Preliminary studies on the anti-bacterial properties of chewing sticks.

Examination of extracts from eight different woods commonly used as chewing sticks showed that one of these, prepared from Terminalia glaucescens, contains an antibacterial substance active against Staphylococcus aureus, although not against other Gram-positive or Gram-negative bacteria tested. It is suggested that the traditionally good dental and oral health of Africans has been the result largely of a non-cariogenic diet, together with the mechanical cleansing action provided by the use of chewing sticks, rather than a consequence of any special antibacterial activity of the sticks themselves.     

Post-harvest fungal quality of selected chewing sticks

OBJECTIVE: To study post-harvest fungal overgrowth on chewing sticks used for oral hygiene measures and role of disinfection. METHODS: The post-harvest fungal spoilage of chewing sticks (Garcinia kola, Glyphea brevis and Azadirachta indica) was investigated by subjecting the chewing sticks to different preparatory methods (some disinfected in 0.7% sodium hypochlorite before storage), storage conditions (unsealed or sealed in clear polythene) and different storage periods (2, 3 and 4 weeks). RESULTS: Significant differences (P = 0.05) in mean percentage fungal colonization were dependent on plant type and storage period, but not on preparative methods and storage conditions. There were, however, significant interactions between chewing sticks and preparative methods, storage conditions and storage periods, respectively. Azadirachta indica was observed to be more susceptible to post-harvest spoilage organisms than other test plants. Generally, percentage fungal colonization increased with increase in storage period. Four genera, Penicillium spp., Aspergillus spp., Mucor spp. and Botryodiplodia spp., were implicated with post-harvest colonization of chewing sticks after 4 weeks of storage. CONCLUSION: The use of harvested chewing sticks after prolonged storage period is therefore not advisable for oral hygiene measures.     

Antibacterial activity of aqueous extracts of selected chewing sticks

This aim of this study was to determine the antibacterial activity in extracts obtained from various Nigerian chewing sticks. Aqueous extracts from seventeen chewing sticks and the fruit of C. ferruginea, one fruit used in oral hygiene in Nigeria, were screened for antibacterial activity against type cultures of Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa. Eleven of the test extracts showed activity against at least two of these referenced organisms. Minimum inhibitory concentrations (MIC) of these eleven extracts against clinical isolates from orofacial infection were determined. All the extracts demonstrated activity against Staphylococcal and Streptococcal isolates. Over half of the extracts were active against Enterobacteriaceae and obligate anaerobic isolates, including Prevotella melaninogenica, Porphyromonas gigivalis, Fusobacterium nucleatum, and Peptostreptococcus prevotii. Extracts of the Vitellaria paradoxa root, Bridellia ferruginea stem and twigs, Garcinia cola stem, Terminalia glaucescens root, Morinda lucida root, and Cnestis ferruginea fruit showed appreciable activity against all classes of bacterial isolates. The extracts of these plants may serve as sources for chemotherapeutic agents for the management of orofacial infections.     

Cleaning effectiveness of chewing sticks among Tanzanian schoolchildren.

The oral hygiene of habitual chewing stick and toothbrush users who participated in an oral health education (OHE) programme in schools was evaluated. The study comprised all chewing stick users (n = 45) in standard 4 in 8 randomly selected experimental schools and all chewing stick users (n = 17) in standard 4 in 4 randomly selected control schools. Each chewing stick user was randomly matched with a toothbrush user of the same sex, age and school. Their ages ranged from 10 to 13 years with a mean of 11.5 years. The children in standard 4 of the 8 experimental schools received OHE. Among many topics aiming to improve oral health of children, the practice of systematic brushing was taught. The children practised weekly brushing sessions in schools under the supervision of instructed teachers. At baseline, the chewing stick users exhibited statistically significant more plaque, but their gingival condition was comparable with their matched toothbrush counter-parts. After 3 months, the chewing stick and the toothbrush users in the experimental schools, had reduced their plaque and gingival bleeding scores significantly to the same extent, whereas no substantial changes in oral hygiene occurred in the control group. The findings show that schoolchildren who participated in a school programme that emphasizes effective toothbrushing were able to improve their oral hygiene regardless of whether they were habitual chewing stick or toothbrush users.     

Inhibition of protease activities of periodontopathic bacteria by extracts of plants used in Kenya as chewing sticks (mswaki)

Extracts from five plants used as chewing sticks, and tannic acid, gallic acid and methyl ester of gallic acid, were tested for their ability to inhibit proteolytic activities of three strains of Bacteroides gingivalis, three strains of Bacteroides intermedius and two strains of Treponema denticola. Aqueous extract from the plants Rhus natalensis and Euclea divinorum were the most inhibitory of those tested, inhibiting by 50% the proteolytic activity of the test organisms, at concentrations of up to 200 micrograms/ml. Tannic and gallic acids had similar effects at concentrations of less than 10 micrograms/ml, while the methyl ester of gallic acid was less inhibitory. These findings suggest that extracts from plants used as chewing sticks may possess enough inhibitory components to interfere with the virulence and growth of periodontopathic bacteria in vivo, provided they are able to gain access to the subgingival sites such bacteria preferentially inhabit.     

