AIM OF THE STUDY: To assess the effectiveness of miswak in maintaining periodontal health among adults.
MATERIALS AND METHODS: We searched for randomised controlled trials (RCTs) investigating the effect of miswak published in PubMed, EBSCOHOST (Dentistry & Oral Sciences), SCOPUS, and Cochrane Database for Systematic Review (CDSR) from inception to May 08, 2022. The primary outcomes of interest were changes in the periodontal health measured with plaque and gingivitis scores as well as subgingival bacteria load. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach while the estimates of effect were pooled using a random-effects model.
RESULTS: Ten eligible articles were identified, of which 9 could be analysed quantitatively. The remaining report was included as part of the qualitative analysis. The meta-analysis showed that miswak was comparable with the toothbrush in reducing the mean plaque score (p= 0.08, SMD: 0.39, and 95% CI: -0.05 to 0.83) and mean gingivitis score (p= 0.37, SMD: 0.13, and 95% CI: -0.16 to 0.43). Even higher certainty of evidence for the effect of miswak on mean plaque reduction on labial surface of anterior teeth. However, the adjunctive effect of miswak was significantly more superior for reducing plaque (p= 0.01, SMD: 0.68, and 95% CI: 0.14 to 1.22) and gingivitis score (p= 0.04, SMD: 0.66, and 95% CI: 0.03 to 1.29).
CONCLUSIONS: Miswak effectively reduced plaque and gingivitis scores to a level comparable to toothbrush when used exclusively. Adjunctive miswak use was particularly effective in improving periodontal health. However, the included studies inadequately reported on the method of toothbrushing using miswak and the frequency of miswak use. Therefore, further clinical studies are recommended to explore on the advantages and proper method of miswak practice for optima outcome and safety.
MATERIAL AND METHODS: A PRISMA-compliant systematic search of literature was done from the MEDLINE, CENTRAL, Science Direct, PubMed and Google Scholar. Literature that fulfilled eligibility criteria was identified. Data measuring plaque score and bleeding score were extracted. Qualitative and random-effects meta-analyses were conducted.
RESULTS: From 1736 titles and abstracts screened, eight articles were utilized for qualitative analysis, while five were selected for meta-analysis. The pooled effect estimates of SMD and 95% CI were -0.07 [-0.60 to 0.45] with an χ2 statistic of 0.32 (p = 0.0001), I2 = 80% as anti-plaque function and 95% CI were -2.07 [-4.05 to -0.10] with an χ2 statistic of 1.67 (p = 0.02), I2 = 82%.
CONCLUSION: S. persica chewing stick is a tool that could control plaque, comparable to a standard toothbrush. Further, it has a better anti-gingivitis effect and can be used as an alternative.
METHODS: Using the PRISMA 2020 Protocol, a systematic search of the publications was undertaken from the MEDLINE, CENTRAL, Science Direct, PubMed, and Google Scholars for randomized control trials published through 31st January 2022 to determine the effectiveness of Salvadora persica-extract mouthwash relative to chlorhexidine gluconate as anti-plaque and anti-gingivitis properties.
RESULTS: A total of 1809 titles and abstracts were screened. Of these, twenty-two studies met the inclusion criteria for the systematic review while only sixteen were selected for meta-analysis. The overall effects of standardized mean difference and 95% CI were 0.89 [95% CI 0.09 to 1.69] with a χ2 statistic of 2.54, 15 degrees of freedom (p
METHODS: This clinical trial was conducted at the Faculty of Dentistry, Universiti Teknologi MARA Shah Alam, Selangor, Malaysia, from September 2010 to April 2012. Periodontal chips were formulated using S. persica, benzyl isothiocyanate (BITC) and chitosan extracts. All patients were treated with full mouth scaling and root planing at baseline. Thereafter, the periodontal pockets (≥5 mm in length) were divided into 4 groups: the control group; group 2 (plain chitosan chip); group 3 (S. persica extract); and group 4 (BITC extract). Plaque index (PI), bleeding on probing (BOP), periodontal probing pocket depth and clinical attachment levels were recorded at days 0 and 60 only.
