Review on Pharmacological and Therapeutics uses of Miswak
Mr. Ritik. S. Jain, Mr. Irfan Sayyed, Mr. Girish. Y. Pawar, Mr. Paresh. A. Patil, Mr. Dipesh. R. Karnavat
Department of Pharmacognosy, Ahinsa Institute of Pharmacy, Dhule Road, Dondaicha 425408.
Miswak is a belonging to family Salvaadoraceae and having binomial name salvadora persica. Salvadora persica use not only today, it is greatly use in ancient period. In ancient period it is use in oral cleaning. Miswak shows therapeutics as wll as pharmacological properties. So due to improper information about uses of miswak people avoiding the uses of miswak. It is naturally occurring plant so it has maximum therapeutics and pharmacological effect and rarer toxic effect. So in these article we discuss about proper therapeutic and pharmacological uezs of miswak.
Species- Persica oleoids
Binomial name- Salvadora persica
Miswak is derived from a plant species of Salvadora persica belonging to the family Salvadoraceae. The full taxonomic classification of Salvadora persica is given in Table 1. Salvadora persica, or the Arak tree, is known in English as the “tooth brush tree.” It is an upright evergreen that grows as a small tree or shrub with a crooked trunk. It is seldom more than one foot in diameter, reaching a maximum height of 3 meters.
The leaves are small, rounded to ovate, slightly fleshy, thick and succulent, having a strong smell of cress or mustard. The fragrant flowers are small. The fruits are like fleshy berries; small and barely noticeable. They are edible in both fresh and dried form.13,27 Salvadora persica is capable of surviving in extreme conditions and can tolerate very dry environments to highly saline soils.28 It is widespread in arid regions, on saline lands, in coastal regions, thorn shrubs, desert flood plains, and grassy savannahs.29 It is native to the Arabian Peninsula, Africa, Iraq, India, Pakistan, and Sri Lanka.
How to use Miswak Sick:
1] Cleaning your Teeth with Miswak
Using a miswak twig to brush your teeth is easy and fun! If you have a "fresh" twig-one that hasn't been used yet-start by chewing off of the bark at either end of the twig. Stop when you've exposed an inch or so of the wood underneath. Spit out and discard the bark.
A slight "spicy" or "burning" taste can result from chewing on a miswak twig. Though some find this slightly unpleasant, it's not harmful.
2] Chew the center until it becomes soft and forms bristles:
When you've exposed the wood underneath the bark at the tip of your twig, start chewing on it. You're aiming to soften this wood so that it breaks up into thin, fibrous bristles. This should only take a minute or two — you'll know you're ready when the tip of the wood is soft enough that it can be fanned out slightly like a small brush.
· Ideally, you want a very slight resistance to the bristles (similar to what you'd get from a soft-bristled toothbrush)
3] Soak the tip in water:
Traditionally, miswak is performed without toothpaste or other oral health products, though you may use these if you wish. To perform miswak in the traditional style, simply dip the bristly end of the twig in water (like you would before adding toothpaste to a toothbrush).
Alternatively, many traditional miswak practitioners use rosewater in place of ordinary water for its pleasant scent.
You're now ready to brush. You can grip the stick however feels comfortable to you — keep in mind that you'll be brushing with the tip of the stick, rather than the side, as with a toothbrush. Traditionally, miswak sticks are held by putting the thumb of the right hand just below and behind the bristly tip, putting the little finger under the back of the stick, and wrapping the remaining three fingers over the top.
5] Brush your teeth with the bristled end.
Now, start brushing! Press the bristly tip of the stick into your teeth and move it gently up and down to scrub their front surfaces. Move slowly around your mouth, taking your time and hitting every surface of your teeth with the bristles. Don't press extra-hard-your goal is to gently scrub the teeth, not scrape or gouge them. To someone who's used to using a toothbrush, miswak may feel somewhat awkward at first, but after a few attempts it quickly becomes intuitive.
Don't forget to clean the backs of your teeth just as you would with a toothbrush!
6] Cutoff old bristles every few days:
Keep your miswak stick fresh by using a knife (or your bare hands) to cut or break off the old bristles when they become worn. Depending on how often you clean your teeth and the type of stick you're using, your bristles' average lifespan will vary. In general, you'll want to cut your stick's bristles away every time they get the appearance of an old, ratty broom. Usually, this will mean cutting them every few days. There are some notable exceptions to this rule. Some types of processed, commercially-sold miswak sticks have lifespans of over six months due to the preservatives added to them.
