Periodontal status among adult cigarette smokers using Miswak (Salvadora persica) for oral hygiene: A cross-sectional study from Asir Region of Saudi Arabia

Purpose: To compare the periodontal status of exclusive users of Miswak (Salvadora persica) with that of exclusive toothbrush users among adult smokers of cigarettes in Saudi Arabia. Methods: This educational-institutional study included one hundred and fifty adult patients (age and socioeconomic status matched, SES) between the ages of 18 and 75, and were listed as the group I, II, and III, with 50 participants each (participants with no oral hygiene, toothbrush users and miswak users respectively). Oral hygiene habits, the number of cigarettes smoked, and time since the habit began. Periodontal and radiographic parameters were reported. Results: All parameters related to periodontium (plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), gingival recession (Rec), clinical attachment level (CAL) and bone loss (BL)) showed that the analysed groups exhibited differences (p < 0.001). Least amount of BL (anterior and posterior) was found in toothbrush users and Miswak users, while least amount of attachment loss (both anterior and posterior) was recorded among Miswak users (p > 0.05). Positive association was found for GI (r = 0.753) and recession (r = 0.436, p < 0.001) in terms of the number of cigarettes smoked in group 1, and anterior PPD (r = 0.388, p < 0.001) in group III for the duration of smoking. A negative correlation was found for BOP in group III (r = - 0.339, p < 0.05) in terms of frequency of tooth cleaning and GI (r = - 0.381) (p < 0.001) in group II, in terms of time taken attain oral hygiene. Conclusion: This study indicates less severe periodontal damage among adult current cigarette smokers in miswak users than in toothbrush users. Thus, there some potentials for miswak use for promotion of oral hygiene.