Effectiveness of a miswak extract-containing toothpaste on gingival inflammation: a randomized clinical trial

Objectives: In this study, the efficacy of a miswak extract-containing toothpaste (Salvadora persica) on gingival inflammation was compared with that of a herbal and a conventional toothpaste. Methods: Non-smoking outpatients with sulcus bleeding index (SBI) >= 25% and with periodontal pocket depths <= 3 mm were randomly selected and divided into three groups: M-group, miswak extract-containing toothpaste; P-group, herbal toothpaste; and C-group, conventional toothpaste. After instructing the patients to brush their teeth twice a day for 3 weeks with the assigned toothpaste using a flat-trimmed manual toothbrush, a thorough oral examination was performed by a calibrated examiner (EH). The primary outcome was the SBI after 21 days. Furthermore, the amount of plaque was measured by approximal plaque index (API). Results: Sixty-six patients with a mean age of 57.8 +/- 10.2 years were recruited and enrolled. After 3 weeks of brushing, all three patient groups showed a significant reduction in SBI. The P-group (SBI reduction: 17.1% +/- 9.1) and the M-group (14.5% +/- 8.1) showed the strongest effect followed by the C-group (9.4% +/- 7.8). All three groups showed a significant reduction in API without significant differences between the groups. Conclusions: The use of each of the three tested toothpastes caused a significant reduction in gingival inflammation and amount of plaque. The miswak extract-containing toothpaste showed a similar effect as the herbal toothpaste and can be safely used for domestic oral hygiene in patients with gingivitis.