**2. Salvadora Persica**

The Salvadora Persica tree drives its Persian name, Darakht-e-Miswak or tooth brush tree. South of Iran, next to Persian Gulf, is the main growing area of this plant. This plant belongs to the Salvadoraceae family, a crowded evergreen shrub that has a soft inclined to a white wood. Since the brushes made of its wood strengthen the gums, it has been called "Miswak tree" (Meswak tree) in traditional medicine (Poureslami 2007).

Chemical compounds such as sodium chloride, calcium oxalate, silica, fluoride, sulfated compounds, vitamin C and tannic acid have been found in this plant. Moreover, this plant contains saponin, flavonoid, an alkaloid named Salvadorin, Trim ethylamine, an herbal steroid named beta-sit sterol and benzyl isothiocyanate. It is claimed that the vitamin C and sit sterol content of this plant have great roles in strengthening the gum capillaries and preventing gum inflammation. calcium salts and fluoride are quite effective in preventing dental caries. Moreover, the silica and calcium salts in the plant act as grinder and detergent. Trim ethylamine is known to be effective in reducing surface adhesion and also in decreasing plaque accumulation. Tannins, tannic acid, Sulfated compounds and benzyl isothiocyanate, are reported to have antimicrobial effects and help the healing of gum inflammation. Leaves, fruits and seeds of this plant have been used in traditional medicine as appetizer, mild laxative, diuretic and anti-fungal medication and people in some Asian and African countries have used it for many years (Akhtar & Ajmal 1981 , Al Sadhan &

The Effects of Plant Extracts on Dental Plaque and Caries 397

miswak extract can be used in mouth rinses and toothpastes for control dental plaque and

The results of a study showed that miswak extract could be a promised natural material as

Almas and co-workers compared the antibacterial effects of Miswak extract with eight commercial mouth rinses. They evaluated the antimicrobial effects on Pyogenes Faecalis, Mutans Streptococci, Candida Albicans plus Aureus and Epidermidis staphylococci by determining the inhibition zones. In their study, none of the solutions was considered a gold standard; they compared the antimicrobial effect of Miswak with that of each mouth rinse and the antimicrobial effects of the eight mouth rinses with each other. According to their results, mouth rinses containing chlorhexidine had the greatest antibacterial effects, while mouth rinses containing cetylpyridinium had moderate effect; Miswak extract had a low

Chemically, sanguinarine is a benzophenanthridine alkaloid derived from the alcoholic extraction of powdered rhizomes of the bloodroot plant, Sanguinaria Canadensis, that grow in central and south America and Canada. Sanguinarine contains the chemically reactive iminium ion which is probably responsible for its activity. It appears to be retained in plaque for several hours after use, and is poorly absorbed from the gastrointestinal tract. Several clinical studies have been carried out into its effects. A sanguinarine mouth rinse and toothpaste regime given for 6 months during orthodontic treatment reduced plaque by 57% and gingival inflammation by 60% compared with figures of 27% and 21% for the placebo control group. Reviews on antimicrobial mouth rinses including sanguinarine conclude that short-term studies have shown variable but significant plaque inhibitory effects but the effect on gingivitis appears to be equivocal. In respect of its possible modes of action, it has also been shown that sanguinarine at a concentration of 16 microgram per milliliter completely inhibited 98% of microbial isolates from human dental plaque and that sanguinarine and zinc act synergistically in suppressing the growth of various oral strains of

A wide range of toothpastes are commercially available and recently interest in naturally based products ,such as Qualimiswak and Prodontax, has increased. Parodontax (Madaus. Cologne. Germany )is composed of sodium bicarbonate and various herbal extracts including Camomile, Echinacea, Sage, Myrrh, Rhatany, and Peppermint oil. The individual components are reputed to have a variety of medicinal properties. Chamomile is claimed to have anti-inflammatory characteristics and Echinacea to have activating effect on leukocytes. Sage is reputed to be an antiseptic while both Myrrh and Rhatany are astringents that have been recommended for incorporation in to dentifrices and mouthwashes. The antibacterial effect of these herbal extracts on anaerobes has been

Mullally and colleagues reported that Parodontax toothpaste was as effective as the

conventionally formulated dentifrice in the control of plaque (Mullally et al 1995).

an additive to glass ionomer cements (El- Tatari et al 2011).

caries (Poureslami 2007).

effect ( Almas et al 2005).

streptococci (Eley1999).

reported (Yankell 1988).

**4. Sage & Myrrh** 

**3. Bloodroot plant (Sanguinarine)** 

Almas 1999 , Almas et al 2005 , Ezmirly et al 1981 , Darmani et al 2006 , Darout et al 2002 , Al-Otaibi et al 2003).

During recent years, many researchers throughout the world have studied Miswak as a helpful plant in oral hygiene. Clinical trials have shown that regular use of chewing stick of Salvadora Persica reduces plaque. It has been reported that incidence of caries among users of chewing sticks is low despite the intake of a carbohydrate rich diet and a lack of modern dental prophylactic measures. The Arabian researchers concluded from a comprehensive survey of several thousands of Saudi school children that the low incidence of gingival inflammation was attributable to the practice of using Miswak for teeth cleaning (Gazi et al 1992).

In vitro studies indicate that, of a variety of common oral bacteria, members of the genus streptococcus (including the mutans streptococci ) are especially sensitive to the antimicrobial activities of S. Persica (Al-lafi & Ababneh 1995).

In a study the efficacy of Miswak in the prevention of dental caries has been investigated and compared with the efficacy of ordinary toothbrush and toothpaste. The data collected at the end of the study showed that the risk of dental caries for each tooth in the control group was 9.35 times more than the case group (Aldini & Ardakani 2007).

