Antibiofilm Properties of Miswak ( Salvadora persica ) Compared to Conventional Oral Health Measures: A Systematic Review

Aim: The systematic review aim was to assess the antibiofilm properties of miswak ( Salvadora persica ) in comparison with conventional oral health measures in the adult population. Materials and Methods: A comprehensive search strategy was formed, and electronic databases (Scopus, PubMed, Web of Science, ProQuest, and Cochrane Library), gray literature, and clinical trials registry (clinicaltrials.gov) were searched to identify the relevant articles. The inclusion criteria were based on the PICOS strategy. Randomized controlled trials (RCTs) involving the adult population comparing the use of miswak with conventional oral health measures were included in the review. Adult populations undergoing orthodontic treatment and other study designs were excluded. The included studies were assessed for qualitative analysis, and the data extraction was done by two independent reviewers. The outcome of the review was to compare the antibiofilm activity of miswak and conventional oral hygiene measures. The risk of bias in these research studies has been determined based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. Results: Out of 474 identified articles, 10 studies have been included for qualitative analysis, based on eligibility criteria, with a total of 442 individuals. These studies, published between 2011 and 2023, primarily focused on assessing the antiplaque efficacy of miswak and its effectiveness in reducing cariogenic bacterial load. Miswak exhibited positive effects in antibacterial and antiplaque activity, showing the potential to reduce plaque accumulation and gingival inflammation. Conclusion: When Salvadora persica is used to maintain dental hygiene, there is a noteworthy decrease in the amount of cariogenic bacteria and plaque. To evaluate the benefits and appropriate outcomes of miswak practice in terms of maintaining dental health, more clinical research is advised.