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Abstract Introduction: The rate of tooth decay and periodontal diseases today is still high, regardless of progress in oral and dental hygiene. The traditional toothbrush or chewing stick called "Miswak" has been used since ancient times. Many significant effects of Miswak such as antibacterial, anti-caries and antiperiopathic effects have been recognized today. Tooth care is a very important issue and both prevention and treatment of dental caries could be very helpful in maintaining good personal health. In this research, the efficacy of natural toothbrush or Miswak in prevention of dental caries was investigated and compared with the efficacy of ordinary toothbrush and toothpaste. Aim: Miswak was introduced for preventing dental caries by the Holy Prophet Mohammad (S.A.W) 1400 years ago and has been used since then in many Islamic countries. In this research, the efficacy of Miswak in prevention of dental caries was investigated and compared with the efficacy of ordinary toothbrush. Methods: This analytical and clinical trial was performed in a high school student population (girls and boys) in the city of Yazd, Iran in 2001-2002. Twelve high schools were randomly chosen. From these high schools, 380 second year students (190 cases and 190 controls) were enrolled and their teeth condition such as the number of decayed, missing and filled teeth (DMF) were recorded in a specific questionnaire. The degrees of decay in the decayed teeth were recorded as well. Then, Miswak sticks were distributed to the case group and required dental training was given to both groups. After one year, the examinations were repeated and findings recorded in the same questionnaires. For analyzing the data, one-way variance analysis, Chi square, Paired t-test and two variable analyses were used. Results: At the start of the study, there were no significant differences between the two groups (case and control) with regards to their dental condition and the frequency of brushing of their teeth (p-value=0.162). In addition, there were no significant differences in DMF between the two groups. The prevalence of dental caries was slightly less in the control group (0.89 times of this in the case group). The data collected at the end of the study showed a significant increase in DMF in the control group (P-value=0.000). There was a 55% increase in the rate of dental caries in the control group as compared to the case group (0.89 before the study and 1.38 after the study). The risk of dental caries for each tooth in the control group was 9.35 times more than the case group (9.14% and 0.98% respectively). Conclusion: Despite the same training and similar intention in brushing of teeth and the same dental situation in two groups at the start of the study, rate of dental caries which was primarily more in the case group in the beginning was lesser than the control group at the end of this study. This might be as a result of the antimicrobial effects of Miswac. A study with more cases and longer time period is needed to prove this suggestion. Our data shows the need to encourage the use of Miswac in the general population, especially in developing countries for its effectiveness in the prevention of progress of dental caries.

Keywords: Miswac, Dental caries, Salvadora persica

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