Oral hygiene in Namibia: A case of chewing sticks.

ETHNOPHARMACOLOGICAL RELEVANCE: Chewing sticks have served as the primary form of dental care for rural communities in resource-poor settings for millennia. They are one of the most important under-researched, non-timber forest products in Namibia. This review provides an overview of plants that are used as chewing sticks in Namibia and highlights pharmacological as well as phytochemical studies conducted on them. AIM OF THE STUDY: This review aims to present a summary of studies that have been done on the ethnomedicinal uses, phytochemistry, biological activity as well as evidence on the scientific validation and geographical distribution of chewing sticks in Namibia. It also highlights research gaps and provides an impetus for the scientific investigations of these plant species. MATERIAL AND METHODS: Literature searches using keywords including oral hygiene, chewing sticks, ethnomedicinal uses, phytochemistry, antimicrobial, antioxidants, anti-inflammatory activities and toxicity studies, chewing sticks, and distribution in Namibia on various electronic search engines was conducted. RESULTS: Of the 41 plant species identified, Cordia sinensis Lam., Faidherbia albida (Delile) A.Chev. and Harpagophytum zeyheri Decne. are used for both gargling and as mouthwash. The plant families Fabacae, Ebenaceae, and Burseraceae account for 22.0%, 12.2%, and 7.30% of plant species recorded as chewing sticks in Namibia respectively. This study revealed a significant relationship between plant family and scientific validation. Species belonging to Burseraceae, Apocynaceae, Montiniaceae, and Cucurbitaceae families have only been partially validated. The Kunene region, home to the Ovahimba ethnic group, had the highest proportion (87.8%) of chewing sticks species compared to other regions. CONCLUSION: This review revealed that most of the plants used as chewing sticks in Namibia require an in-depth pharmacological and phytochemical investigation as deduced from the paucity of literature on the therapeutic methods, mechanisms of action, efficacy, toxicity, and clinical relevance of these species.

Salivary Fluoride Retention: A Comparative Analysis between Fluoride Containing Chewing Sticks and a Non Herbal Fluoridated Toothpaste.

AIM: To determine and compare salivary fluoride retention after the use of different fluoride-containing chewing sticks and a non-herbal fluoridated toothpaste. MATERIALS AND METHODS: This double-blind cross-over experimental study was undertaken among twenty randomly selected senior secondary students in Ibadan, Nigeria. Saliva samples were collected to establish baseline fluoride concentration before the use of chewing sticks and non-herbal fluoridated toothpaste. Four commonly used chewing sticks and one non-herbal fluoridated toothpaste were each used at two days interval, and saliva samples were collected at 0, 10, 30, 45 and 60 minutes after each use. These samples were stored and transported in Gio'Style coolers to the laboratory, where they were analyzed for fluoride concentration using a spectrophotometer at a wavelength of 620 nm. Data were analyzed using descriptive and inferential statistics at p < 0.05. RESULT: At baseline mean (± SD) salivary fluoride concentration of participants was 25.95 (± 4.58) ppm. The mean (± SD) salivary fluoride concentration at 0 minutes was 228.0 (± 032.80) ppm, 427.65 (± 122.85) ppm, 413.45 (± 78.08) ppm, 329.05 (± 83.12) ppm and 323.80 (± 66.41) ppm corresponding to Alchornea laxiflora, Zanthoxylum zanthoxyloides, Anogeissus leocarpus, Masularia acuminate and non-herbal toothpaste respectively. At 60 minutes Zanthoxylum zanthoxyloides had the highest mean (± SD) fluoride concentration of 44.75 (± 13.32) ppm. The differences in mean (± SD) salivary fluoride concentrations amongst these tooth cleaning aids at 60 minutes were statistically significant (p < 0.001). CONCLUSION: Zanthoxylum zanthoxyloides had the highest mean (± SD) salivary fluoride retention followed by the non-herbal fluoridated toothpaste. CLINICAL SIGNIFICANCE: The use of chewing sticks can be a cost-effective and efficient means of caries prevention if used properly at regular interval.

A review of the traditional and modern uses of Salvadora persica L. (Miswak): Toothbrush tree of Prophet Muhammad.

ETHNOPHARMACOLOGICAL RELEVANCE: Salvadora persica L., also known as Arak (in Arabic) and Peelu (in Urdu), is the most common traditional source of tooth or chewing stick (miswak) highly recommended by Prophet Muhammad. To date, extensive studies have probed primarily into the validation of its traditional uses in oral care. Nonetheless, there is still a dearth of updated compilation and critical analysis of other potential ethnopharmacological properties of S. persica. This review therefore aims to provide an up-to-date detailed structured description of the traditional uses of S. persica and a critical analysis of its modern uses, highlighting its phytochemistry, pharmacological properties, and bioapplications. MATERIALS AND METHODS: Various databases (Science Direct, PubMed, Wiley Online Library, and Google Scholar), books, and relevant primary sources were probed, surveyed, analysed, and included in this review. The literature cited in this review dated from 1979 to 2017. RESULTS: S. persica was found to possess a plethora of bioactive compounds and broad pharmacological properties, including antimicrobial, antioxidant, enzyme inhibitory activity, antiulcer, anticonvulsant, sedative, analgesic, anti-inflammatory, hypoglycemic, hypolipidemic, antiosteoporosis, and antitumor activities. Studies also revealed the potential use of S. persica as a natural food preservative and a novel functional food ingredient. In addition, improvement in growth and reproductive performances have been observed by the introduction of S. persica in animal feed. Lastly, S. persica has also been used in the green synthesis of nanoparticles showing potential biotechnological applications. CONCLUSION: S. persica showed a wide scope of application and its uses have been extended far beyond the initial traditional uses of its roots, stems, and twigs in oral care. We found a number of other ethnopharmacological uses and potential bioapplications of different parts of S. persica that warrants further investigations. Though widely studied using several in vitro and in vivo models, and tested clinically for oral hygiene mainly, several gaps and research priorities have been identified which needs to be addressed in future.