When you're done cleaning your teeth, quickly clean your miswak of any debris and give it a brief rinse. Keep the miswak in a clean but open space, not in a bag or container, which can encourage mold growth by trapping moisture next to the stick. Keep miswak sticks away from any sinks or toilets to avoid the accidental transfer of bacteria due to splashes.
Using Miswak in an Islamic Context:
For some, miswak is just a way to keep the teeth clean. However, for observant Muslims, miswak often plays a more serious role in religious worship. Muslims are required to wash themselves in a ritual form of purification (wudu) before certain acts of worship (most commonly, the daily prayers known as salat). Though cleaning the teeth isn't explicitly required as part of a Muslim's wudu ritual, it is considered optional and is often strongly encouraged. Thus, for serious Muslims, the use of a stick for performing miswak prior to prayer is something that can occur multiple times per day.
2] Understand the importance of oral purification:
Achieving a state of purity before prayer is very important for Muslims. The Quran explicitly states that "[God] loves those who purify themselves." Cleaning oneself shows devotion to God, observance of Islamic scriptures, and emulation of Muhammad the prophet, who himself practiced miswak and recommended that others do so.
In addition, Miswak usage before prayer is often seen to make the prayer more worthy or desirable in God's eyes. According to one Hadith, "The preference for prayer in which a 'siwak' (miswak) is used to prayer in which it is not used is seventy times.
Study miswak usage in the Hadiths:
Though use of miswak for oral purity is not discussed at great length in the Quran, it is referenced many times in the Hadiths (the scriptural accounts of the practices and sayings of the prophet Muhammad). Below are just a few quotes from the Hadiths where miswak usage is mentioned as being especially desirable or praiseworthy in the eyes of Muhammad:
"The Messenger of Allah said, 'Had I not thought it difficult for my nation, I would have commanded them to use the miswak before every Salat.'"
"The first thing that the Messenger of Allah (may Allah bless him and grant him peace) did on entering the house, was Miswak.”
“Ablution is part of faith and using a Miswak is part of ablution.”
“There is a cure for every illness in Miswak besides death.”
If you are an observant Muslim but you live somewhere it is difficult to get a genuine miswak stick or you have misgivings about using a twig to clean your teeth, don't worry! Many Muslims achieve the same level of oral purity by using an ordinary toothbrush (with or without toothpaste) as they would with traditional miswak practices. The most important aspect of wudu is to sincerely intend to purify yourself in the eyes of God and to make the best possible effort to do so. The precise tool you use to clean your teeth isn't nearly as important as the simple fact that you're cleaning your teeth as a sign of devotion to God.
Islamic practices even make special allowances for people who don't have any oral cleaning tools available to them before they pray. In this case, it's generally recommended to do the best job you can with your index finger.
Making Your Own Miswak Twig
One of the great things about using miswak to clean your teeth is that the stick you use can potentially be free! Though most majority-Muslim countries will have cheap, easily-available miswak sticks for sale, it's also possible to make your own miswak stick just as traditional practitioners would have. To start, find a suitable tree. Traditionally, miswak sticks are taken from Salvadora Persica trees (also called "toothbrush" or "arak" trees). Below are just a few suitable alternatives that are native to the Mediterranean, Middle East, and Levant where miswak is most frequently practiced:
2] Cut a small, sturdy twig from the tree
Next, simply take a small twig or stick from the tree's branches or any exposed roots using a knife or your bare hands. Your stick doesn't need to be especially big-traditionally, miswak sticks are about as long as your hand is wide. Be careful not to take more than you need or to hurt the tree more than necessary — this is wasteful and disrespectful.
3] Wash thoroughly before using
When you take any sort of plant product out of the wild, you run the risk of exposing yourself to harmful chemicals or germs, no matter how clean the plant looks. To reduce the chance of this risk happening to you, be sure to thoroughly wash any miswak sticks you cut directly from the tree before using them. Use disinfectant soap or an equivalent antibacterial substance to clean the stick and rinse with water to remove the soap. Repeat several times for cleanliness.
Be sure to store your miswak sticks in a clean, dry place before using them. Since you've just washed them, they will be wet and can potentially pick up dirt or dust if you're not careful.
Never take your miswak stick from a tree you know to be poisonous or otherwise harmful. No matter how much you clean a miswak stick from a poisonous tree, using the stick will expose you to chemicals that can make you sick. You will also want to avoid any trees that you know to have been treated with a pesticide or any other potentially harmful chemicals. Below are just a few types of trees from which you should not take miswak sticks (this list is incomplete, so consult a botanical resource if you're ever unsure whether a certain tree is unsafe).
5] When in doubt , buy or order a miswak twig:
Though people in certain parts of the world have been taking their own miswak sticks from nature for thousands of years, for the in experienced, this can be an intimidating task. If you are ever worried about whether or not a certain miswak stick is safe to use, consider buying yours from a reputable vendor.