Antibacterial activity of extracts from some African chewing sticks.

The antibacterial activity of aqueous, isobutanol, and benzene extracts of five popular African chewing sticks was studied by the agar ditch plate method. The isobutanol extract produced the greatest antimicrobial activity, and the benzene extract the least. Streptococci were the most sensitive to the extracts, while Escherichia coli was the most resistant. It would appear that the active principles of the various chewing-stick extracts are not the same and that the extract from a given chewing stick is chemically heterogeneous. It is suggested that the regular use of the African chewing stick, acting as an antiseptic, may control the formation and activity of dental plaque and therefore reduce the incidence of gingivitis and possibly dental caries.     

Efficiency of traditional chewing sticks in oral hygiene programs among Ethiopian schoolchildren

The effect of oral hygiene programs was studied in 248 children from five schoolclasses in Asella, Ethiopia. All children received professional toothcleaning after an initial clinical examination, and were again examined after a trial period of 3 months. The classes were assigned to the following procedures: one class received information and instruction in the use of the toothbrush, and a second class in the use of the mefaka, a wooden chewing stick traditionally used for oral cleaning. The children were advised to clean their teeth daily. Two other classes received similar information and instruction with regard to the toothbrush and the mefaka. Oral cleaning was then performed daily under direction and supervision, in one class with the toothbrush and in the other class with the mefaka. The fifth class was used as control. Instruction only was found to have no effect on the amount of oral deposits. Supervised oral cleaning, on the other hand, improved the oral hygiene of the schoolchildren significantly. The mefaka was found to be as effective as the toothbrush in removing oral deposits. It was concluded that the mefaka should be recommended for use in preventive dental programs in Ethiopia since it is effective, inexpensive, and familiar to the population.     

The antimicrobial effects of seven different types of Asian chewing sticks.

There are various plants, which are used as chewing sticks in different parts of the world. Several studies have been reported on the antimicrobial effects of chewing sticks on oral bacteria. The aim of this study was to compare the antimicrobial effect of aqueous extract of seven different types of chewing sticks found in Pakistan and other Asian countries. The ditch plate method was used to test the antimicrobial activity of seven Asian chewing sticks. It was found that at there was antimicrobial effect on Streptococcus fecalis at 50% concentration of Kikar (Acacia arabica) from Pakistan and Arak (Salvadora persica) from Saudi Arabia. The inhibition zones up to 2 mm were found in those two chewing stick extracts. It is recommended that the chewing sticks will be a great help in developing countries with financial constraints and limited oral health care facilities for their populations.     

Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes

Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The aim of this study was to assess and compare the periodontal status of adult Sudanese habitual miswak and toothbrush users. The study population comprised male miswak users (n = 109) and toothbrush users (n = 104) with age range 20-65 years (mean 36.6 years) having 18 or more teeth present. They were recruited among employees and students at the Medical Sciences Campus in Khartoum, Sudan. One examiner used the Community Periodontal Index (CPI) to score gingival bleeding, supragingival dental calculus, and probing pocket depth of the index teeth of each sextant. In addition, the attachment level was measured, which, along with the CPI, was used to assess the periodontal status of the two test groups. Gingival bleeding and dental calculus were highly prevalent in the study population. Approximately 10% of the subjects had ≥4 mm probing depth and 51% had ≥4 mm attachment loss in one or more sextants. Subjects in the age group 40-65 years had a significantly (p < 0.05) higher number of sextants with gingival bleeding and with ≥4 mm probing depth and attachment loss than the 30-39 years group. Miswak users had significantly (p < 0.05) lower dental calculus and ≥4 mm probing depth and higher ≥4 mm attachment loss as well as a tendency (p = 0.09) to lower gingival bleeding in the posterior sextants than did toothbrush users. These differences were not significant in the anterior sextants. It is concluded that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users, suggesting that the efficacy of miswak use for oral hygiene in this group is comparable or slightly better than a toothbrush. Given the availability and low cost of miswak, it should be recommended for use in motivated persons in developing countries.