It has been told rinsing with Miswak extract stimulated parotid gland secretion and raised the plaque PH, suggesting a potential role in caries prevention (Sofrata et al 2007).

It has been observed that miswak was as effective as a toothbrush for reducing plaque on buccal surfaces of teeth both experimentally and clinically (Mohammed et al 2006).

Another study compared the oral health efficacy of persica mouthwash with that of a placebo. The results showed that use of persica mouthwash improves gingival health and lower carriage rate of cariogenic bacteria when compared with the pretreatment values (Khalessi et al 2004).

Scientific evaluation of use of miswak revealed that it is at least as effective as toothbrushing for reducing plaque and gingivitis and that the antimicrobial effect of S. persica is beneficial for prevention/treatment of periodontal diseases (Al- Otaibi 2004).

A clinical study was conducted using patients` saliva and measuring the effect of miswak (chewing stick), miswak extract, toothbrush, and normal saline on mutans and lactobacilli. The results showed that there was a marked reduction in Strep. Mutans among all groups. When the groups were compared, the reduction in Strep. Mutans was significantly greater using miswak in comparison to toothbrushing and there was no significant differences for lactobacilli reduction. The investigators concluded that miswak has an immediate antimicrobial effect. Strep. Mutans were more susceptible to miswak antimicrobial activity than lactobacilli (Almas & Al-Zeid 2004).

It seems persica mouthwash doesn`t have any side effects. Results of a study has shown the mouthwash significantly lowers the gingival index, plaque index, and bleeding index in case group without any reported side effects (Kaur et al 2004).

The results of the three serial studies showed that miswak extract, alone or in combination with toothpaste, can affect the growth of plaque bacteria. The investigators concluded that

Almas 1999 , Almas et al 2005 , Ezmirly et al 1981 , Darmani et al 2006 , Darout et al 2002 ,

During recent years, many researchers throughout the world have studied Miswak as a helpful plant in oral hygiene. Clinical trials have shown that regular use of chewing stick of Salvadora Persica reduces plaque. It has been reported that incidence of caries among users of chewing sticks is low despite the intake of a carbohydrate rich diet and a lack of modern dental prophylactic measures. The Arabian researchers concluded from a comprehensive survey of several thousands of Saudi school children that the low incidence of gingival inflammation was attributable to the practice of using Miswak for teeth cleaning (Gazi et al

In vitro studies indicate that, of a variety of common oral bacteria, members of the genus streptococcus (including the mutans streptococci ) are especially sensitive to the

In a study the efficacy of Miswak in the prevention of dental caries has been investigated and compared with the efficacy of ordinary toothbrush and toothpaste. The data collected at the end of the study showed that the risk of dental caries for each tooth in the control group

It has been told rinsing with Miswak extract stimulated parotid gland secretion and raised

It has been observed that miswak was as effective as a toothbrush for reducing plaque on

Another study compared the oral health efficacy of persica mouthwash with that of a placebo. The results showed that use of persica mouthwash improves gingival health and lower carriage rate of cariogenic bacteria when compared with the pretreatment values

Scientific evaluation of use of miswak revealed that it is at least as effective as toothbrushing for reducing plaque and gingivitis and that the antimicrobial effect of S. persica is beneficial

A clinical study was conducted using patients` saliva and measuring the effect of miswak (chewing stick), miswak extract, toothbrush, and normal saline on mutans and lactobacilli. The results showed that there was a marked reduction in Strep. Mutans among all groups. When the groups were compared, the reduction in Strep. Mutans was significantly greater using miswak in comparison to toothbrushing and there was no significant differences for lactobacilli reduction. The investigators concluded that miswak has an immediate antimicrobial effect. Strep. Mutans were more susceptible to miswak antimicrobial activity

It seems persica mouthwash doesn`t have any side effects. Results of a study has shown the mouthwash significantly lowers the gingival index, plaque index, and bleeding index in

The results of the three serial studies showed that miswak extract, alone or in combination with toothpaste, can affect the growth of plaque bacteria. The investigators concluded that

the plaque PH, suggesting a potential role in caries prevention (Sofrata et al 2007).

buccal surfaces of teeth both experimentally and clinically (Mohammed et al 2006).

antimicrobial activities of S. Persica (Al-lafi & Ababneh 1995).

was 9.35 times more than the case group (Aldini & Ardakani 2007).

for prevention/treatment of periodontal diseases (Al- Otaibi 2004).

case group without any reported side effects (Kaur et al 2004).

Al-Otaibi et al 2003).

(Khalessi et al 2004).

than lactobacilli (Almas & Al-Zeid 2004).

1992).

miswak extract can be used in mouth rinses and toothpastes for control dental plaque and caries (Poureslami 2007).

The results of a study showed that miswak extract could be a promised natural material as an additive to glass ionomer cements (El- Tatari et al 2011).

Almas and co-workers compared the antibacterial effects of Miswak extract with eight commercial mouth rinses. They evaluated the antimicrobial effects on Pyogenes Faecalis, Mutans Streptococci, Candida Albicans plus Aureus and Epidermidis staphylococci by determining the inhibition zones. In their study, none of the solutions was considered a gold standard; they compared the antimicrobial effect of Miswak with that of each mouth rinse and the antimicrobial effects of the eight mouth rinses with each other. According to their results, mouth rinses containing chlorhexidine had the greatest antibacterial effects, while mouth rinses containing cetylpyridinium had moderate effect; Miswak extract had a low effect ( Almas et al 2005).
