Ancient Teeth Cleaning Miswak Twig Fights Oral Bacteria

miswak antibacterial twigs

Miswak Twigs. Photo by Iqbal Osman

Twigs from the medicinal Miswak tree – Salvadora persica – have been used for many centuries, pre-dating the modern toothbrush.

Well, it turns out this ancient toothbrush does more than just clean food out from teeth surfaces and in between the teeth.

Miswak (or Meswak) twigs also kill pathogenic bacteria.

Miswak twigs do more than just kill bad bacteria. They do what our modern antibiotic medicines are increasingly failing to do. They kill antibiotic-resistant bacteria – also referred to as superbugs.

Traditional medicine from the Miswak tree

The Salvadora persica tree – more of a bush – is indigenous to India, Africa, Sri Lanka, South America and throughout the Middle East. It has a long history of use in these countries as a teeth cleaner. It also has a clean fragrance likened to watercress. It is also pungent, a bit like mustard plant. It is referred to as the mustard bush in some countries for this reason.

The Miswak’s twigs, along with its roots, are used to clean the teeth and oral cavity. Sometimes the smaller stems are dried to insert between the teeth. The ends of the twigs are frayed to provide a brush of sorts. These are used to brush the enamel of the teeth. The twigs are also chewed on to increase the general health of the teeth and gums.

It is not as if Miswak twigs are the only plant used as a toothbrush by our ancestors. At least 182 plant species have been used by ancient cultures to clean teeth around the world. Many of these are also antibacterial – such as the Neem tree used throughout India.

Clinical research shows Miswak kills germs

Multiple studies have shown that Miswak is antibacterial. In a 2017 study, researchers from the Medical Sciences College at King Saud University tested 12 people. The subjects’ saliva was tested for oral bacteria. They then brushed with Miswak twigs once, twice and four times on separate occasions. After each, their saliva was tested again.

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The researchers found that the Miswak twig reduced pathogenic oral bacteria increasingly with each use. In other words, two brushings removed more bacteria than one, and four reduced more than two. And when the tip of the twig was cut between brushings, even more bacteria were removed. Bacteria reduced by the Miswak twig included Haemophilus influenzae, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

Other research evidence in multiple studies has found that Miswak inhibits the following microorganisms:

• Staphylococcus aureus
• Streptococcus mutans
• Streptococcus faecalis
• Streptococcus pyogenes
• Pseudomonas aeruginosa
• Aggregatibacter actinomycetemcomitans
• Porphyromonas gingivalis
• Haemophilus influenzae
• Candida albicans

These are some of the most disease-causing bacteria out there. These microbes can and do cause a plethora of different medical conditions. But specific to the oral cavity, many of these also cause gingivitis and periodontal disease. They also cause dental caries.

Miswak Twigs. Courtesy of Saudi Medical Journal

Miswak Twigs. Courtesy of Saudi Medical Journal

It is no wonder that picking, brushing and chewing with Miswak twigs has proven useful over the centuries.

Clinical study shows potency of Miswak as a toothpaste

This traditional use of Miswak twigs has been proven out by modern clinical evidence. A late 2015 study from researchers from Germany’s Johannes Gutenberg University tested the effectiveness of Miswak as a toothpaste ingredient.

The researchers tested 66 patients who had periodontal disease for three weeks. They were divided into three groups. One group used a conventional toothpaste. The other used herbal toothpaste. A third group used a toothpaste containing Miswak extract.

After the 21 days, the researchers found that the Miswak extract toothpaste significantly reduced gingivitis symptoms by reducing bleeding in the sulcus. The Miswak toothpaste reduced gingivitis-bleeding by 54 percent more than the conventional toothpaste.

The conventional toothpaste reduced the gingivitis symptoms by 9.4 percent, while the Miswak toothpaste reduced gingivitis symptoms by 14.5 percent. The herbal toothpaste performed the best among the group, slightly higher than the Miswak toothpaste at 17.1 percent.

Three weeks is a relatively short period to see this level of improvement. A few months would likely show dramatic improvement in oral health.

oral probiotics

Miswak twigs fight antibiotic-resistant bacteria

Fighting off the common oral bacteria pathogens as listed above with Miswak twigs is now proven by this and a number of other studies. But what about the superbugs – those bacteria that have become resistant to antibiotics? Here is a list of some of the worst multi-drug resistant bacteria – named for their initial resistance to their primary antibiotics:

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• Methicillin-resistant Staphylococcus aureus (MRSA)
• Methicillin-resistant Staphylococcus epidermidis (MRSE)
• Penicillin-resistant Streptococcus pyogenes
• Penicillin-resistant Enterococcus faecalis
• Carbapenem-resistant Escherichia coli
• Carbapenem-resistant Klebsiella pneumoniae
• Carbapenem-resistant Pseudomonas aeruginosa
• Carbapenem-resistant Serratia marcescens
• Carbapenem-resistant Acinetobacter baumannii
• Carbapenem-resistant Stenotrophomonas maltophilia

Miswak kills antibiotic-resistant bacteria

Researchers from the College of Medicine at Saudi Arabia’s Najran University tested the above list of multi-drug resistant bacteria against extracts of Miswak twigs.

