Plaque Removal and Gingival Bleeding Using Biodegradable Toothbrushes: Salvadora persica, Bamboo, and Nylon: A Comparative Study

BACKGROUND There is little information available comparing eco-friendly products versus traditional plastic-based oral care implements. Therefore, this study was conducted to compare the plaque removal efficacy and bacterial contamination of biodegradable miswak (S. persica) toothbrushes with bamboo toothbrushes and conventional toothbrushes. MATERIAL AND METHODS This single-blinded, parallel randomized, observational comparative study comprised 30 participants aged 18-35 years. Participants were randomized into 3 groups of 10 participants each: miswak (S. persica) brush, bamboo brush, and regular toothbrush). Participants were trained on proper brushing technique. Plaque and bleeding scores were measured by Loe and Sillness and Ainamo and Bay indices, respectively, at baseline (T0), at 4 weeks (T1), and 8 weeks (T2). Microbial contamination on the bristles of all 3 brushes was also evaluated. Multigroup comparison was done using one-way ANOVA, whereas inter-group comparisons were made using post hoc Bonferroni correction. RESULTS All 3 groups had lower plaque scores at the end of 8 weeks. A statistically significant reduction in the bleeding index in the miswak group was seen from baseline to week 8, with a 16.68% reduction in bleeding sites. Similar reductions were seen in the bamboo brush (21.04%) and conventional brush (22.7%) groups. Regular toothbrushes had almost 4 times more microbial contamination than bamboo brushes and more than double the level of miswak toothbrushes. Significant difference with ANOVA test was seen among the 3 tooth brushes, with P value 0.001. CONCLUSIONS Miswak natural toothbrushes and bamboo toothbrushes can be as effective as a conventional plastic toothbrush.