Miswak

The miswak is a teeth-cleaning twig made from the Salvadora persica tree. The miswak's properties have been described thus: "Apart from their antibacterial activity which may help control the formation and activity of dental plaque, they can be used effectively as a natural toothbrush for teeth cleaning. Such sticks are effective, inexpensive, common, available, and contain many medical properties".

The miswak is predominant in Muslim-inhabited areas. It is commonly used in the Arabian peninsula, the Horn of Africa, North Africa, parts of the Sahel, the Indian subcontinent, and Central Asia.

Science
The World Health Organization (WHO) recommended the use of the miswak in 1986, but in 2000, an international consensus report on oral hygiene concluded that further research was needed to document the effect of the miswak. Some of this further research has been done on a population of 203, and concluded, "that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users". Yet another comparative study conducted on a sampling of 480 Saudi Arabian adults found that "the level of need for periodontal care in the sample chosen is low when compared with the findings of similar studies undertaken in other countries. The frequent use of the 'Miswak' was associated with a lower need for treatment".

Miswak extract vs. oral disinfectants
Studies indicate that Salvadora persica extract exhibits low antimicrobial activity compared to other oral disinfectants and anti-plaque agents like triclosan and chlorhexidine gluconate.

"Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity." However, the benefits of triclosan were discounted by the United States Food and Drug Administration in 2016 and its safety is uncertain as a hygiene product ingredient. Chlorhexidine gluconate was also linked to serious allergic reactions, albeit rarely.

Chemical composition
Salvadorine and benzylisothiocyanate appear to be responsible for the antibacterial activity of Miswak. The plant also contains insoluble fluoride in high concentration, calcium, salicylic acid, and some antioxidants of unclear function.

Other considerations
A 2016 paper has been published comparing human DNA left on used miswak and toothbrushes, including the effect of time, to determine whether miswak is a reasonable source of DNA when found at crime scenes. The conclusion was that miswak contains a high enough quantity of DNA, and retained good DNA profiling; and when compared to toothbrushes, miswak is a reasonable source of DNA for forensic profiling. In addition, time of storage up to four months had no or little effects on results.

Religious prescriptions
The use of the miswak is frequently advocated in the hadith (the traditions relating to the life of Muhammad). Situations where the miswak is recommended to be used include before or during wudu (ablution), on waking up in the morning, before going to the mosque, before entering one's house, before and after going on a journey, on Fridays, before sleeping and after waking up, when experiencing hunger or thirst and before entering any good gathering.

In addition to strengthening the gums, preventing tooth decay and eliminating toothaches, the miswak is said to halt further decay that has already set in. Furthermore, it is reputed to create a fragrance in the mouth, eliminate bad breath, improve sensitivity of taste-buds and promote cleaner teeth.

Hadiths concerning the miswak
It is often mentioned that the Islamic prophet Muhammad recommended the miswak's use. He is quoted in various hadith extolling its virtues:

"Were it not that I might over-burden the Believers I would have ordered them to use Siwak (Miswak) at the time of every Prayer."

"Four things are from among the practices of the Prophets: Circumcision, Perfume, Miswak, and Marriage."

"Make a regular practice of Miswak for verily it is the purification for the mouth and a means of the pleasure of the Lord."

"Use the Miswaak, for verily, it purifies the mouth, and it is a Pleasure for the Lord. Jib-ra-eel (A.S.) exhorted me so much to use the Miswaak that I feared that its use would be decreed obligatory upon me and upon my Ummah. If I did not fear imposing hardship on my Ummah I would have made its use obligatory upon my people. Verily, I use the Miswaak so much that I fear the front part of my mouth being peeled (by constant and abundant brushing with the Miswaak)"

Alternative forms
Modern uses of arāk wood in oral hygiene expands beyond miswak itself. Extracts containing its active components have been added to mouthwash and toothpaste. There is also a German patent for similar formulations for domesticated animals.