RESULTS: A total of 12 patients participated in this study. Overall, 240 periodontal pockets were evaluated. The study revealed significant improvements in PI, BOP and reduction in periodontal pocket depth in all 4 groups (P <0.05). The improvement in clinical attachment level was significantly higher (P <0.001) among the group that received S. persica chips compared to the control and other chip-treated groups.
CONCLUSION: Periodontal chips containing S. persica can be used as adjuncts to treat patients with periodontitis.
METHODS: A 24 h plaque re-growth, double-blinded, randomized crossover trial was carried out. Participants (n = 14) randomly rinsed with test formulation, 0.12% chlorhexidine (control) and placebo mouthwashes for 24 h. A week before the trial, all participants received scaling, polishing and oral hygiene education. On the trial day, the participants received polishing at baseline and rinsed with 15 ml of randomly allocated mouthwash twice daily without oral hygiene measures. After 24 h, plaque index was scored and then the participants entered a 6-days washout period with regular oral hygiene measures. The same protocol was repeated for the next 2 mouthwashes.
RESULTS: The results were expressed as mean (±SD) plaque index. The test mouthwash (0.931 ± 0.372) significantly reduced plaque accumulation when compared with placebo (1.440 ± 0.498, p 0.0167).
CONCLUSIONS: The test mouthwash has an anti-plaque effect for a 24 h period. Longer-term clinical studies are highly encouraged to investigate its anti-plaque effect for longer periods.
TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov as NCT02624336 in December 3, 2015.
METHODS: Two-fold serial micro-dilution method was used to measure minimal inhibitory concentration (MIC) of aqueous extracts of Gt, Sp and their combinations. Adsorption to hexadecane was used to determine the cell surface hydrophobicity (CSH) of bacterial cells. Glass beads were used to mimic the hard tissue surfaces, and were coated with saliva to develop experimental pellicles for the adhesion of the primary colonizing bacteria.
RESULTS: Gt aqueous extracts exhibited better anti-plaque effect than Sp aqueous extracts. Their combination, equivalent to 1/4 and 1/2 of MIC values of Gt and Sp extracts respectively, showed synergistic anti-plaque properties with fractional inhibitory concentration (FIC) equal to 0.75. This combination was found to significantly reduce CSH (p<0.05) and lower the adherence ability (p<0.003) towards experimental pellicles.
CONCLUSION: Combination between Gt and Sp aqueous extracts exhibited synergistic anti-plaque activity, and could be used as a useful active agent to produce oral health care products.
METHODS: The selected patients were divided into three groups, Group I (PDT + SRP), Group II (SP + SRP) and group III (SRP alone). Clinical inflammatory periodontal parameters including plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) gain were assessed. Assessment of crevicular fluid interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) was performed using enzyme-linked immunosorbent assay technique. All measurements were recorded at baseline, 3 months and 6 months follow-up periods, respectively.
RESULTS: A total of 73 patients completed the study. A significant improvement in the BOP was seen in Group II at both follow up visits when compared with other groups (p < 0.05). Only in Group-I that showed statistically significant reduction in moderate periodontal pockets at 3 months (p = 0.021), and significant reductions in deep pockets at 3-months (p = 0.003) and 6-months (p = 0.002), respectively. CAL gain also was reported to be seen in group-I at both visits (p < 0.05). Group- I and II significantly reduced the levels of IL-6 at 3-month period compared to Group-III. This reduction was further maintained by group-II and group-III at 6 months, respectively. TNF-α showed statistically significant decrease in Group II as compared to Group I and Group-III and this reduction was maintained by the end of 6-month visit (p = 0.045).
CONCLUSION: Both the treatment modalities PDT and SP helped in reducing periodontal inflammation. PDT reported significant gain in clinical attachment level, whereas the SP significantly reduced the bleeding levels.