Recent Advances in the Oral Therapeutic Applications of Salvadora persica (Miswak): A Comprehensive Review
DOI:
https://doi.org/10.65327/ans.v11i1.2564Keywords:
Salvadora persica, Miswak, Benzyl isothiocyanate, Periodontal disease, Oral hygieneAbstract
Oral diseases affect more than three billion people globally, with dental caries and periodontal disease representing the largest share of the burden. Despite widespread use of fluoride products and chlorhexidine-based antiseptics, conventional oral hygiene tools carry persistent limitations, including adverse effects, access barriers in low-resource settings, and concerns about long-term microbiota disruption. Salvadora persica, the source of the traditional miswak chewing stick, is a WHO-endorsed oral hygiene tool with deep cultural roots across the Middle East, Africa, and South Asia. This narrative review synthesises evidence published between 2021 and 2025 on its phytochemistry, mechanisms of oral therapeutic action, clinical efficacy across oral conditions, comparative performance against conventional agents, novel formulations, and safety profile.
Benzyl isothiocyanate, derived from glucosinolates concentrated in S. persica roots, acts as the primary antimicrobial constituent through membrane disruption and biofilm inhibition against Streptococcus mutans, Porphyromonas gingivalis, and Fusobacterium nucleatum. Flavonoid polyphenols modulate COX-2, TNF-alpha, and IL-6 pathways, while mineral constituents support enamel remineralisation through calcium, phosphorus, and fluoride ion release. Meta-analyses and randomised controlled trials confirm that miswak in stick, toothpaste, and mouthwash forms reduces plaque and gingival inflammation comparably to conventional toothbrushing, with adjunctive use producing significantly greater reductions than mechanical cleaning alone. Performance against chlorhexidine is somewhat lower for plaque control but comparable for soft tissue anti-inflammatory outcomes. Preclinical models support wound healing and early antiproliferative activity, while nanoparticle-based formulations show enhanced antimicrobial potency. Evidence gaps remain in long-term safety, paediatric populations, and microbiome-level outcomes
Downloads
References
Bernabé E, Marcenes W, Abdulkader R, et al. Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2025. doi:10.1016/s0140-6736(24)02811-3
Wu J, Chen J, Lv C, Zhou L. Global, regional, and national levels and trends in burden of dental caries and periodontal disease from 1990 to 2035: result from the Global Burden of Disease Study 2021. BMC Oral Health. 2025;25. doi:10.1186/s12903-025-06108-w
Deus FP, Ouanounou A. Chlorhexidine in dentistry: pharmacology, uses, and adverse effects. Int Dent J. 2022;72:269–277. doi:10.1016/j.identj.2022.01.005
Takenaka S, Sotozono M, Ohkura N, Noiri Y. Evidence on the use of mouthwash for the control of supragingival biofilm and its potential adverse effects. Antibiotics. 2022;11. doi:10.3390/antibiotics11060727
Farag M, Abdel-Mageed WM, Gamal AEA, Basudan O. Salvadora persica L.: toothbrush tree with health benefits and industrial applications — an updated evidence-based review. Saudi Pharm J. 2021;29:751–763. doi:10.1016/j.jsps.2021.05.007
Ramli H, Aripin KNN, Said SM, Hanafiah R, Dom TNM. The effectiveness of miswak (Salvadora persica L. and Azadirachta indica A.Juss.) practices in reducing plaque and gingivitis among adults: a systematic review and meta-analysis. J Ethnopharmacol. 2022. doi:10.1016/j.jep.2022.115598
