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Ethnobotanical Leaflets 11: 38-44. 2007. Contribution
of Trees for Oral Hygiene in Yoseph Negusse Araya Department of Biological Sciences The Open University, Walton Hall E-mail: Y.N.Araya < Y.N.Araya@open.ac.uk > Issued ABSTRACT The contribution of trees as tooth brush to maintain oral hygiene of
local communities is discussed. Species commonly used in Eritrea and East
Africa, as well as how the toothbrush (miswak) is utilized are presented. The
potential benefits of tooth brush trees as a source of supplementary income
is mentioned along with concerns for endangered species. KEYWORDS: Endangered
species, Eritrea, miswak, oral hygiene, Salvadora
persica , Tooth brush. INTRODUCTION A
visitor to the towns of Eritrea(1) may be intrigued to see a piece
of woody twig sticking out of the mouth of the townsfolk. Such twig is very
likely to be the traditional tooth brush, commonly known as “mewetz” in
Tigrigna and “miswak (2)
” in Arabic. Such regular use of the traditional tooth brush is said to
have helped make Eritreans, especially the lowlanders, renowned for their
shiny white teeth. The use of miswak is also appreciated as the age old
Tigrigna proverb says, “Mewetz is for
the eyes while Tahses is for the
teeth”. The meaning being, any sort of mewetz, i.e. miswak, is nice to
see (being a sign of personal hygiene) while the best for teeth is Tahses (Dodonia
angustifolia). Further a field, Almas (2002) and Hyson (2003) report, that miswak (chewing sticks(3)) were in use from as early as some 7000 years ago by the Babylonians; and later on throughout the Greek, Roman and Islamic empires. It is also believed to be the precursor to the modern day toothbrush and was used in Europe about 300 years ago (Lewis and Lewis, 1977).Today, miswak is being used in Africa, South America, Asia, the Middle East including Saudi Arabia, and throughout the Islamic countries (e.g. Yarde and Robinson, 1996; Hattab, 1997, Darout et al., 2005). This
paper will try to communicate the importance of miswak for oral hygiene; how
it is employed and the species used. Brief mention will also be made on its benefit
to the local community, both health-wise and as a source of supplementary
income. Concerns of miswak harvesting on endangered species is also
discussed. WHAT IS MISWAK Preparation The toothbrush is generally
obtained from any slim woody part of the tree. Mostly it is harvested from
branches although harvest from woody roots is also known. Long twig sections
of 50 or 100 cm are cut and transported to the market before being cut to
retail sizes. The thickness of miswak is dependent on the type of tree and
the part of branch harvested while the length is more dependent on the
retailer. Examples of retail sizes for the most common miswak species are
given as follows. For the native olive tree (Olea europea subsp. africana) the miswak is usually about 7-10 mm thick
and 7-10 cm long; for Tahses (Dodonia angustifolia) it ranges from 4-6
mm thick and 6-8 cm long; while for Aday (Salvadora persica) roots it
could be 10 mm thick and as long as 20 cm. The
commercial miswak brushes are easily available from street vendors in any
towns. They are usually displayed on cloths laid out in the street and usually carried in plastic bags. The
price varies depending on the type of species and sometimes on size. Olea
europea subsp. africana costs US $ 7 cents
apiece; the Dodonia angustifolia US $ 3.5 cents and Salvadora persica US $ 3.5 cents. In
addition there is a triangularly patterned miswak known as “Lemon” or “Dambutch” (species not identified)
which is imported from neighbouring countries and sells for US $ 14 cents a
piece in the streets of Asmara. More
recently, some online stores overseas have taken to selling miswak to the web
e.g.. http://shop.store.yahoo.com/talkislam/ and http://www.thepeelucompany.com. After purchase, the brush may be directly used or in
some cases soaked in water for a few hours to soften the fibers. Before use
the top 5-10 mm of bark is pared away with a sharp knife and then one chews
the bristles. The teeth can then be cleaned by drawing the miswak from the
edge of the gums up or down to the cutting edge of the teeth. Species used In the In Table 1. Species used for miswak in Eritrea, Ethiopia
and Kenya.