Antibacterial activity of aqueous extracts of Indian chewing sticks on dental plaque: An in vitro study.

The anti-microbial efficacy of aqueous extracts of Indian chewing sticks against different kinds of plaque bacteria in vitro was investigated. Supra-gingival plaque is cultured and subjected to the antibacterial activity of the aqueous extracts of chewing sticks (Neem, Acacia, Pongamia glabra, Achyranthes aspera, Streblus asper) separately. The results of the study demonstrate that all the five chewing sticks under study possess inhibitory potential against bacteria present in dental plaque mainly on aerobes. The antibacterial efficacy of aqueous extracts has antibacterial effects and could be used as a therapeutic agent and therefore, it appears to be potent anti-microbial agents that could be considered as a medicinal plant. Results of this study showed chewing sticks contained antibacterial agents, but the concentration and composition of the active substances differed among the plants.

Effect of traditionally used neem and babool chewing stick (datun) on streptococcus mutans: an in-vitro study.

PURPOSE: 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. This study was conducted to evaluate the effectiveness of traditionally used neem and babool chewing sticks (datun) extracts on Streptococcus mutans. MATERIALS AND METHODS: The present invitro study was conducted to assess effectiveness of 5%, 10%, and 50% neem and babool extract on Streptococcus mutans. The ditch plate method was used to test the antimicrobial activity. Ditches were prepared on blood agar plates with the help of punch having 6mm diameter. The plates were left for 1h at room temperature and then incubated at 37°C for 48h and examined for zone of inhibition. RESULTS: There was no zone of inhibition observed with 5% babool and neem aqueous extract. There was significant difference in mean diameter of zone of inhibition of 10% neem and babool extract (p-value 0.001 < 0.05). Similarly the mean difference in 50% neem and babool extract was found to be significant (p-value < 0.001). CONCLUSION: Both neem and babool extracts had antimicrobial activity against Streptococcus mutans, while antimicrobial activity was significantly higher in neem aqueous extract than babool aqueous extract.

Poor oral Hygiene may be the Sole Cause of Oral Cancer.

PURPOSE: The purpose of this case-control study was to draw attention to the possibility that poor oral hygiene resulting from infrequent and inadequate use of chewing sticks might be the sole cause of oral cancer in 60 patients investigated in the maxillofacial units of two specialist hospitals in eastern Nigeria. METHODS: Sixty cases and 60 controls made up the study population. We matched them for age, gender, period of admission and study site. The interview of all the participants contained data on demographic factors, family history of cancer, tobacco habits, oral hygiene, dietary habits and use of alcohol. We took biopsies of the lesions for histo-pathological examination. We entered the collected data into Microsoft excel package and transported it to Stata for generation of statistical test. RESULT: Poor oral hygiene due to infrequent tooth brushing was associated with primary oral cancer in this patient sample. On the other hand, frequent tooth brushing was related to healthy status. CONCLUSION: In the absence of other known carcinogens, poor oral hygiene may be the single factor that caused oral cancer in these subjects. Research is needed to investigate the pathological mechanism that is associated with this risk factor.

Chewing-stick practices using plants with anti-streptococcal activity in a ugandan rural community.

BACKGROUND: The high dental disease burden in developing countries has created a need to explore and develop cheap and accessible methods of dental disease prevention. Traditional toothbrushes (chewing-sticks) prepared from specific plants have been used for dental hygiene for generations. When properly used, chewing-sticks may be as effective as synthetic toothbrushes. This study set out to describe traditional chewing-stick practices in a Ugandan rural community, and evaluate the antibacterial activity of two most commonly used plants. METHODS: Interviews were done to identify chewing-stick plants and obtain socio-cultural information relating to the practice in two villages in rural Uganda. Field walks were done to pick and voucher the plants, for taxonomical identification and storage. For the two most reported plants, aqueous extracts were prepared and tested for antibacterial activity against Streptococcus mutans using the agar-well diffusion method. RESULTS: Of the 21 key informants interviewed, all were using or had used chewing-sticks in the past. A total of eight plants were identified as sources of chewing-sticks, with Rhus vulgaris and Lantana trifolia most commonly mentioned. Chewing-sticks were preferred over synthetic tooth brushes because they were less likely to traumatize the gums. Their use has been limited of recent due to scarcity of some plants. R. vulgaris and L. trifolia aqueous extracts showed antibacterial activity against S. mutans with mean diameters of inhibition of 24.33 ± 0.58 and 14.17 ± 0.29 mm on Blood agar respectively, compared to benzyl penicillin control 30.67 ± 0.29 mm. CONCLUSION: R. vulgaris and L. trifolia are the most common sources of chewing-sticks for cleaning teeth in this community. The plants contain compounds that are active against S. mutans. These plants merit further studies as they are possible sources of cheap dental health care for the rural poor.