     

Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes

Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The aim of this study was to assess and compare the periodontal status of adult Sudanese habitual miswak and toothbrush users. The study population comprised male miswak users (n = 109) and toothbrush users (n = 104) with age range 20-65 years (mean 36.6 years) having 18 or more teeth present. They were recruited among employees and students at the Medical Sciences Campus in Khartoum, Sudan. One examiner used the Community Periodontal Index (CPI) to score gingival bleeding, supragingival dental calculus, and probing pocket depth of the index teeth of each sextant. In addition, the attachment level was measured, which, along with the CPI, was used to assess the periodontal status of the two test groups. Gingival bleeding and dental calculus were highly prevalent in the study population. Approximately 10% of the subjects had > or =4 mm probing depth and 51% had > or =4 mm attachment loss in one or more sextants. Subjects in the age group 40-65 years had a significantly (p < 0.05) higher number of sextants with gingival bleeding and with > or =4 mm probing depth and attachment loss than the 30-39 years group. Miswak users had significantly (p < 0.05) lower dental calculus and > or =4 mm probing depth and higher > or =4 mm attachment loss as well as a tendency (p = 0.09) to lower gingival bleeding in the posterior sextants than did toothbrush users. These differences were not significant in the anterior sextants. It is concluded that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users, suggesting that the efficacy of miswak use for oral hygiene in this group is comparable or slightly better than a toothbrush. Given the availability and low cost of miswak, it should be recommended for use in motivated persons in developing countries.     

Effect of two common Nigerian chewing sticks on gingival health and oral hygiene.

This study was conducted with the objective of assessing the effect on gingival health and oral hygiene of two chewing sticks, commonly used in a Yoruba community in Nigeria. Sixty, 12-year old primary school pupils participated in the study. After baseline data were collected on the status of oral hygiene and gingival health, complete prophylaxis was carried out on all the children. They were then divided into three groups to which toothbrushes, Pako Ijebu (Massularia acuminata) and Orin Ayan (Distemonanthus benthamianus) were assigned. They received instructions and supervision appropriate to the implement they were provided with. At the expiration of the six weeks intervention period, post-intervention readings were taken. There was no significant difference in the oral hygiene status between those using the toothbrush and those using the chewing sticks. Slight improvements were detected in the gingival status of those using the chewing sticks relative to those in the group using toothbrush. The best score was recorded among those using the Orin Ayan (D. Benthamianus). These differences were however not statistically significant. Even though an association between gingival health and use of these chewing sticks could not be drawn, it is suggested that further studies be conducted in this area.     

Differences in chewing strategies used by edentate people

The present study aimed at testing whether eccentric anterior bruxing facets are associated with clinical signs from the temporomandibular joints and with palpatory tenderness of the muscles of mastication. Wear facets in the canine and incisor areas were assessed by inspecting dental stone casts made at baseline and at the end of a 4-year clinical trial involving 129 adolescents and young adults. The subjects who showed distinct increase in wear were divided into three groups: (i) wear pattern indicating an anterior thrust of the working side mandible, (ii) wear pattern indicating a posterior thrust of the working side mandible and (iii) other wear patterns. The assessment of wear patterns was made without knowledge of clinical signs of temporomandibular disorders (TMD). The eventual change in muscular or joint signs of TMD from baseline to the final examination was then obtained from the records, and the association with wear pattern was calculated.
There was no significant evidence of an association between eccentric anterior wear and signs of TMD. The direction of the mandibular thrust generated by bruxing was also unassociated with the presence of TMJ and muscular signs. In conclusion, the predictive value of eccentric anterior wear facets in young subjects is too low to be helpful in the diagnosis of TMD .     

Uptake and release of fluoride from fluoride-impregnated chewing sticks (miswaks) in vitro and in vivo

The purpose was to investigate the uptake and release of fluoride (F) from F-impregnated chewing sticks (miswaks). In the first series, 3-cm-long pieces were impregnated in 1, 2, 3 and 4% NaF solutions for 3 h, 1 day and 3 days (10 pieces/test). There was a dose-response effect with respect to both impregnation time and the concentration of the F solution. In the second and third series, totally 40 miswak pieces were impregnated in 3% NaF for 1 day and 3 days; the outer layer (bark) was separated from the inner spongy part (pulp) and analyzed separately. F was released from both parts, but somewhat more was released from the bark than from the pulp; a plateau was reached at around 30 min. In vivo, 9 healthy subjects used three products for 2 min in a crossover design: (1) a miswak impregnated in 3% NaF for 1 day, (2) a miswak impregnated in 3% NaF for 3 days, and (3) 1 g of F toothpaste (containing 1,450 ppm F as NaF) on a toothbrush. The highest F concentration at the approximal area was obtained after using the miswak impregnated in 3% NaF for 3 days compared with the other products (p < 0.05 or p < 0.01). To conclude, NaF-impregnated miswaks produced a rapid release of F in vitro as well as in vivo and may be an interesting vehicle for home care use for caries prevention in countries where they are used regularly.