Salvadora persica L. chewing stick and standard toothbrush as anti-plaque and anti-gingivitis tool: A systematic review and meta-analysis

Ethnopharmacological relevance: Salvadora persica L. chewing stick, commonly known as miswak is still being used as an oral hygiene tool for plaque control and prevention against gingivitis. Various studies have reported on the therapeutics and prophylactic effects particularly on periodontal disease. This review aimed to evaluate the effectiveness of S. persica chewing stick compared to the standard toothbrush for anti-plaque and anti-gingivitis. Material and methods: A PRISMA-compliant systematic search of literature was done from the MEDLINE, CENTRAL, Science Direct, PubMed and Google Scholar. Literature that fulfilled eligibility criteria was identified. Data measuring plaque score and bleeding score were extracted. Qualitative and random-effects meta-analyses were conducted. Results: From 1736 titles and abstracts screened, eight articles were utilized for qualitative analysis, while five were selected for meta-analysis. The pooled effect estimates of SMD and 95% CI were -0.07 [-0.60 to 0.45] with an chi(2) statistic of 0.32 (p = 0.0001), I-2 = 80% as anti-plaque function and 95% CI were -2.07 [-4.05 to -0.10] with an chi(2) statistic of 1.67 (p = 0.02), I-2 = 82%. Conclusion: S. persica chewing stick is a tool that could control plaque, comparable to a standard toothbrush. Further, it has a better anti-gingivitis effect and can be used as an alternative.