Azizan NF, Mohd N, Azis NMN, Baharin B. Effectiveness of Salvadora persica toothbrush and Salvadora persica chewing stick in plaque and gingivitis control: a randomized control trial. BMC Complement Med Ther. 2023;23. doi:10.1186/s12906-023-04295-z
Adam FA, Mohd N, Rani H, Yusof MMYP, Baharin B. A systematic review and meta-analysis on the comparative effectiveness of Salvadora persica extract mouthwash with chlorhexidine gluconate in periodontal health. J Ethnopharmacol. 2022. doi:10.1016/j.jep.2022.115863
Ramli H, Mohd-Dom T, Mohd-Said S. Clinical benefits and adverse effects of siwak (S. persica) use on periodontal health: a scoping review of literature. BMC Oral Health. 2021;21. doi:10.1186/s12903-021-01950-0
Kobetitsch S, Gierlikowska B, Kunert O, et al. Salvadora persica leaves: phytochemical profile and in vitro-inhibitory activity on inflammatory mediators implicated in periodontal disease. Pharm Biol. 2024;62:563–576. doi:10.1080/13880209.2024.2374801
El-Sherbiny G, Gazelly AM, Sharaf M, et al. Exploitation of the antibacterial, antibiofilm and antioxidant activities of Salvadora persica (miswak) extract. J Bioresour Bioprod. 2022. doi:10.1016/j.jobab.2022.11.006
Ibrahim I, Moussa A, Chen Z, Zhang J, Cao W, Yu C. Bioactive phenolic components and antioxidant activities of water-based extracts and flavonoid-rich fractions from Salvadora persica L. leaves. Nat Prod Res. 2021;36:2591–2594. doi:10.1080/14786419.2021.1908281
Almasri RS, Bedir AS, Raish SAM. Comprehensive ethnopharmacological analysis of medicinal plants in the UAE: Lawsonia inermis, Nigella sativa, Ziziphus spina-christi, Allium cepa, Allium sativum, Cymbopogon schoenanthus, Matricaria aurea, Phoenix dactylifera, Portulaca oleracea, Reichardia tingitana, Salvadora persica, Solanum lycopersicum. Nutrients. 2025;17. doi:10.3390/nu17030411
Khanam A, Ahmad A, Iftikhar N, et al. Variation in phenolic profile, antioxidant, and anti-inflammatory activities of Salvadora oleoides Decene. and Salvadora persica L. fruits and aerial part extracts. Life. 2022;12. doi:10.3390/life12091446
Abdel-Razakh HH, Bakari G, Park J, Pan C, Hoza A. Phenolic contents and antioxidant properties of Bauhinia rufescens, Ocimum basilicum and Salvadora persica, used as medicinal plants in Chad. Molecules. 2024;29. doi:10.3390/molecules29194684
Umbreen S, Mukhtar N, Harun N, Ali S. Effect of environmental drivers on functional traits of Salvadora population in the semi-arid regions: a case study from Division Sahiwal Pakistan. Ecol Evol. 2025;15. doi:10.1002/ece3.71938
Mujeeb A, Abideen Z, Aziz I, et al. Phytoremediation of potentially toxic elements from contaminated saline soils using Salvadora persica L.: seasonal evaluation. Plants. 2023;12. doi:10.3390/plants12030598
Vejendla I, Krithikadatta J, Vinothkumar TS, et al. Antibiofilm properties of miswak (Salvadora persica) compared to conventional oral health measures: a systematic review. Scientifica. 2025;2025. doi:10.1155/sci5/9344221
Azizan NF, Mohd N, Azis NMN, Baharin B. Knowledge, awareness, and practice towards the use of Salvadora persica L. (miswak) chewing stick: a scoping review. Healthcare. 2025;13. doi:10.3390/healthcare13212747
Mekhemar M, Geib M, Hassan Y, Dörfer C. Salvadora persica: nature's gift for periodontal health. Antioxidants. 2021;10. doi:10.3390/antiox10050712
Almobarak A, Alqedairi A, Binrayes A, Lambarte R, Niazy AA, Aljarbou FA. Benzyl isothiocyanate exhibits antibacterial and antibiofilm activity against Fusobacterium nucleatum while preserving viability of human bone marrow mesenchymal stem cells: an in vitro study. Front Cell Infect Microbiol. 2025;15. doi:10.3389/fcimb.2025.1683203
