its effectiveness in promoting oral health.; Other Names: Salvadora persica
Active Comparator: Control (Tooth brushing); Participants in this arm used the modified bass technique using normal tooth brush and tooth paste	Other: Toothbrush; A toothbrush is a small, handheld device used for cleaning teeth and maintaining oral hygiene. It typically consists of a handle and a head with bristles that help remove plaque, food particles, and bacteria from the teeth and gums, often used in conjunction with toothpaste.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The plaque index score	The plaque index score, a continuous measure assessed using the Simplified Oral Hygiene Index (OHI-S) developed by Greene and Vermillion (1964) (Greene and Vermillion 1964)	At baseline and after 3 weeks

Collaborators and Investigators

• Sponsor: King Abdulaziz University

Study record dates

Study Major Dates

• Study Start (Actual): September 12, 2025
• Primary Completion (Actual): December 12, 2025
• Study Completion (Actual): January 19, 2026

Study Registration Dates

• First Submitted: January 19, 2026
• First Submitted That Met QC Criteria: February 12, 2026
• First Posted (Actual): February 13, 2026

Study Record Updates

• Last Update Posted (Actual): February 13, 2026
• Last Update Submitted That Met QC Criteria: February 12, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: plaque removal; Miswak; Salvadora persica; Brushing technique
• Additional Relevant MeSH Terms: Stomatognathic Diseases; Tooth Diseases; Tooth Demineralization; Dental Caries
• Other Study ID Numbers: 35-03-25; Institutional Review Board (Other Identifier: The University of Tennessee Health Science Center)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No