Miswak sticks are available both online and from specially brick-and-mortar stores (most commonly in muslim countries and commuunities)- in developed countries with modern health regulations, these com mercially-sold sticks will be sanitary and reliably safe to use.
Salvadorapersica is an upright evergreen small tree or shrub, seldom more than one foot in diameter reaching maximum height of three meters. The leaves are small, oval, thick and succulent with a strong smell of cress or mustard.
Alcoholic Extraction of Salvadora Persica Chewing Sticks:
800g of Salvadora Persica chewing sticks were cut by using a knife and ground to a commercially available food blender. 120ml of 60% ethanol was added to 40g of powder in a sterile well capped flask, left for 3 days at room temperature and then filtered using No.1 filter paper. The extract was incubated at 37oC until it became dry and stored in sterile screw capped vials in the refrigerator until needed.
Pharmacological properties of miswak:
1. Antibacterial properties
2. Antimycotic activity
3. Analgesic activity:
4. Stimulation of Slivery secreation:
6. Locomotor activity:
7. Topical medicament:
8. Antiulcer activity:
11. Hypolipidemic Activity
12. Anticonvulsant and sedative effect
13. Antiplasmodial Activity 
Some of known commercial tooth paste produced from Salvadorapersicaare: Sarkan tooth paste, UK, Quali-Meswak tooth paste, Switzerland, Epident tooth paste, Egypt, Siwak F tooth paste, Indonesia Fluoroswak, Miswak Pakistan Dentacare Miswak Plus, Saudi Arabia. 
2. Oral hygiene:
Chewing sticks have been used for centuries as a tooth cleaning device. One of the most commonly used type is known as the miswak. Miswak is an oral hygiene aid and in widespread use even beyond the Arab world. The World Health Organization has recommended and encouraged the use of these sticks as a tool for oral hygiene in areas where their use is customary.
3. Removal of smear layer:
The effects of aqueous extracts of chewing sticks (Salvadorapersica) on the healthy and periodontally involved human dentine were evaluated with Scanning Electron Microscopy (SEM) in vitro.
25% aqueous extract of freshly prepared miswak solution was used for the study. Twelve human premolars teeth (6 healthy and 6 with periodontal disease) recently extracted for orthodontic and periodontal reasons were used. 24 SEM specimens were prepared and treated with miswak extract with different conditions e.g. soaking with miswak extract. Soaking the healthy and periodontally diseased root dentine in miswak extract resulted in partial removal of smear layer and occlusion of tubules was observed in dentine specimens burnished with miswak solution.
It was concluded that CHX 0.2% and miswak extract 50% had a similar effect on dentin in the control group. Miswak extract removed more smear layer as compared to CHX.
4. Root canal irrigant:
The objectives of the current study were to evaluate the in vitro and in vivo antimicrobial effects of an alcoholic extract of Salvadora Persica solution as a root canal irrigant and to compare it with the currently used root canal irrigants (5.25% sodium hypochlorite, 0.2% chlorhexidine, and normal saline).
The results of in vitro antimicrobial effect of alcoholic extract of Salvadora Persica, sodium hypochlorite, chlorhexidine, and normal saline showed that all concentrations of Salvadora Persica extract, sodium hypochlorite, and chlorhexidine had a significant antimicrobial effect against aerobic and anaerobic bacteria recovered from teeth with necrotic pulps, while normal saline had no significant antimicrobial effect. The best antimicrobial effect for Salvadora Persica extract was noticed at lowest concentration according to broth micro dilution method.
Results revealed that 15% alcoholic extract of Salvadora Persica had significant antimicrobial effect which was not significantly different from sodium hypochlorite and chlorhexidine, and significantly different from normal saline.
5. Plaque control:
Few studies have reported on the cleaning effectiveness of chewing sticks. Crosssectional studies show conflicting results. A cross- sectional study in Ghana among adults revealed higher plaque and gingival bleeding in chewing stick users as compared with toothbrush users. Another retrospective study showed that Miswak users had deeper pockets and more prevalence of periodontal diseases. In contrast, no differences in plaque and gingival bleeding were found between toothbrush and chewing stick users among 7-15 years old children in Tanzania. It is reported that patients using Miswak regularly show decreased gingival bleeding on probing compared with non-Miswak users. Thus, poor oral hygiene with those using chewing sticks may be a reflection of poor techniques.
On the other hand, controlled longitudinal studies were more consistent. A clinical trial study on Ethiopian school children comparing mefaka (Miswak) with conventional toothbrush, found Miswak to be as effective as the toothbrush in removing oral deposits. The study also found instruction and supervision to be important since the children in the sample were found not to be familiar with Miswak techniques.
