Ramli Haslinda, Nor Aripin Khairun Nain, Mohd Said Shahida, Mohamad Hanafiah Rohazila, Mohd Dom Tuti Ningseh
Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia; Department of Periodontology and Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia.
Department of Basic Medical Sciences II, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Putra Nilai, 71800, Negeri Sembilan, Malaysia.
J Ethnopharmacol. 2022 Nov 15;298:115598. doi: 10.1016/j.jep.2022.115598. Epub 2022 Aug 6.
Salvadora persica L. and Azadirachtaindica A.Juss. are listed within the most common sources of miswak or chewing stick that widely used among Western Asia and Muslim populations worldwide. Miswak use in conjunction with toothbrush (adjunctive) has become apparent among the adults. Furthermore, miswak has been reported to have mechanical and pharmacological activities, and benefits to the oral health, by many studies.
To assess the effectiveness of miswak in maintaining periodontal health among adults.
We searched for randomised controlled trials (RCTs) investigating the effect of miswak published in PubMed, EBSCOHOST (Dentistry & Oral Sciences), SCOPUS, and Cochrane Database for Systematic Review (CDSR) from inception to May 08, 2022. The primary outcomes of interest were changes in the periodontal health measured with plaque and gingivitis scores as well as subgingival bacteria load. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach while the estimates of effect were pooled using a random-effects model.
Ten eligible articles were identified, of which 9 could be analysed quantitatively. The remaining report was included as part of the qualitative analysis. The meta-analysis showed that miswak was comparable with the toothbrush in reducing the mean plaque score (p= 0.08, SMD: 0.39, and 95% CI: -0.05 to 0.83) and mean gingivitis score (p= 0.37, SMD: 0.13, and 95% CI: -0.16 to 0.43). Even higher certainty of evidence for the effect of miswak on mean plaque reduction on labial surface of anterior teeth. However, the adjunctive effect of miswak was significantly more superior for reducing plaque (p= 0.01, SMD: 0.68, and 95% CI: 0.14 to 1.22) and gingivitis score (p= 0.04, SMD: 0.66, and 95% CI: 0.03 to 1.29).
Miswak effectively reduced plaque and gingivitis scores to a level comparable to toothbrush when used exclusively. Adjunctive miswak use was particularly effective in improving periodontal health. However, the included studies inadequately reported on the method of toothbrushing using miswak and the frequency of miswak use. Therefore, further clinical studies are recommended to explore on the advantages and proper method of miswak practice for optima outcome and safety.
佩氏海桑（Salvadora persica L.）和印楝（Azadirachta indica A. Juss.）是最常见的牙刷柄或咀嚼棒的来源，在西亚和全球穆斯林人群中广泛使用。在成年人中，将牙刷柄与牙刷结合使用（辅助使用）已变得很明显。此外，许多研究报告称牙刷柄具有机械和药理活性，并对口腔健康有益。
评估牙刷柄在维持成年人牙周健康方面的有效性。
我们在PubMed、EBSCOHOST（牙科与口腔科学）、SCOPUS和Cochrane系统评价数据库（CDSR）中搜索了从创刊到2022年5月8日发表的关于牙刷柄效果的随机对照试验（RCT）。感兴趣的主要结果是用菌斑和牙龈炎评分以及龈下细菌载量衡量的牙周健康变化。使用推荐分级、评估、制定和评价（GRADE）方法评估证据质量，同时使用随机效应模型汇总效应估计值。
确定了10篇符合条件的文章，其中9篇可以进行定量分析。其余报告作为定性分析的一部分纳入。荟萃分析表明，在降低平均菌斑评分（p = 0.08，标准化均值差：0.39，95%置信区间：-0.05至0.83）和平均牙龈炎评分（p = 0.37，标准化均值差：0.13，95%置信区间：-0.16至0.43）方面，牙刷柄与牙刷相当。对于牙刷柄对上前牙唇面平均菌斑减少的效果，证据的确定性甚至更高。然而，牙刷柄在减少菌斑（p = 0.01，标准化均值差：0.68，95%置信区间：0.14至1.22）和牙龈炎评分（p = 0.04，标准化均值差：0.66，95%置信区间：0.03至1.29）方面的辅助效果明显更优。
单独使用时，牙刷柄能有效将菌斑和牙龈炎评分降低到与牙刷相当的水平。辅助使用牙刷柄在改善牙周健康方面特别有效。然而，纳入的研究对使用牙刷柄刷牙的方法和牙刷柄的使用频率报告不足。因此，建议进一步开展临床研究，以探索牙刷柄使用的优势和正确方法，以获得最佳效果和安全性。
