Salvadora persica vs. conventional dental hygiene for gingivitis and plaque Original paper

In this randomized controlled trial, there was no evidence that using a toothbrush or chewing stick containing Salvadora persica was beneficial for reducing dental plaque or gingivitis, compared to brushing alone.

This Study Summary was published on February 6, 2024.

Quick Summary

In this randomized controlled trial, there was no evidence that using a toothbrush or chewing stick containing Salvadora persica was beneficial for reducing dental plaque or gingivitis, compared to brushing alone.

What was studied?

The effect of Salvadora persica (SP; also known as “the toothbrush tree”) on the primary outcomes of plaque levels (evaluated using the plaque index) and gingivitis severity (evaluated as the periodontal inflamed surface area, or PISA).

The outcomes were evaluated on the anterior (front) teeth and posterior (back) teeth and on the buccal (cheek-side) and lingual (tongue-side) surfaces of the teeth.

Who was studied?

78 nondentistry students and staff (average age of 25) from a university in Kuala Lumpur, Malaysia.

How was it studied?

In this 3-week randomized controlled trial, the participants had their teeth professionally cleaned 2 weeks prior to beginning the trial; after cleaning, the participants were instructed to continue their dental hygiene habits until the start of the trial. At the start of the trial, the participants were divided into 3 groups: the SP chewing-stick group, the SP toothbrush group, and the conventional toothbrush group.

The SP stick group used a stick of SP that was similar in size and shape to the shaft of a conventional toothbrush. Prior to use, the participants in this group trimmed 1 centimeter off the end of the stick, soaked the stick in water for 24 hours, and chewed the end of the stick for 2 minutes to break it up into fibrous bristles. The nature of the SP toothbrush was not specified, only that the properties of SP were “preserved in its bristle”. The conventional toothbrush group used a small-head/soft-bristle toothbrush with Colgate® toothpaste.

The 2 toothbrush groups were instructed to brush using the modified Bass technique (which involves brushing to get under the gums and brushing away from the gums) for a minimum of 2 minutes. The chewing-stick group was instructed to spend 5 to 10 minutes on their dental hygiene and to brush their teeth in a circular motion. The interventions lasted 3 weeks.

What were the results?

Each group improved their overall plaque index and PISA scores at 3 weeks, compared to baseline.

Both toothbrush groups had greater improvements to their PISA scores at 3 weeks on the anterior teeth, compared to the chewing-stick group, indicating that brushing was better than the checking stick for improving gingivitis.

Anything else I need to know?

A toothbrush features bristles that are oriented perpendicularly to the shaft of a toothbrush. However, the SP stick has bristles oriented parallel to the stick. This likely made brushing the teeth more difficult, although the participants took 2.5–5 times the amount of time to brush their teeth with the SP chewing stick.

This study also had a short duration of 3 weeks. If the duration were longer (e.g., 6 to 9 months, as might be the interval between professional dental cleanings in some countries), the differences would likely become larger.

The two SP groups did not use toothpaste, unlike the conventional toothbrush group. This introduced a major source of confounding.

This Study Summary was published on February 6, 2024.