Prophetic Medicine: An Old Prescription for a New Era
By Dr. Hossam Arafa

Siwak and Dental Hygiene
A variety of oral hygiene measures have been performed since the dawn of time. This has been verified by various excavations throughout the world where toothpicks, chew-sticks, twigs, linen strips, birds' feathers, animal bones and porcupine quills were recovered. Those that originated from plants, although primitive, represent a transitional step towards the modern toothbrush. About 17 different plants have been used as natural instruments of oral hygiene.

The most widely used twig since early times is the Siwak or Miswak. The stick is obtained from a plant called salvadore persica that grows around Makkah and in the Middle East in general. Although there is no reference to the use of the siwak in the Qur'an, there are several hadith mentioning the benefits of siwak in maintaining oral hygiene; hence, it has been used widely among Muslims since the Prophet Muhammad (pbuh). In this respect, our Prophet (pbuh) can be considered among the first dental instructors of proper oral hygiene.

Composition
Salvadora persica is a small tree or shrub with a crooked trunk that is seldom more than one foot in diameter. It has scabrous and cracked bark, and is whitish with pendulous branches. The root bark is light brown and the inner surfaces are white. It has an odorlike cress, and its taste is warm and pungent.

To ascertain its chemical composition, the air-dried stem bark of salvadora persica was extracted with 80% alcohol and then ether, and underwent exhaustive chemical procedures which indicated that it is composed of trim ethylamine, an alkaloid which may be salvadorine, chlorides, high amounts of fluoride and silica, sulfur, Vitamin C and small quantities of tannins, saponins, fiavenoids andsterols.

Repeated use of siwak during the day produces an unusually high level of oral cleanliness. It has been proven that plaque is formed immediately after eating. After 24 hours, it starts to act on the teeth. However, it can be eliminated through meticulous tooth-brushing.

Proper oral hygiene should be taught by dentists, but it requires a person's time and dexterity. Among those Muslims who ritually practice the use of siwak, rigid oral hygiene by a dentist may not be required.

Siwak and other twigs can be effective in removing soft oral deposits. They can even be promoted as effective instruments in oral health and dental programs for the population at large. There is evidence that salvadora persica contains antibacterial properties. Some other components are astringents, detergents and abrasives. These properties encourage some toothpaste laboratories (Beckenham, UK, Sarakan Ltd.) to incorporate powdered stems and/or root material of salvadora persica in their products.

Although commercial powders may be highly efficient in plaque removal, their use has been shown in a survey to cause a high incidence of gingivitis. Plaque eradication is essential, but it should not be in a manner that creates negative side effects for other tissues.

In conclusion, siwak and powdered siwak are excellent tools for oral cleanliness. They are highly recommended in preventive dental health programs in Muslim countries. Recommendations should be made to manufacturers of toothpaste to include the powdered form of siwak in an abrasive form of toothpaste.