Shetty et al International Journal of Public Health Dentistry 5 International Journal of Public Health Dentistry 1:1 (2010)5-10. © Celesta software Pvt Ltd RESEARCH ARTICLE Comparative study to assess the effect of chewing stick and toothbrush on oral hygiene and periodontal status among Indian population Raghavendra M. Shetty; Sunaina Shetty; Sachin B. M; Ramesh Amirisetty; Abhishek Agrawal Abstract Aim: The purpose of this study was to asses and compare the oral hygiene, gingival and periodontal conditions among a group of Indian population who used miswak, toothbrush or combined miswak\brush for their routine daily oral hygiene. Materials and Methods: A total of 528 subjects participated in this study (63.6% females and 36.4% males), ranging in age from 20 to 45 years (mean ± SD = 35.43 ± 12.83). All subjects were interviewed regarding their oral hygiene habits and use of miswak and conventional toothbrush. After fulfilling the entry criteria participants were classified according to their oral hygiene habits as miswak users (group I), tooth brush users (group II) or both miswak users and tooth brush users (group III). All subjects were assessed using Simplified Oral Hygiene Index (OHI-S), gingival index, pocket depth and gingival recession. Data was analysed using ANOVA test and Scheffe test according to need. The level of significance used was 5% level. Results: It showed that there was no statistically significant difference of OHI-S between groups (P= 0.751). On the other hand, all the three groups differ significantly in relation to mean gingival index (p= 0.000). Also, Group II demonstrated a significantly higher mean pocket depth than Group I (p=0.019). However, gingival recession was significantly higher in Group I in comparison to Group II and Group III (P=0.000). Conclusion: This study demonstrated that, apart from gingival recession that might be encountered in miswak users, the miswak exhibits a significantly higher improvement in gingival and periodontal conditions as compared to tooth brush. Key Words: Tooth brush; oral hygiene; gingivitis; periodontal pocket; gingival recession; Chewing stick; Oral hygiene; Periodontal Status. Received on: 07/13/2010 Accepted on: 08/15/2010 Introduction Oral hygiene measures have been practiced by different populations and cultures around the world since antiquity. The oral hygiene habits in a certain population depend on various factors, such as cultural background, religious norms, educational levels and socioeconomic status(1). There are different methods available for the maintenance of oral health. These are mainly mechanical and chemical. Toothbrushes and dentifrices are widely used for cleaning the teeth. The traditional toothbrush or chewing stick called “Miswak” has been used since ancient history(2). Chewing sticks were used by the Babylonians some 7000 years ago; they were later used throughout the Greek and Roman empires and have been used by Jews, Egyptians, and Muslims. Today they are used in Africa, Asia, the Eastern Mediterranean region, and South America(3). It has different names in different societies for instance; miswak, siwak or arak is used in the Middle East, miswaki, in Tanzania, datan in India and Pakistan(4). The World Health Organization has recommended and encouraged the use of these sticks as a tool for oral hygiene in areas where their use is customary(5). The promotion of good oral health by miswak is mainly attributed to mechanical cleansing efficacy, including the mechanical effects of its fibers. Also, the release of beneficial chemicals such as trimethyleamine, salvadorine, mustard oil, vitamin c, resins, flavodine, saponins, sterol and fluoride might all play an important role(6). Therefore, periodontal treatment need was found to be low in habitual miswak users(7). Contradictory data have been reported on the oral health of miswak users. Several reports have indicated that chewing sticks are effective in reducing plaque and gingival inflammation if properly used and miswak has been reported to be as effective as tooth brushing(8-10). Moreover, miswak was found to have a clinical implication of