title: Comparative effect of chewing sticks and toothbrushing on plaque removal and gingival health.
abstract: OBJECTIVE
  The aim of the study was to compare the effect of the chewing stick (miswak), and toothbrushing on plaque removal and gingival health.
  
  
  METHODS
  The participants comprised 15 healthy Saudi Arabian male volunteers aged 21 to 36 years, attending the Dental Center at Al-Noor Specialist Hospital in Makkah City in Saudi Arabia. The study was designed as a single, blind, randomized crossover study. The Turesky modified Quigley-Hein plaque and Löe-Silness gingival indices and digital photographs of plaque distribution were recorded at baseline, one week after professional tooth cleaning, and again following three weeks use of either the miswak or toothbrush. Professional tooth cleaning was repeated, and after a further three weeks use of either the miswak or toothbrush (using the alternative method to that used in the first experimental period), plaque and gingival indices, and digital photographs of plaque distribution were recorded anew.
  
  
  RESULTS
  Compared to toothbrushing, the use of the miswak resulted in significant reductions in plaque (p < 0.001) and gingival (p < 0.01) indices. Image analysis of the plaque distribution showed a significant difference in reduction of plaque between the miswak and toothbrush periods (p < 0.05).
  
  
  CONCLUSIONS
  It is concluded that the miswak is more effective than toothbrushing for reducing plaque and gingivitis, when preceded by professional instruction in its correct application. The miswak appeared to be more effective than toothbrushing for removing plaque from the embrasures, thus enhancing interproximal health.
authors.affiliation: Department of Cariology and Endodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. moshari.alotaibi@ofa.ki.se
authors.forename: Meshari
authors.initials: M
authors.lastname: Al-Otaibi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Harthy
authors.forename: Birgitta
authors.initials: B
authors.lastname: Söder
authors.forename: Anders
authors.initials: A
authors.lastname: Gustafsson
authors.forename: Birgit
authors.initials: B
authors.lastname: Angmar-Månsson
mesh_terms: D000328:Adult; D004396:Coloring Agents; D018592:Cross-Over Studies; D003773:Dental Plaque / Q000175:diagnosis / Q000628:therapy*; D003774:Dental Plaque Index; D003777:Dental Prophylaxis; D005500:Follow-Up Studies; D005891:Gingivitis / Q000517:prevention & control*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D029592:Oleaceae; D009910:Oral Hygiene / Q000295:instrumentation*; D010512:Periodontal Index; D023861:Photography, Dental; D010946:Plants, Medicinal; D012529:Saudi Arabia; D016037:Single-Blind Method; D014099:Toothbrushing / Q000295:instrumentation*
chemical_list: D004396:Coloring Agents