References: Eritrea, Ministry of
Agriculture (1995); Ethiopia (Azene et
al., 1993); Kenya (ICRAF,
1992). IMPORTANCE OF Oral health is part of total health and essential
to quality of life. The World Health
Organization puts oral diseases among the top 5 causes of burden in ‘lost healthy years’ worldwide
(WHO, 2004). The major cause of such oral diseases is due to dental caries
which are mainly a result of poor hygiene. Moreover, systemic health may be
affected as a result of problems in oral hygiene (Bone, 2005). Toothbrush
sticks can be used by the vast majority of people who cannot afford to buy
the commercial western toothbrush and toothpaste. The toothbrush sticks are
important for the oral and dental hygiene of the users and hence may be
useful in decreasing dental caries. (e.g. Kassu, 1999) A number of studies have been carried out to assess the efficiency and potential use of the miswak, some of which are mentioned as follows. Studies on the chemical contents Salvadora persica miswak have shown significant contents of antibacterial substances (e.g. Hattab, 1997; Kassu, 1999; Almas, 2002). A survey study by Ndungu (1990), on the efficacy of common miswak versus the western tooth brush, showed that for patients with moderate plaque deposits, the miswak is as efficacious as the toothbrush in plaque control. Gazi et al., (1990) also corroborate by mentioning that a miswak, used five times a day, may offer a suitable alternative to a toothbrush for reducing plaque and gingivitis. However both investigations agree that, miswak alone is not a complete alternative for patients with severe plaque deposits or for maintaining interproximal dental health. PROS In
terms of oral health, the major advantages of miswak over that of western
toothbrush are that it is cost effective for users, especially for those in
developing countries. This is because firstly, the miswak can be used for
longer time duration - several weeks at a time. It usually is replaced when
it gets too dry or rather more likely when lost. Another merit, unlike its
common English name “toothbrush stick”, it is actually combined toothbrush
and tooth paste. This further cuts down the cost, e.g. 75 ml tooth paste
costs about US $ 2 in Asmara, several fold of the price of miswak (US $
0.10). Another advantage is the ready availability of miswak in towns or
villages. In addition, as it is dry and small size, it is easily carried
around, hence enabling the user to prompt use after every meal or when
killing time. Miswak
can also be a means of significant supplementary income generation (Blay,
2004). If a farmer has some trees or shrubs of the commonly used species in
the locality, he/she can regularly prune it and sell the twigs for miswak in
nearby towns. Furthermore, some miswak species like Acacia nilotica and Albizia
coriaria could easily be integrated in agroforestry projects, which can
result in an added benefit. However
there are some potential concerns on the use of miswak. These are mainly the
effect of harvest on the plant and use of the miswak itself. Up to
now the miswak encountered have been commonly used in the past and their
effects on teeth are known only by experience. However, local people report
that species like Balanites aegyptiaca and Salvadora persica
have some negative side effects such as teeth discolouring if used for an
extended period of time. The rough miswak fibres may also have the
undesirable effect of scratching the teeth enamel and worse bleeding the gums
to allowing bacteria in (Sote, 1994). Another cause of concern is that of
immoderate use (e.g. Bos, 1993), in particular as miswak is carried around
and used in most places any time of day. This requires further study on the
species in use and their effects on gums and teeth. Another
concern, which is likely to grow with growth in the miswak market, is that of
unsustainable harvesting of miswak trees. Such harvest could result in poor
growth of the trees and even death. This is especially of concern if the
trees are those considered to be locally endangered. Examples of such trees
in Eritrea are Balanites aegyptiaca, Dobera glabra, Rhus abyssinica, and
Rhus natalensis (Environment Eritrea, 1995). This seems to be one of
the main reasons for the Ministry of Agriculture’s tendency to discourage
miswak sellers in towns and cities. CONCLUSION The
traditional tooth brush or the miswak
is a major means of keeping oral hygiene and dental health in Eritrea. As
such, the frequent use of miswak is widely considered a cultural symbol of
personal hygiene. A number of species are used for such purpose, some of
which are endangered. However, sustainable harvesting should enable effective
utilization, without damage to the trees. At this junction, further study on
the economics of the trade, choice of suitable species (and in some cases
alternatives to endangered species) as well as effectiveness of specific
species for dental hygiene is suggested. It is hoped that such a cultural
heritage be given due attention to play a continued role for dental hygiene
while providing useful supplementary economic benefits for the local
community. END NOTES 1-Eritrea is a small country
located in the horn of Africa. It is bounded by Sudan, Ethiopia and Djibouti
as well as the Red Sea. 2-I
have opted to use term ‘miswak’ throughout this paper as it is the most
frequently used name in literature. 3-The miswak I refer to in this
paper is obtained from small whole branches of trees, unlike that of the West
African e.g. Ghanian ‘chewing sticks’ which are normally split from large
woody tree trunks. REFERENCES Almas, Khalid. 2002.
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