# Traditional Oral Hygiene Practices and Their Effectiveness: A Systematic Review of the Evidence

## TL;DR

This review compares traditional oral hygiene practices like miswak and oil pulling to conventional methods, finding they may be similarly effective for short-term plaque and gum health.

## Contribution

The study systematically evaluates the non-inferiority of traditional oral hygiene practices in comparison to conventional methods.

## Key findings

- Miswak significantly reduced plaque and gingival inflammation, performing as well as or better than conventional toothbrushes.
- Herbal dentifrices with neem, clove, turmeric, and ginger were as effective as fluoridated products in reducing plaque and inflammation.
- Oil pulling with sesame or coconut oil showed moderate microbial load reduction and improved gingival health.

## Abstract

Given the increasing interest in natural and sustainable oral hygiene options, this systematic review evaluates the efficacy of traditional oral hygiene practices, specifically miswak and oil pulling, in maintaining oral health compared with conventional practices, addressing the question: how do these practices affect plaque and gingival outcomes relative to toothbrushing and standard rinses? We hypothesized non-inferiority for short-term plaque/gingivitis control, with limited evidence for longer-term outcomes.

A systematic review was conducted following PRISMA guidelines. Comprehensive literature searches were performed in PubMed, Embase.com, Global Health (CABI), Scopus, and Web of Science up to April 2024 using predefined inclusion criteria, focusing on randomized controlled trials and quasi-experimental designs that evaluated traditional oral hygiene methods against conventional practices. Data extraction, quality assessment, and risk bias analysis were conducted independently by two reviewers. Preliminary pilot searches (targeted scoping) were undertaken to refine concepts, eligibility criteria, and keywords. No formal scoping review was registered.

Thirty-one studies met the inclusion criteria. Miswak statistically significantly reduced plaque accumulation and gingival inflammation, performing comparably to or better than conventional toothbrushes. Herbal dentifrices and mouthwashes containing neem, clove, turmeric, and ginger exhibited antimicrobial properties and were as effective as fluoridated products in reducing plaque and gingival inflammation. Oil pulling with sesame or coconut oil showed moderate reductions in microbial load and improved gingival health, though findings varied compared to chlorhexidine mouthwash. Indigenous methods, (e.g., finger brushing, twigs, charcoal) offered accessibility and sustainability benefits but lacked extensive clinical validation.

Traditional oral hygiene practices may offer benefits similar to conventional methods. Nonetheless, methodological limitations and variability among studies necessitate cautious interpretation of these findings. Further thorough research is required to confirm their efficacy and integration into modern oral care.