Bakr N, Mohamed A, Salem G. Comparative evaluation of the remineralizing potential of Salvadora persica and probiotic yogurt on incipient enamel lesions: an ex-vivo study. Dent Med Probl. 2024. doi:10.17219/dmp/158561
Ayoub N, Badr N, Al-Ghamdi S, et al. HPLC/MSn profiling and healing activity of a muco-adhesive formula of Salvadora persica against acetic acid-induced oral ulcer in rats. Nutrients. 2021;14. doi:10.3390/nu14010028
Bokhary T, Refaat B, Bakr EH, et al. Salvadora persica extract attenuates cyclophosphamide-induced hepatorenal damage by modulating oxidative stress, inflammation and apoptosis in rats. J Integr Med. 2022. doi:10.1016/j.joim.2022.05.001
Adam FA, Mohd N, Rani H, Baharin B, Yusof MMYP. Salvadora persica L. chewing sticks and standard toothbrush as anti-plaque and anti-gingivitis tool: a systematic review and meta-analysis. J Ethnopharmacol. 2021. doi:10.1016/j.jep.2021.113882
Abdellatif HM, Hebbal M, Alsagob EI, et al. Comparative effectiveness of miswak and toothbrushing on dental plaque and gingivitis: a randomized controlled trial. Healthcare. 2024;12. doi:10.3390/healthcare12212150
Shaalan O, El-Rashidy AA. Antibacterial effect of miswak herbal toothpaste compared to fluoride toothpaste in high caries risk patients: randomized clinical trial. J Clin Exp Dent. 2023;15:e526–e534. doi:10.4317/jced.60332
Kohli N, Hugar S, Hallikerimath S, Gokhale NS, Kadam KS, Soneta SP. Comparative evaluation of antibacterial efficacy and remineralization potential of acidulated phosphate fluoride gel with herbal dental gel containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum: an in vitro study. Int J Clin Pediatr Dent. 2024;17:307–315. doi:10.5005/jp-journals-10005-2796
Adam FA, Mohd N, Rani H, Yusof MM, Baharin B. Salvadora persica L.: an effective anti-plaque and anti-gingivitis toothpaste — a systematic review and meta-analysis of randomized control clinical trials. J Herb Med. 2023. doi:10.1016/j.hermed.2023.100677
Harun NA, Ramli N, Azli ARK, Hassan H, Adam KBC, Halil MHM. The effect of Salvadora persica ethanolic extract on oral tissue healing in rats: an in vivo study. Saudi Dent J. 2023;35:663–667. doi:10.1016/j.sdentj.2023.05.019
Shahzad M, Ahmad HA, Ambadi S, Peterson SR, Yang I. Traditional oral hygiene practices and their effectiveness: a systematic review of the evidence. Oral Health Prev Dent. 2026;24:107–118. doi:10.3290/j.ohpd.c_2475
Al-Mahmood S, Sabea D. Comparative evaluation of the effectiveness of 40% miswak mouthwash and 0.12% chlorhexidine mouthwash in treating gingivitis: a blinded, randomised clinical trial. Oral Health Prev Dent. 2021;19. doi:10.3290/j.ohpd.b1179501
Basudan A, Al-Zawawi AS, Divakar D, Shaheen M, Aldulaijan H. Efficacy of 0.12% chlorhexidine and Salvadora persica-based mouthwash in reducing oral Candida carriage and periodontal inflammation in cigarette smokers and non-smokers after non-surgical periodontal therapy. Oral Health Prev Dent. 2023;21. doi:10.3290/j.ohpd.b4169713
Barahuie F, Dianat T, Nejad GN, Shahbakhsh M, Tamandani DKK. Evaluation of chemical, biochemical and anti-microbial effects of Salvadora persica and Moringa oleifera extract to produce organic disinfectant products. Arch Razi Inst. 2023;78(4):1379–1386. doi:10.32592/ari.2023.78.4.1379
Arshad H, Sami M, Sadaf S, Hassan U. Salvadora persica mediated synthesis of silver nanoparticles and their antimicrobial efficacy. Sci Rep. 2021;11. doi:10.1038/s41598-021-85584-w
