I HAVE noticed in recent years that there is the increasing presence of television programmes which promote alternative medicine. There has been no official regulation in place to curb the outrageous claims of some on these so-called herb doctors.

Despite the fact that my belief in alternative medicine is certainly not strong enough to motivate personal use, I cannot sincerely dispel its importance.

For example, why is it that despite in Jordan, Saudi Arabia and United Arab Emirates there is no significant water fluoridation nor comprehensive preventative programme, yet the population enjoys a relatively good oral health? The answer to that question involves a practice to which most of the world probably considers to be primitive.

Dental caries and gum disease determine the level of oral health status of a person. Unfortunately, such diseases are so common, that eventually every adult in the world has one or both. Therefore, these two diseases can be considered a real public-health problem. And believe me, being a practising dentist for over two decades, I should know.

In general, every country has, and should have, its own system to prevent and cure its nation from diseases according to its resources and culture. I have always suggested through this medium that the government should establish a National Agency for Disease Control. Dentists and physicians trained in the Western scientific systems usually have views on the prevention of oral and general disease that differ basically from those of local communities.

Surprisingly, instead of focusing on, and knowing, the real causes of the  two major dental diseases (which are simply dirt and diet), and instead of directing all the efforts to invent and encourage the use of effective tools to prevent and control these two diseases effectively, the profession has fallen in treatment which consumes too much time, resources, effort and money.

Chewing-sticks are commonly used in Jordan, Saudi Arabia and the United Arab Emirates for oral hygiene, religious and social purposes. Here at home, some years ago, especially in rural areas, the chew-stick was popular. Blacksage and neem stalks were
commonly used to clean one’s teeth. The most studied chew-sticks are the Miswak, Fagara, Zanthoxyloides, Serindeia wernikei, Neem, Paku and Acaccia arabica. Research was conducted mainly in Nigeria, where 90% of the population uses the chew-stick. In India, one can buy a neem chew-stick in numerous stores. Many advertisements appear saying not to use a toothbrush, but rather a chew-stick, which  is far better.

Recently, the World Health Organization (WHO) has recommended and encouraged the use of these sticks as an effective tool for oral hygiene. It was confirmed by the experts that the toothbrush is not superior to the chew-stick as regards its capacity to remove dental plaque. In fact, the juice extracted from most chew-sticks have been found to have strong antibacterial activity against some oral Staphylococcus aureus, and on Anaerobic Streptococcus. The use of the chew-stick is entirely consistent with the Primary Health Care (PHCA) Approach Principles, and in particular that of a focus on prevention, community participation and the use of appropriate technology. By using it, the notion of self-reliance can be encouraged and implemented in poor countries where it is available locally and does not need technology or expertise, or extra resources to manufacture it. It can be used by both children and adults, thus it is appropriate for all societies.

I recall that in the late 1980s, a Minister of Health told me he was seriously contemplating introducing chew-sticks as part of our national oral health programme. But whether we use a toothbrush or a chew-stick, the fact remains that the ‘secret’ to good oral health is the effective control of dental plaque, which can be achieved by either items.