Salvadora-persica (Miswak) as an Antibacterial/Antiplaque Mouthrinse: Systematic Review and Meta-analysis

Objectives: Salvadora persica is the active ingredient found in miswak, which has been used throughout history as an oral hygiene measure. Studies have found a consistent association between the use of miswak and the decreased number of oral bacteria and plaque scores. The purpose of this systematic review and meta-analysis was to assess whether mouthrinses containing Salvadora persica offers a more favorable or an equivalent outcome in comparison to chlorhexidine mouthrinses.
Methods: A comprehensive literature search for in-vivo studies reporting miswak rinses used as an antibacterial and/or antiplaque agent in comparison to chlorhexidine and/or placebo was conducted with no language restriction. The search engines used were PubMed and Google Scholar. After defining the inclusion / exclusion criteria, data extraction from the studies were carried out in this review and screened by two independent reviewers. Risk of bias of the eligible studies were assessed. Meta-analysis of the extracted data was performed. Sensitivity analyses using subgroups and homogeneity evaluation were conducted.
Results: Fourteen eligible articles were accepted in this review. The meta-analysis that Salvadora persica had statistically non-significant effect on plaque scores compared to chlorhexidine (P=0.88 OR: 0:01 and 95% CI: [-0.14, 0.16]). However, when compared to placebo, Salvadora persica showed statistically significant antiplaque (P= 0.02, OR: -0.23 and 95%CI: [-0.42, -0.03]) and antibacterial effect (P= <0.00001, OR: -1.45 and 95% CI: [-1.89, -1.01]).
Conclusions: Evidence showed that the use of Salvadora persica extract was associated with significant reduction in the number of oral bacteria and plaque.