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The miswak (miswaak, siwak, sewak, Arabic: سواك or مسواك) is a teeth cleaning twig made from the Salvadora persica tree (known as arāk, أراك, in Arabic). It is reputed to have been used over 7,000 years ago. The miswak's properties have been described thus: "Apart from their antibacterial activity which may help control the formation and activity of dental plaque, they can be used effectively as a natural toothbrush for teeth cleaning. Such sticks are effective, inexpensive, common, available, and contain many medical properties". It also features prominently in Islamic hygienical jurisprudence.

The miswak is predominant in Muslim-inhabited areas. It is commonly used in the Arabian peninsula, the Horn of Africa, North Africa, parts of the Sahel, the Indian subcontinent, Central Asia, Southeast Asia and Caucasus .[citation needed] In Malaysia, miswak is known as Kayu Sugi (Malay for 'chewing stick').

Religious prescriptions
A pack of miswak sticks.

The use of the miswak is frequently advocated in the hadith (the traditions relating to the life of Muhammad). Situations where the miswak is recommended to be used include before religious practice, before entering one's house, before and after going on a journey, on Fridays,[11] before sleeping and after waking up, when experiencing hunger or thirst and before entering any good gathering.[citation needed]

In addition to strengthening the gums, preventing tooth decay and eliminating toothaches, the miswak is said to halt further decay that has already set in. Furthermore, it is reputed to create a fragrance in the mouth, eliminate bad breath, improve sensitivity of taste-buds and promote cleaner teeth.[citation needed]
Hadiths concerning the miswak

It is often mentioned that the Islamic prophet Muhammad recommended the miswak's use.[12] He is quoted in various hadith extolling its virtues:[13][14]

Were it not that I might over-burden the Believers I would have ordered them to use Siwak (Miswak) at the time of every Prayer.[15]

Four things are from among the practices of the Prophets: Circumcision, Perfume, Miswak, and Marriage.[15]

Make a regular practice of Miswak for verily it is the purification for the mouth and a means of the pleasure of the Lord.[15]

Use the Miswaak, for verily, it purifies the mouth, and it is a Pleasure for the Lord. Jib-ra-eel (A.S.) exhorted me so much to use the Miswaak that I feared that its use would be decreed obligatory upon me and upon my Ummah. If I did not fear imposing hardship on my Ummah I would have made its use obligatory upon my people. Verily, I use the Miswaak so much that I fear the front part of my mouth being peeled (by constant and abundant brushing with the Miswaak)

Science
The World Health Organization (WHO) recommended the use of the miswak in 1986, but in 2000, an international consensus report on oral hygiene concluded that further research was needed to document the effect of the miswak.[3] Some of this further research has been done on a population of 203, and concluded, "that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users".[4] Yet another comparative study conducted on a sampling of 480 Saudi Arabian adults found that "the level of need for periodontal care in the sample chosen is low when compared with the findings of similar studies undertaken in other countries. The frequent use of the 'Miswak' was associated with a lower need for treatment".

Miswak has been recommended by world health organization for oral hygiene because of its availability, beneficial effect and affordability. The popularity of Miswak in Arab countries has meant that there have been several studies that have confirmed the ability of miswak to provide effective mechanical and chemical cleansing when used as an adjunct to other oral hygiene aids.

Fluoridated tooth paste and manual tooth brushes have been the standard of clinical preventive dental care for over 50 years.