The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 13 , ISSUE 2 ( March-April, 2012 ) > List of Articles


In vitro Antimicrobial Comparison of Chlorhexidine, Persica Mouthwash and Miswak Extract

Amir Moeintaghavi, Hamidreza Arab, Mehrangiz Khajekaramodini, Rohollah Hosseini, Hossein Danesteh, Hamed Niknami

Citation Information : Moeintaghavi A, Arab H, Khajekaramodini M, Hosseini R, Danesteh H, Niknami H. In vitro Antimicrobial Comparison of Chlorhexidine, Persica Mouthwash and Miswak Extract. J Contemp Dent Pract 2012; 13 (2):147-152.

DOI: 10.5005/jp-journals-10024-1111

Published Online: 01-10-2012

Copyright Statement:  Copyright © 2012; The Author(s).



Herbal mouthwashes, such as persica (Salvadora persica, mint and yarrow extracts) and miswak extract have been shown to decrease gingival inflammation and plaque accumulation. The aim of this study was to compare the antimicrobial activities of persica and miswak extract with the conventional mouthwash chlorhexidine against Streptococcus salivarius, Streptococcus sanguis, Lactobacillus vulgaris and Candida albicans.

Materials and methods

In this in vitro study, blood-agar culture (Merk, Germany) was used to grow the streptococcus strains, saburd-dextrose culture (Merk, Germany) was used to grow C. albicans and MRS-agar was used to grow L. vulgaris. Various concentrations of these substances (0.1, 0.05 and 0.025% of miswak extract, 0.1, 0.05, 0.025 and 0.0125% of persica, 0.2, 0.1, 0.05 and 0.025% of chlorhexidine) were added to paper disks, separately, inserted into culture plates and transferred into the incubator. The inhibition zone around each disk was measured after 24 hours and the data was analyzed by the Kruskal-Wallis test.


Chlorhexidine possessed antibacterial activity at all concentrations tested. It was more effective than persica and miswak at all concentrations on S. salivarius (p = 0.022 for 0.1%, 0.009 for 0.05 and 0.025%). It had greater effect than the other two tested material on S.sanguis only at concentration 0.01%. Chlorhexidine was the most effective against S.salivarius; persica was the most effective against Lactobacillus (p = 0.005) and the least effective against S. salivarius; and miswak extract was the most effective against S. salivarius and S. sanguis at concentrations 0.1 and 0.05% (p = 0.005) and ineffective against L. vulgaris. None of these mouthwashes were effective against C. albicans.


This study revealed that chlorhexidine remains the gold standard as an antimicrobial agent, although herbalbased mouthwashes do have marginal antimicrobial activities. It is necessary to conduct more clinical and microbiological studies focusing on periodontal pathogens and anaerobic microorganisms.

Clinical significance

Mechanical plaque control is the main way for periodontal disease prevention and mouthrinses are used to improve its efficacy. Based on the results of this study, chlorhexidine has the most antibacterial effect and although persica mouthwash and miswak are routinely used in some Asian countries their antibacterial efficacies are suspected.

How to cite this article

Moeintaghavi A, Arab H, Khajekaramodini M, Hosseini R, Danesteh H, Niknami H. In vitro Antimicrobial Comparison of Chlorhexidine, Persica Mouthwash and Miswak Extract. J Contemp Dent Pract 2012;13(2):147-152.

