Introduction

In Nigeria, as in other developing countries, a very significant proportion of orofacial diseases are due to microbial infections.^{1, 2}  This being the case, there is widespread use of antibiotics in dental practice in these regions and this gives microorganisms enhanced opportunities for the development of resistance to a broad spectrum of antibiotics.  Antibiotics are also widely used and misused in the management of other infections within the region.³  The need to conserve antibiotics in order to prevent the selection of antibiotic resistant organisms has now been recognized⁴ and there is, therefore, the need to look for non-antibiotic substances with proven antimicrobial activity, which can be used in the treatment of microbial infections, including those that are encountered in dental practice.

Chewing sticks are used very widely in Africa and Asia as a means of maintaining oral hygiene.^{5, 6}  They are made from the roots, twigs, or stem of a plant.  The preferred part or parts are cleaned with water to remove dirt, cut to a convenient length which varies from 15-30 cm long, and tied into a bundle.  The user holds one end directly in his mouth and chews it into a fibrous brush-like fringe, which is used to scrub the surfaces of the teeth.  A combination of vertical and horizontal strokes of the “brush” on tooth surfaces removes plaque.  The tongue is scrubbed as well.  Cleansing movement is directed away from the gingival margin to avoid induced recession and undue damage to the gums.  Chewing sticks are used in the mornings before breakfast and at night after supper for daily oral hygiene maintenance.  About five minutes of complete devotion to this exercise is deemed adequate to achieve good cleansing.  According to Sote and Wilson⁷, chewing sticks obtained form a variety of selected plants are used as a traditional method of mechanical oral hygiene by up to 80–90% of Nigerians.  Studies by Danielsen et al.⁸, Van Palentstein Helderman et al.⁹, Aderinokun et al.¹⁰, and Almas and Al-Zeid¹¹ have demonstrated chewing sticks are at least as effective as toothbrushes in maintaining oral hygiene.  Sathananthan et al.¹²  reported Africans that use chewing sticks have fewer carious lesions than those that use toothbrushes, and their use has been encouraged by the World Health Organization.¹³  Apart from their mechanical effects, many of these chewing sticks have been shown to have significant antimicrobial activity against a broad spectrum of microorganisms.  In an early report Fadulu¹⁴ described the activity of several plant extracts against Streptococcus mutans, a cariogenic organism.  Since then several investigators including Akpata and Akinrimisi¹⁵, Wolinsky and Sote^{16, 17} as well as Rotimi et al.¹⁸ have made similar reports of the antimicrobial activity of chewing stick extracts.

	Page 2 of 9
Citation Number: Vol. 6, No. 3, Page 087