The researchers obtained fresh twigs harvested when the S. persica bushes were beginning to bloom. These fresh twigs were cut and dried for two weeks at room temperature. Then the cut twigs were ground into powder with a blender, and extracts were prepared – using either water or alcohol (aqueous extract or alcohol extract).

The researchers found that the alcohol Miswak extract of 400 milligrams per milliliter Miswak successfully killed the bacteria strains in the above list. But the water extracts were not far behind: They also killed all the bacteria species listed above.

The researchers used inhibition zone calculations to determine the strength of the Miswak antibacterial effects upon these superbug strains. They also utilized minimum inhibitory concentration (MIC) values to determine the potency of their antibacterial qualities. Minimum inhibitory concentration values are also used to assess an agent’s ability to avoid resistance from bacteria. Lower concentration MICs generally relate to better antibacterial potential.

As controls, the researchers utilized two antibiotic medicines often used for many multi-drug resistant bacteria. These worst-case antibiotics included vancomycin and tobramycin.

The research found that the Miswak extracts successfully inhibited the multi-drug resistant bacteria strains listed above. MIC values ranged from 1.56 milligrams per milliliter to 12.5 mg/mL for water extracts – and .039 to 3.125 for alcohol extracts.

These illustrate considerable ability to kill multi-drug resistant bacteria.

This doesn’t mean the extracts had the same antibacterial strength against each of these. While they killed both, researchers found the Miswak extract was slightly stronger against gram-negative bacteria than gram-positive bacteria.

Both the water and the extracts had strong zones of inhibition against antibiotic-resistant E. coli, K. pneumonia, P. aeruginosa and S. marcescens. The alcohol extract also had significant killing potential against MRSA and antibiotic-resistant A. baumannii.

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Thus we can conclude that the Miswag twigs not only fight bacteria that infect the mouth: They also fight the most lethal strains of antibiotic resistant bacteria.

Miswak has a number of medicinal properties

Being antimicrobial is not the only quality of Miswak. The S. persica tree has been shown in various studies as having anti-viral properties, anti-fungal properties and of course anti-plaque capability.

In addition, a review of research from the College of Dentistry at Najran University found that Miswak is antioxidant, analgesic (eases pain) and anti-inflammatory (curbs inflammation).

Major constituents of Miswak

The twigs, roots and stems of the S. persica tree have a number of constituents – as do many medicinal plants. These include, among others:

Trimethylamine, essential oils, benzyl isothiocyanate, salvadorine and other alkaloids, resins, sulfur, silica, tannic acid, sodium bicarbonate, calcium, fluoride, chloride, benzyl-phenylacetamide, vitamin C and various flavonoids.

These combine to provide healing qualities along with antimicrobial effects. You might also notice that Miswak contains natural fluoride. The combination of calcium and fluoride ions provided by Miswak helps remineralize the teeth.

The combination of alkaloids in Miswak have the effect of not only repelling bacteria, but stimulating the gums. The various essential oils in Miswak are also antimicrobial, but they will stimulate the flow of saliva.

We can conclude that this ancient use of plants is smarter than our current production of polluting plastic toothbrushes and chemical toothpastes.


Miswak toothbrushes

Miswak toothpaste



Reham Albabtain, Muhammad Azeem, Zenebech Wondimu, Tulay Lindberg, Anna Karin Borg-Karlson, Anders Gustafsson. Investigations of a Possible Chemical Effect of Salvadora persica Chewing Sticks. Evidence-Based Complementary and Alternative Medicine, vol. 2017, Article ID 2576548, 10 pages, 2017. doi:10.1155/2017/2576548

Azaripour A, Mahmoodi B, Habibi E, Willershausen I, Schmidtmann I, Willershausen B. Effectiveness of a miswak extract-containing toothpaste on gingival inflammation: a randomized clinical trial. Int J Dent Hyg. 2015 Dec 22. doi: 10.1111/idh.12195.

Mohamed Saeed Zayed Al-Ayed, Ahmed Morad Asaad, Mohamed Ansar Qureshi, Hany Goda Attia, and Abduljabbar Hadi AlMarrani, Antibacterial Activity of Salvadora persica L. (Miswak) Extracts against Multidrug Resistant Bacterial Clinical Isolates. Evidence-Based Complementary and Alternative Medicine, vol. 2016, Article ID 7083964, 5 pages, 2016. doi:10.1155/2016/7083964

Haque MM, Alsareii SA. A review of the therapeutic effects of using miswak (Salvadora Persica) on oral health. Saudi Med J. 2015 May;36(5):530-43. doi: 10.15537/smj.2015.5.10785.

Dahiya P, Kamal R, Luthra RP, Mishra R, Saini G. Miswak: A periodontist’s perspective. J Ayurveda Integr Med. 2012 Oct;3(4):184-7. doi: 10.4103/0975-9476.104431.

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