PDF Share
  1. Mouthrinses as an antibacterial adjunct in periodontal treatment. J Can Dent Assoc 1994;60(10):906-11.
  2. Effect of polyhexamethylene biguanide mouthrinse on bacterial counts and plaque. J Clin Periodontol 2001;28(12):1121-26.
  3. Clinical effect of chlorohexidine mouthwashes on patient undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop 1997;111(6):606-12.
  4. Efficacy of chlorhexidine mouthrinses with and without alcohol: A clinical study. J Periodontol 2002;73(3):317-21.
  5. Effect of applying chlorhexidine antibacterial agent on the shearbond strength of orthodontic brackets. Angle Orthod 1996;66(4):313-16.
  6. An in vitro investigation of anti microbial activity of an herbal mouth rinse. J Clin Dent 1998;9(2):46-48.
  7. An in vivo comparison of the antimicrobial activities of three mouthrinses. J Clin Dent 1998;9(2):43-45.
  8. Inhibiting effect of aqueous extracts of eight Nigerian chewing sticks on bacterial properties favouring plaque formation. Caries Res 1983;17(3):253-57.
  9. The effect of Salvadora persica extract (miswak) and chlorhexidine gluconate on human dentin: A SEM study. J Contemp Dent Pract August 2002;(3)3:27-35.
  10. Miswak (chewing stick) and its role in oral health. Postgraduate Dentist Middle East 1993;3(4):214-18.
  11. In vitro antimicrobial effects of aqueous and alcohol extracts of miswak (chewing sticks). Cairo Dental Journal 1997;13(2):221-24.
  12. The effect of the extract of the miswak (chewing stick) used in Jordan and the Middle East on oral bacteria. Int Dent J 1995;45(3):218-22.
  13. Subgingival plaque microbiota in Saudi Arabians after use of miswak chewing stick and tooth brush. J Clin Periodontol 2004;31(12):1048-53.
  14. Periodontal status of adult sundanse habitual users of miswak chewing sticks or toothbrushes. Acta Odontol Scand 2000;58(1):25-30.
  15. An in vivo study of the plaque control efficacy of persica: A commercially available herbal mouthwash containing extracts of Salvadora persica. Int Dent J 2004;54(5):279-83.
  16. The inhibiting effect of aqueous Azadirachta indica (Neem) extract upon bacterial properties influencing in vitro plaque formation. J Dent Res 1996;75(2):816-22.
  17. Clinical comparison between the effect of persica and chlorhexidin 0.2% on the dental plaque and periodontal inflamation. J Shahid Beheshti Dent Sch 2002;20(3):370-78.
  18. The antimicrobial effect of seven different types of Asian chewing sticks. Odontostomatol Trop 2001;24(96):17-20.
  19. The natural toothbrush. J Cline Dent 1997;8(5):125-29.
  20. Periodontal treatment needs among Saudi Arabian adults and their relationship to the use of the miswak. Community Dent Health 1991;8(4):323-28.
  21. Antibacterial effect of chlorhexidine on bacteria adsorbed onto experimental dental plaque. Diagn Microbiol Infect Dis 1996;26(3-4):109-15.
  22. An in vitro antimicrobial comparison of miswak extract with commercially available nonalcohol mouthrinses. Int J Dent Hyg 2005;3(1):18-24.
  23. The immediate antimicrobial effect of a toothbrush and miswak on cariogenic bacteria: A clinical study. J Contemp Dent Pract 2004;5(1):105-14.
  24. The antimicrobial effect of Azadirachtu indica (Neem) and Salvadora persica (Arak) chewing sticks. Indian J Dent Res 1999;10(1):23-26.
  25. Effect of extract of miswak on the in vitro growth of Candida albicans. Microbios 1994;80(323):107-13.
  26. In vitro antimicrobial activity of Salvadora persica L. Extracts against some isolated oral pathogens in Iraq. Turk J Biol 2008;32:57-62.
  27. Strong antibacterial effect of miswak against oral microorganisms associated with periodontitis and caries. J Periodontol 2008;79(8):1474-79.
  28. Analytical electron microscopy of chlorhexidine-induced tooth stain in humans: Direct evidence for metal induced stain. J Periodontal Res 1993;28(4):255-65.
  29. A review on phytochemical and pharmacological investigations of miswak (Salvadora persica Linn). J Pharm Bioallied Sci 2011;3(1):113-17.
  30. Identification and quantification of some potentially antimicrobial anionic components in miswak extract. Indian J Pharm 2000;32(1):11-14.
  31. Paraclinical effects of miswak extract on dental plaque. Dent Res J 2007;4(2):106-10.
  32. Effects of extracts of miswak and derum on proliferation of Balb/C 3T3 fibroblasts and viability of cariogenic bacteria. Int J Dent Hyg 2006;4(2):62-66.
  33. Effect of different mouthrinses on morning breath. J Periodontol 2001;72(9):1183-91.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.