Comparative Assessment of Clinical Parameters and Interleukin-6, Osteocalcin Levels in Postmenopausal Women with Periodontitis Following Non-surgical Periodontal Therapy with and without Miswak as an Adjunctive Dentifrice: An Observational Study

A BSTRACT Background: Periodontitis is a chronic inflammatory disease of tooth-supporting tissues, with postmenopausal women being more susceptible due to hormonal changes affecting bone metabolism and immune response. Osteocalcin (OCN) and interleukin-6 (IL-6) are key markers of bone turnover and inflammation. Miswak, a natural chewing stick with antibacterial and anti-inflammatory effects, may enhance periodontal therapy outcomes. Aim and Objectives: The objective of this study was to evaluate the adjunctive efficacy of miswak dentifrice with nonsurgical periodontal therapy (NSPT) in postmenopausal women with periodontitis by assessing clinical outcomes and salivary IL-6 and OCN levels. Materials and Methods: Postmenopausal women with Stage 3 periodontitis were assigned to control (NSPT + standard dentifrice) and test (NSPT + miswak dentifrice) groups. Clinical parameters – plaque index, gingival index, probing depth, and clinical attachment level – were recorded at baseline, 3, and 6 months. Salivary IL-6 and OCN were quantified at baseline and 6 months using enzyme-linked immunosorbent assay. Oral health–related quality of life was assessed through a Visual Analog Scale. Statistical tests compared intra- and intergroup differences. Results: Both groups showed improvement, but the miswak group exhibited greater reductions in probing depth, attachment loss, and IL-6 levels, along with a significant rise in OCN. IL-6 was more responsive to inflammatory changes, whereas OCN moderately reflected bone healing. Conclusion: Miswak dentifrice used adjunctively with NSPT enhances clinical outcomes, reduces inflammation, and promotes bone turnover in postmenopausal women. Larger trials are warranted to confirm these findings.