Miswak: The Natural Toothbrush

The Miswak was known before Islam, but Islam added a religious perspective to its usage.
Islamic Advice The Prophet [sallallahu alayhe wa sallam (SAWS)] recommended Muslims to clean their teeth using a miswak every day; especially after waking, when performing wudhu, before salah, when reciting the Qur'an, before sleeping, and when the mouth smells bad. 
There are many ahadeeth that speak about it. Following are some of them: A'isha said that the Prophet (SAWS) said, "Ten things are natural (for one to do): Trimming the moustache, growing a beard, (using) the miswak, sniffing up water, cutting the nails, washing hands, plucking armpits, shaving pubic hair, and conserving water". (Muslim). 
He (SAWS) said, "If it were not that it would create hardship for my people, I would have ordered them to use the miswak with every wudhu and with every salah." 
The miswak was known before Islam, but Islam added a religious perspective to the use of the miswak. Medical Discoveries The miswak is a natural tool for brushing the teeth. It is taken from the roots and branches of particular desert trees. 
It differs from one region to another, but in Arabia and Asia it is taken from the Arak tree. This is the most well known variety, and is the kind that was used by the Prophet (SAWS). 
Its scientific name is Salvadora Persica. The miswak is also obtained from other trees. In Africa, for example, it is cut from Lime and Orange trees, and in America some are cut from the Senna tree. As the Arak tree is so well known, and as it was the kind that the Prophet (PBUH) used, it has been widely scientifically studied. We will summarize the various discoveries here. It is a tree that grows in hot equatorial countries, especially in desert valleys. It is widespread in the South of Saudi Arabia, Yemen, Sudan, Egypt and elsewhere. 
Salvador Persica 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 cress or mustard. Health Effects of Miswak Physically, the miswak is a natural toothbrush. It is composed of a compact group of minute natural fibers that perform exactly the same job as a normal toothbrush except that it is made of natural fibers and not plastic ones. 
For this reason it may well be gentler on the gums. Miswak's natural toothpaste is made up of a number of substances that play an important role in cleaning teeth. 
Many researchers have studied the miswak in depth, and have proven that miswak contains over ten different natural chemical compounds considered essential for good oral and dental hygiene. They are: fluoride, silica, tannic acid, resins, alkaloids (salvadorine) , volatile oils (sinigrin), sulfur vitamin C, sodium bicarbonate, chlorides, calcium, benzylisothiocyanat e (BIT), and others including salicylic acids, sterols, trimethylamine, saponins, flavenoids. 
Some of these components are stain removers and teeth whiteners, some protect teeth against caries, some are bactericidal and antiseptic, some help in healing and to repair tissue, some promote remineralization (building) of tooth enamel, and some give the taste and smell. 
Cytotoxicity Results of cytotoxictests showed no cytotoxic (cell damaging) effects from using freshly cut miswak. However, the same plant use 24 hours after cutting did contain harmful components. 
Based on these findings researchers recommend cutting the used portion of the miswak after it has been used for a day and preparing a fresh part. Scientific Comparison Between Miswak and Toothbrushes:A clinical trial study on Ethiopian schoolchildren, comparing mefaka (miswak) with the 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 not familiar with miswak techniques. Gingival Recession It has been reported that miswak users have significantly more sites of gingival recession (receding gums) than toothbrush users; however, this may be a reflection of poor technique. Commercial Miswak Products Some of the known commercial toothpastes produced from the Salvadora Persica plant are: Sarkan toothpaste (UK), Quali-Meswak toothpaste (Switzerland), Epident toothpaste (Egypt), Siwak-F toothpaste (Indonesia), Fluroswak miswak (Pakistan), and Dentacare Miswak Plus (Saudi Arabia). How to Use Miswak The method of preparing a miswak for use is to cut a branch or root of the Arak tree into pieces between 10 cm and 20cm in length, and between 4mm and 14mm in diameter. Occasionally some are thicker than this. 
Fresh miswak is brown in color, with a hot, pleasant taste. People usually strip off some of the miswak's thin bark from one end, then chew that end a little to separate the fibers so that they become like the fibers of a normal toothbrush. They then use it to brush their teeth. Length and Diameter A length of 15cm is recommended. 
This is convenient to grip and is easy to manipulate in a confined space. The diameter is normally less than 1 centimeter. This gives a supple stick firm enough to transmit the pressure of the cleansing action to the teeth without breaking off. Freshness: Miswak should be freshly cut so that it is supple, easily chewed, and still rich in active constituents. The root should be whitish-brown in color; a dark brown color indicates that the miswak is no longer fresh. If a stick is dry, the end for chewing should initially be soaked in fresh water for 24 hours. 
It should be noted that soaking for unduly long periods causes loss of active constituents and diminishes the therapeutic properties, although the mechanical effects on the teeth can still be expected to occur. The end: Before miswak is used, the end should be washed with water. It is then chewed repeatedly until the fibers stand out like the bristles of a toothbrush. 
These fibers should be trimmed every 24 hours. 
Brushing Technique The techniques employed for removing plaque mechanically are similar to that for the toothbrush and the chewing stick; i.e., vertical and horizontal brushing. The cleaning movement should always be directed away from the gingival margin of the teeth (away from the gums) on both the buccal (outer/cheek) and lingual (inner/cheek) surfaces. Care should be taken to avoid damaging the soft tissues of the mouth. 
Satisfactory cleaning can be achieved if this procedure is followed for five minutes.There are two basic holds: Pen-grip (three-finger) or palm-grip (five finger-grip) .
In each case the aim is to ensure firm but controlled movement of the brush end of the miswak within the oral cavity, so that every area of the mouth is reached with relative ease and convenience. 
When to Use Miswak In general, it is recommended that the miswak be used five times a day. The use of the miswak can be satisfying if enough time is devoted to its application during the period it is the habit of keeping it in the mouth while doing other things, so that the sick is neglected. Common Mistakes in Miswak Use 
1. The end is either too thin or too thick
2. Keeping it in the mouth while doing other things. 
3. Not cutting the end every day. 
4. Forgetting that teeth have five faces (inner, outer, two sides, and biting/chewing face), and only cleaning the outer faces. To Conclude Miswak can be a good, healthy, and natural alternative to the toothbrush