Khojasteh-Taheri R, Ghasemi A, Meshkat Z, Sabouri Z, Mohtashami M, Darroudi M. Green synthesis of silver nanoparticles using Salvadora persica and Caccinia macranthera extracts: cytotoxicity analysis and antimicrobial activity against antibiotic-resistant bacteria. Appl Biochem Biotechnol. 2023. doi:10.1007/s12010-023-04407-y
Balto H, Bekhit M, Auda S, et al. Synergistic effect of Salvadora persica and chitosan nanoparticles against oropharyngeal microorganisms. Sci Rep. 2024;14. doi:10.1038/s41598-024-63636-1
Chaaben R, Mnif B, Elleuch K. Salvadora persica nanoparticles effect on the specific properties of a bio-composite dental material. J Thermoplast Compos Mater. 2025;38:3456–3470. doi:10.1177/08927057251314408
Alaraj M, Acar T, Kosińska I, et al. Pretreatment with Salvadora persica L. (miswak) aqueous extract alleviates paracetamol-induced hepatotoxicity, nephrotoxicity, and hematological toxicity in male mice. Vet World. 2021;14:589–594. doi:10.14202/vetworld.2021.589-594
Owis A, El-Hawary M, Amir DE, et al. Flavonoids of Salvadora persica L. (meswak) and its liposomal formulation as a potential inhibitor of SARS-CoV-2. RSC Adv. 2021;11:13537–13544. doi:10.1039/d1ra00142f
Hussein MO, Alangari AA. First report of anaphylaxis to miswak (Salvadora persica). Pediatr Allergy Immunol. 2024;35. doi:10.1111/pai.14256
Youssef B, Ramadan K, ElShebiney SA, Ibrahim EA. Antidepressant-like effects of aqueous extracts of miswak (Salvadora persica) and date palm (Phoenix dactylifera) on depression-like behaviors using CUMS model in male rats. J Food Biochem. 2022. doi:10.1111/jfbc.14164
Fageeh HN, Mansoor MA, Fageeh HI, et al. Plaque removal and gingival bleeding using biodegradable toothbrushes: Salvadora persica, bamboo, and nylon — a comparative study. Med Sci Monit. 2024;30. doi:10.12659/msm.944469
Abozaid D, Asharf M, Mohamed PA, Mohamed M, Elwakeel E, Azab A. Antimicrobial and physicomechanical performance of Salvadora persica (miswak)-modified glass ionomer cement: a systematic review. Beni-Suef Univ J Basic Appl Sci. 2026;15. doi:10.1186/s43088-026-00742-1
Fisher J, Splieth C, Matanhire-Zihanzu CN, Glick M. Advancing the concept of global oral health to strengthen actions for planetary health and One Health. Int J Equity Health. 2024;23. doi:10.1186/s12939-024-02176-6
Moussa LG, Sonmez OF, Bedi R. Incorporating oral health into the One Health agenda: contributions and implications. Sci One Health. 2025;4. doi:10.1016/j.soh.2025.100111
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 International Journal For Research In Applied And Natural Science
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
In consideration of the journal, Green Publication taking action in reviewing and editing our manuscript, the authors undersigned hereby transfer, assign, or otherwise convey all copyright ownership to the Editorial Office of the Green Publication in the event that such work is published in the journal. Such conveyance covers any product that may derive from the published journal, whether print or electronic. Green Publication shall have the right to register copyright to the Article in its name as claimant, whether separately
or as part of the journal issue or other medium in which the Article is included.
By signing this Agreement, the author(s), and in the case of a Work Made For Hire, the employer, jointly and severally represent and warrant that the Article is original with the author(s) and does not infringe any copyright or violate any other right of any third parties, and that the Article has not been published elsewhere, and is not being considered for publication elsewhere in any form, except as provided herein. Each author’s signature should appear below. The signing author(s) (and, in