The study further concluded that Miswak should be used in preventive dental programs, as it was economical and familiar to the older people. In a clinical trial among adolescents in Nigeria, the results showed that the Massulariaacuminata chewing stick was as effective in controlling and removing dental plaque as the toothbrush and paste.
6. Dental gel:
The present paper includes in vitro evaluation of antimicrobial activity of Miswak stems against different microorganisms including dental pathogens and formulation of bioactive extract into suitable dental gel.
Air-dried powdered stems were extracted with various solvents and each extract was evaluated for antimicrobial activity against test organisms including dental pathogens by agar diffusion technique. Dichloromethane extract showed significant antimicrobial activity, which was comparable with standards Chloramphenicol and Clotrimazole. This bioactive extract was formulated into dental gel using suitable gelling agent. The gel was evaluated for various physicochemical parameters, spreadability, mucoadhesion, dissolution, in vitro permeation, and antimicrobial activity.
Dichloromethane extract of Miswak stems possesses good antimicrobial activity, confirming the traditional claim. A dental gel containing this extract was successively formulated with enhanced penetration and greater activity. This mucoadhesive dental gel has significant potential for treatment of periodontal diseases.
8. Gingival recession:
A relatively high prevalence of gingival recession among adults in Tanzania has been reported. Gingival recession on buccal surfaces has been ascribed to brushing habits. Since the lingual surfaces in the Tanzanian population exhibits gingival recession to the same extent as the buccal surfaces, as has been reported, then it is doubtful that the Miswak is the cause of high prevalence of gingival recession.
Younes and El-Angbawi reported that about 22% of the Saudi school children with gingival recession used Miswak. The low percentage of calculus deposits found in the group affected by gingival recession may be due to the common use of Miswak.
It has been reported that Miswak users had significantly more sites of gingival recession than did the toothbrush users. Further more, the severity of the recession was significantly more pronounced in the Miswak users than that in the toothbrush users. However, the gingival recession reported in Miswak users may be a reflection of poor techniques.
Miscellaneous application of miswak:
1. Effect on soil salanization
Effects of salinization of soil on emergence, seedling growth and mineral accumulation of Salvadorapersica Linn. (Salvadoraceae) were studied. Results suggested that this tree species is salt tolerant at seed germination and seedling stages. Elongation of stem and root was retarded by increasing salt stress. Young roots and stem were most tolerant to salt stress and were followed by leaves and old roots. Leaf tissue exhibited maximum reduction in dry mass production in response to increasing salt stress. However, production of young roots and death of old roots were found to be continuous and plants apparently use this process as an avoidance mechanism to remove excess ions and delay onset of ion accumulation in this tissue.
This phenomenon, designated “fine root turnover” is of an importance to the mechanisms of salt tolerance. Plants accumulated Na in roots and were able to regulate transfer of Na ions to leaves. Stem tissues were barrier for translocation of Na from root to leaf. Moreover, K significantly increased in leaf, but decreased in root tissues with increased salinization. Nitrogen content significantly decreased in all tissues (leaf, stem and root) in response to low water treatment and salinization of soil. Phosphorus content significantly decreased, while Ca increased in leaf as soil salinity increased. Changes in elements accumulation pattern and the possible mechanisms for avoidance of Na toxicity in tissues and organism level are discussed.
2. Industrial oil production:
Salvadora Persica appears to be potentially valuable oil seed crop for saline and alkali soil, since the seed contain 40-45% of oil rich in industrially important lauric acid (c12) and myristic acid (c14) acids. Attempts were made to asses the performance of the species on the saline and alkali soil.
From the result it was evident that the species can be grown on both soil type. How ever height, spread and seed yield were significantly higher for plants grown on saline soil compare to alkali soil. no significant difference was observed in oil content from both type of soil. The study indicates that S. persica can be cultivated as a source of industrial oil on both saline and alkaline soil for economic and ecological benefit.
1. A review of the therapeutics effects of using miswak (Salvadora Persica) on oral health by Mobammad M. Haque and Saeed A Alsareit in Saudi Med. J 2015; Vol.36(5); 530-543
2. How to use miswak by wikihow staff updated on December 30,2019
3. The Active Chemical Constituent And biological Activity of Salvadora persica by Sukumar Dutta, Aatif Shaikh in International Journal of Current Pharmaceutical Review and research, 3(1), ISSN: 0976-822X
Received on 17.02.2020 Modified on 15.03.2020
Accepted on 06.04.2020 ©Asian Pharma Press All Right Reserved