Miswak on its own
A tie with the toothbrush
On both plaque and sore gums, the gap between a miswak and a toothbrush was too small to call. Neither one won.
Miswak vs. toothbrush
Miswak vs Toothbrush: Where Each One Wins
Used on its own, a miswak cleans about as well as a toothbrush and toothpaste. Used alongside brushing, it beats brushing alone.
Shop the natural miswakWhat we learned from nine research trials
The clearest picture comes from a 2022 review that pooled nine trials, and it found two things. On its own, a miswak is level with a toothbrush and toothpaste. Added to brushing, it beats brushing alone.1
Miswak added to brushing
A clear improvement
People who brushed and also used a miswak had less plaque and healthier gums than people who only brushed, and the result was strong enough to be real rather than chance.
| Comparison | Measured | Size of gap (SMD) | Likely range (95%) | p | Verdict |
|---|---|---|---|---|---|
| Miswak alone vs toothbrush | Plaque | 0.39 | −0.05 to 0.83 | 0.08 | Tie |
| Sore gums | 0.13 | −0.16 to 0.43 | 0.37 | Tie | |
| Miswak added to brushing | Plaque | 0.68 | 0.14 to 1.22 | 0.01 | Miswak wins |
| Sore gums | 0.66 | 0.03 to 1.29 | 0.04 | Miswak wins |
How to read those three numbers
SMD is how big the gap between the two groups is, so a bigger number means a larger difference. The 95% range is where the true effect most likely sits, and when that range crosses zero the result could still be nothing — which is why the two rows for a miswak on its own count as a tie. p is the chance the result is a fluke, and below 0.05 it is treated as real. The two rows for a miswak added to brushing clear that bar. The two on their own do not.
What the trials did not check
All nine trials were short, and nobody has followed miswak users for years, so nobody knows what a miswak does over a lifetime.1
The miswak ties even though almost nobody is taught to use one
Everybody in those nine trials was taught to brush as a small child, but hardly any of them had been shown how to hold a miswak. The reviewers asked for studies on the right way to use one.1
So a miswak reached a tie while the people holding it were guessing. A 2024 trial agrees, because the people taught the technique did better.2 Never being taught is also why people give up on a miswak.
Where the miswak wins outright
The Miswak stick needs nothing else
A toothbrush needs water, toothpaste and a sink before it does anything. A miswak does not need any of that, because it has its own silica, its own trace of fluoride and its own bacteria-killing chemistry. A toothbrush with miswak powder in the bristles is still a toothbrush, and nobody has tested whether it cleans properly without paste.
| Measure | Miswak | Manual toothbrush |
|---|---|---|
| Plaque and sore gums, alone | Level | Level |
| Added to brushing | More plaque removed | Nothing to add |
| Fluoride | About 1 ppm | About 1,450 ppm with paste |
| Same shape every time | Fibers vary | Uniform |
| Technique taught | Rarely | From childhood |
| Replace it | Monthly | Every 3 to 4 months |
Read on
When a toothbrush is the better choice
You wear braces or a retainer
Brackets and wires need a small head that reaches between them, and a chewed fiber tip is too broad.
Your gums have started to recede
Gums that already pull back give way under pressure, so use a soft toothbrush until a dentist checks your technique.
A young child brushes alone
A miswak has to be chewed, trimmed and replaced on a schedule, which is more upkeep than a young child manages.
Sources and references
Nothing here is medical advice or a clinical claim.
- Ramli, H., Mohd-Dom, T. N., Mohd-Said, S. et al. (2022). The effectiveness of miswak practices in reducing plaque and gingivitis among adults: a systematic review and meta-analysis. Journal of Ethnopharmacology, 298:115598.
- Altintepe Dogan, S. S., Ugur, S. G., Dogan, O. (2024). Trial comparing taught and untaught miswak technique.
- Fluoride content analyses of Salvadora persica.
- Clinical guidance on gingival recession and brushing pressure.
- Manufacturer guidance on toothbrush replacement intervals.
Try it alongside your toothbrush
That is the combination the trials found strongest. Start with one pack.
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