Medical perspective

Covid-19 has made us recognize the power of one of the smallest creations of Allah: Viruses! The human oral cavity is home to a rich microbial flora, including bacteria, fungi, and viruses belonging to around 700 different species. This resident microflora also plays an active role in the maintenance of the healthy state by contributing to the host’s defenses and preventing colonization by exogenous microorganisms.

A poor oral hygiene allows bacteria in our mouth to have a feast on its debris and to release acids that cause tooth decay and gum disease. Gradually the soft plaque hardens into calculus which cannot be removed by brushing. Because the mouth is a primary gateway into the body, poor oral health can have negative consequences indirectly promoting other medical problems like cardiovascular diseases, respiratory infections, digestive problems, diabetic complications etc.

Many traditional methods of oral hygiene are practiced throughout the world, like toothpowder with the finger or with a toothbrush, charcoal powder with salt/oil, bark of a tree (miswâk sticks, neem, babool), tobacco powder, ayurvedic toothpowder, etc.

“Miswâk” is an Arabic word, which means “tooth-cleaning stick.” The usage of chewing sticks to clean the teeth can be traced backed to 3,500 BC by the Babylonians. A number of plant species are used to make chewing sticks, but the most popular one is Salvadora persica, which have been in use across South America, Africa, Asia and the Middle Eastern parts of the world. These sticks are popular among different cultures and languages by different names: “Arak” in Arabic, “qisa” in Aramaic, ‘‘qesam’’ in Hebrew, “mastic” in Latin and “Koyoji” in Japanese. There are around 182 species of plant from which a miswâk can be prepared, but the popular choice is S. persica all over the world. The popularity of miswâk became significantly widespread under the influence of Islamic culture.

Studies reveal that many benefits are obtained by use of the miswâk: It contains fluorides that are helpful in fighting against caries; the repeated action of chewing the miswâk produces an anti-cariogenic effect by releasing fresh sap into the oral cavity. Moderate concentrations of silica and sulphur along with small quantities of tannins and higher concentrations of sodium chloride help it to achieve a tooth paste like effect. Tissue healing was found due to its Vitamin C content. The presence of essential oils gives out a mild pungent taste which helps in stimulating the flow of saliva behaving as a buffering agent; calculus formation is retarded by high concentrations of chloride. Thus, the miswâk has its own medicinal properties for oral hygiene.

The development of toothpastes in more modern times started in the 1800s and the nylon based modern toothbrush in 1930s. Modern toothpastes typically contain abrasives (to remove plaques, calculus, tartars), fluorides (to prevent caries and control gingivitis), surfactants (to foam for uniform distribution), antibacterial agents (triclosan), remineralizers, as well as coloring and flavoring agents. Several studies have reported good clinical efficiency of tooth paste in maintaining oral hygiene along with modern toothbrushes. Usage of the toothbrush and toothpaste is quite popular among the masses and is recommended by the dental associations globally.

How should be my oral hygiene practice?

Now that we briefly have come to understand the Islamic and medical perspective in oral hygiene, how can I coordinate the two perspectives in this advanced modern era?

Various Dental Associations around the globe recommend brushing teeth twice a day with fluoride toothpaste for two minutes each time. From the Hadith we can conclude that the sunnah of the Prophet (ﷺ) is doing miswâk during ablution for the 5-time daily prayers, before and after sleep, soon after entering the home and on many other occasions. So, he might have brushed his teeth a minimum of 7 times a day.

Studies have been conducted evaluating the efficiency of (1) using only the miswâk, (2) using the miswâk along with the toothbrush & paste, and (3) using only the toothbrush & paste. The best result was observed in the combination use of toothbrush & paste along with the miswâk as an adjunctive. The efficiency of the miswâk alone depends on its freshness and its proper use.

My recommendation for the readers will be to use a toothbrush & paste at least twice a day and to use a well maintained miswâk during ablutions and other amâls (acts). If miswâks are not commonly available in your area, use a toothbrush or any material which act like bristles. According to Imam Ghazali, Nawawi, and Baghawi, if miswâk or any bristle like substance is not found, then use your fingers or rough cloth to fulfill the sunnah (Shafi’i fiqh).  If a person has no teeth, he should use his fingers to clean his gums.  This will help to meet all the spiritual rewards and benefits, as well as to take care of your oral hygiene too.

If you notice developing calculus especially in the back side of lower incisors do take professional assistance from a dentist. In my practice I have seen many patients who use miswâk regularly but they have had high grade calculus around the teeth which they were not aware of. This was the old calculus which accumulated before starting use of the miswâk.

Manner of using the miswâk

The miswâk should be properly prepared and maintained well. Use a straight and clean twig. Do wash it well before and after use.  It should be stored vertically while not in use, should be used exclusively in the mouth, and the use of both ends should be avoided. Each section of the mouth should be brushed at least thrice in a circular motion: start with the upper and lower jaw on the right-hand side followed by the left-hand side and then the front teeth to follow the sunnah. Cut the bristles (tip) of the miswâk every 1 – 2 days and begin afresh by biting or chewing on it to separate the fibrous ‘bristles’ and make it soft.  Change the miswâk frequently.  The miswâk is to be carried in a case with an opening to the air in order to maintain its freshness.

There is no specific du^Ca’ in the Hadith to be read at the time of using the miswâk, but the following du^Ca’ is being encouraged by fuqaha:

اللهم طهر فمي، ونور قلبي، وطهر بدني، وحرم جسدي على النار، وأدخلني برحمتك في عبادك الصالحين

Allahumma tahhir fami, wa nawwir qalbi, wa tahhir badani, wa harrim jasadi ‘alan nar, wa adkhilni birahmatika fi ‘ibadikas salihin

O Allah! purify my mouth, enlighten my heart, purify my body, make my body forbidden to Jahannam and admit me through Your Mercy among your pious slaves.

Allamah Ayni (RA) has also cited this du^Ca’. (Umdat Al-Qari, 887(5),31)

Purpose of cleanliness

Allah says in the Quran about the consequence of how we choose to live:

“Did you think that We had created you in play (without any purpose), and that you would not be brought back to us?” (Sûrah Al-Mu’minûn, 23: 115)

Allah says in another verse the purpose of our creation:

“I created not the jinn and mankind except that they should worship Me.“ (Sûrah Al-Dhârîyât, 51:56)

 Worship (ibâdah) is a comprehensive action which includes every aspect of human life including rituals, social and individual activities which is intended to please Allah. The tasks of our daily life done according to the command of Allah and the way of our Prophet (ﷺ) becomes an ibâdah. Brushing the teeth and maintaining a good oral hygiene is a routine task done by all of us. Adding a pure intention of pleasing Allah and making it a habit prior to all our amâl [acts] will bring immense blessings for the here and the hereafter. In Ihya Al-^CUlûm (Vol 1, p. 182), it is written that the following intention shall be made when using the miswâk.

“I am cleansing my mouth for the recitation of Quran” or “I am cleansing my mouth so that I can make ẓikr of Allah,” etc. May Allah give us the ṭawfîq [success] to practice this sunnah. Âmîn.

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Sources:

Patel, Shruthi, Kumar. Clinical effect of miswak as an adjunct to tooth brushing on gingivitis. J Indian Soc Periodontol. 2012 Jan-Mar; 16(1): 84–88. https://www.researchgate.net/publication/225044881_Clinical_effect_of_Miswak_as_an_adjunct_to_tooth_brushing_on_gingivitis

Husain A, Khan S. Miswak: The miracle twig. Arch Med Health Sci 2015; 3:152-4.

My thanks to Sheikh Idris, New York, for assistance in verifying the narrations of the quoted ahadith.