Siwak as an Oral Hygiene Aid in Orthodontic Patients

Objectives: To compare the efficacy in plaque control, gingival health and antimicrobial properties of Siwak use in patients wearing fixed orthodontic appliances, in comparison to standard and orthodontic toothbrushes use. Methods: This single-blinded randomized controlled clinical trial assigned forty male patients wearing fixed orthodontic appliances into four groups. Following a session of scaling and polishing, all patients were instructed to use a standard soft toothbrush for one week after which patients were randomly equally allocated to one of four groups, a manual toothbrush group, an orthodontic toothbrush group, a Siwak group and a combination of Siwak and an orthodontic toothbrush group. All but Siwak sole user patients were supplied with a commercially available fluoride-containing dentifrice, with no added anti-plaque or anti-calculus ingredients, and no other oral hygiene devices including mouthrinses, dentifrices and chewing gums were permitted during the trial. All patients were scored for plaque and gingivitis at all teeth surfaces for the exception of third molars (according to Quigley Hein plaque index- modified by Turesky et al. 1970 and Löe and Silness 1963 gingival index, respectively) one week after scaling and polishing and two weeks following group assignment. Bacteriological assessment of Lactobacilli and Streptococcus mutans species levels was performed at the plaque and gingivitis scoring sessions. Results: Effect of Siwak was similar to that of soft and orthodontic toothbrushes with respect to plaque control. Gingival condition was better in the Siwak groups whether used solely or in combination with an orthodontic toothbrush. Thirty percent of the Siwak users demonstrated a reduction in the levels of Lactobacilli species. However, no such reduction in the levels of Streptococcus mutans was found in any of the four groups. Conclusion: The use of Siwak promotes gingival health and aids in reducing the level of Lactobacilli in patients with orthodontic appliances.