The chewing stick, the miswak, is used in many developing countries as the traditional means for oral hygiene. It is prepared from the roots, twigs and stem of Salvadora persica or other alternative local plants. Objectives: To compare the effects of the chewing stick miswak (from Salvadora persica) and toothbrush on subgingival plaque microflora among Saudi Arabian individuals. Further, to investigate whether components extracted from S. persica may interfere with the possibly affected subgingival plaque microorganisms. Material and methods: : 15 healthy Saudi Arabian male volunteers aged 21 to 36 years were included in a single blind, randomized crossover study. The participants were tought how to use each device properly. Plaque sampling for DNA-test was performed at the baseline, one week after professional tooth cleaning, after three weeks of either miswak or toothbrush use, one week after professional tooth cleaning, and again following three weeks of either miswak or toothbrush use (opposite to the previous period), respectively. Identification and quantification of microbial species were performed by the checkerboard method, using whole genomic, digoxigenin labeled DNA probe. Results: Miswak and toothbrushing had a similar influence on the levels of the subgingival microbiota. However, Actinobacillus actinomycetemcomitans was significantly more reduced by miswak (p<0.05) than by toothbrushing. These results were supported by our in vitro results which indicated that extracts from S. persica may interfere with growth and leukotoxicity of A. actinomycetemcomitans. Conclusion: Opposite to toothbrush use, miswak use significantly reduced the amount of A. actinomycetemcomitans in the subgingival plaque.

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