Chemical and Clinical Evaluation)
By Dr. M. Ragaii
El-Mostehy, Dr. A.A.Al-Jassem, Dr. I.A.Al-Yassin, Dr.A.R;
El-Gindy and Dr. E. Shoukry
A variety of oral hygiene measures
have been performed since the dawn of time. This has been
verified by various excavations done all over the world, in
which toothpicks, chew sticks, tree twigs, linen strips, birds'
feathers, animal bones and porcupine quills were recovered
Those that originated from
plants are tasty twigs and although primitive they represented
a transitional step towards the modern toothbrush. It has
been stated that about seventeen plants could be enumerated
as natural sources for several of these oral hygiene devices
The most widely used tree twigs
since early times is the ..Siwak" or ..Miswak" 3
.The stick is obtained from a plant called Salvadore Persica
that grows around Mecca and the Middle East area in general.
It is widely used among Muslims after Prophet Mohammed ( pbuh
) realised its value as a device which should be used by Muslims
to clean their teeth. In this respect our Prophet ( pbuh )
is considered the first dental educator in proper oral hygiene.
Although there is no reference
to the use of Siwak in Al-Quran, yet several quotations could
be read in the compendium of the sayings of Mohammed ( pbuh
) as to the benefits of Siwak in mouth cleanliness. One saying
reads as follows:
"IF IT WERE NOT TOO
MUCH A BURDEN ON THE BELIEVERS, I WOULD PRESCRIBE THAT THEY
USE THE SIWAK BEFORE EACH PRAYER".
Several anecdotes6, incidents, and rules of ethics in using
Siwak were mentioned in various references talking on the
subject of cleanliness of the mouth.
Salvadora Persica is in fact
a small tree or shrub with a crooked trunk, seldom more than
one foot in diameter, bark scabrous and cracked, whitish with
pendulous extremities. The root bark is light brown and the
inner surfaces are white, odour like cress and taste is warm
and pungent. Chemically the air dried stem bark os S. Persica
is extracted with 80% alcohol and then extracted with ether
and run through exhaustive chemical procedures. This showed
that it is composed of:
1 .Trim ethyl amine
2. An alkaloid which may be
4. High amounts of fluoride
6. Vitamin C
7. Small amounts of Tannins,
saponins, flavonoids & sterols
PURPOSE OF THE PRESENT
Because of the great quality
of oral cleanliness noticed in individuals who use Siwak as
the sole device to brush their teeth and because of the low
incidence of dental decay of those individuals this work was
It is intended to study the
1 .The mechanical ability of
Siwak as a cleaning device to the mouth and its ability to
rid the mouth of bacterial plaque (aggregates harmful to the
2. If Siwak is powdered and
used with a toothbrush, could it act as an efficient mouth
3. As compared to other strongly
abrasive toothpowder's, could Siwak rank as highly efficient
as to the used material?
Oral hygiene and patient motivation
towards a clean mouth owe their birth to the teachings of
Mohammed (pbuh). Due to the repeated use of Siwak during the
day, the users showed an unusually high level of oral cleanliness.
It is a well known fact that plaque formed immediately after
meticulous tooth brushing. By the end of 24 hours the plaque
is well on its way towards maturation and hence starts its
deleterious effects on the gingiva 8.
Proper oral hygiene should
be maintained through intensive instructions by the periodontist
as well as by a great expenditure of time and dexterity on
part of the patient. This item is self corrected in Muslims
because Siwak users take Siwak as a device that should be
used as part of their religious ritual regimen.
The results obtained in this investigation have proved that
Siwak and other tree twigs 9 could act as an effective tool
in removing soft oral deposits. It could be even used as an
effective device in preventive dental programme's in mass populations.
The indices used in this investigations were simple and adequate
as they discriminated between experimental stages as well
as between experimental groups.
Using starch is not quite accurate
but it was meant to evaluate the degree by which Siwak and
powdered Siwak could rid teeth of deposits as compared to
the best abrasive viz. commercial powder.
It is noticed that the difference between first and fifth
week of the mean score of plaque percentage for powdered Siwak
is the highest (-11.2%) of all readings. This indicates that
powdered Siwak is used with t mechanically proper device i.e.
tooth brush will give a great deal of oral cleanliness.
It has been reported that Salvadora
Persica contains substances that possess antibacterial properties
Some other components are astringents, detergents and abrasives
8. Those properties encourage some toothpaste laboratories
to incorporate powdered stems and/or root material of Salvadora
persica in their products (Beckenham U.K. Sarakan Ltd.).
Although the commercial powder
gave a high degree of efficiency in plaque removal yet its
use over the experimental period gave a high score of gingivitis
percentage within the group using the powder. It is time that
plaque eradication is essential but this should not be on
the expense of deleterious side effect on other tissues.
It could be concluded that
Siwak and powdered Siwak are excellent tools for oral cleanliness.
Because of its availability in this part of the world, being
inexpensive and readily adopted by Muslims as part of their
religious regimen, it is highly recommended in implementing
a preventive dental health program Islamic countries.
Also recommendations should be directed to manufacturers of
toothpastes to include the powdered form of Siwak in a highly
debriding sophisticated toothpaste.