Strong Antibacterial Effect of Miswak on Periodontitis and Caries bacteria

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Objectives: In many parts of the world the chewing stick (miswak) is used for oral hygiene. Miswak is the oldest reported tooth cleaning aid, which has been traditionally used since 3500 years BC. As well as a mechanical removal of plaque, an antibacterial effect has been postulated, but tests of miswak extract from salvadora persica (Arak) have disclosed only low to moderate antibacterial effects. This may be attributable to the extraction process. Our aim was to test, in vitro, the antibacterial effect of miswak pieces without extraction, on bacteria implicated in the aetiology of periodontitis and caries. Methods: Miswak pieces were standardized by size and weight (0.14 g and 0.07 g), and then tested against Streptococcus mutans, Lactobacillus acidophilus, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and, as a reference, Haemophilus influenzae. The miswak pieces were tested in two ways, embedded in the agar plate or suspended in the air above the agar plate. Results: The inhibitory effect was most pronounced on A. actinomycetemcomitans, P. gingivalis, and H. influenzae, less on S. mutans, and least on L. acidophilus. Suspended miswak had comparable or stronger effects than miswak embedded in agar. The 0.14 g suspended miswak exhibited significantly greater inhibition on A. actinomycetemcomitans and H. influenzae than the 0.14 g miswak embedded in agar(P< 0.01, and P< 0.001 respectively). Conclusions: Miswak embedded in agar or suspended in the air above the agar plate had strong antibacterial effects against all bacteria tested. The antibacterial effect of suspended miswak pieces suggests the presence of volatile active antibacterial compounds. Ongoing work aims to obtaine a working miswak extract, and to further characterize the antibacterial principle of the chewing stick. Figure 1: A, Porphyromonas gingivalis inhibition with 0.14g miswak piece embedded in agar. B, Haemophilus influenza with 0.07g suspended miswak.