WHY is it that despite the fact that in most countries in the Middle East, there is no significant water fluoridation or comprehensive preventive dental programme, yet the populations enjoy relatively good oral health? The answer to that question involves a practice 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. So in general, every country should have its own system to prevent and cure its nation from diseases according to the resources and culture.
Dentists trained in the Western Scientific System usually have views on the prevention of oral disease that differ basically from those of local communities. Surprisingly, instead of focusing on, and knowing, the real causes of these two 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, effort and money.
Chewing-sticks are commonly used in Jordan, Saudi Arabia, and the United Arab Emirates for oral hygiene, religious and social purposes. The Ancient Egyptians were concerned about dental hygiene. We know this today, because they also had a habit of being entombed with their treasures. So we were able to discover that tombs from 3000 years before Christ contain small tree twigs, the ends of which had been frayed into soft fibres.
It may surprise you to know that when I was in New York less than three months ago, I saw chew-sticks selling there. Anyway, here at home, some years ago, especially in rural areas, the chew-stick was popular. Black sage and neem stalks were commonly used to clean one’s teeth. Now, it has been determined that chew-sticks from thirteen different plants not only contain substances that possess antibacterial properties, but have astringent, detergent and abrasive properties as well. These properties have encouraged some toothpaste laboratories to incorporate powered stems and/or root material in their products.
The chemical constituents of Salvadora Persica, for example, include trimethyamines, alkaloids, chlorides, high amounts of fluoride and silica, sulphur, Vitamin C, and small amounts of tannin, saponins, flavonides and sterols.
The most studied chew-sticks are the Miswak, Fagara Zanthoxyloides, Serindea wernikei, Neem, Paku and Acaccia Arabica. Research was conducted mainly in Nigeria, where 90% of the population uses chew-sticks.
Recently, the World Health organization (WHO) 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.
The use of the chew-stick is entirely consistent with the Primary Health Care Approach (PHCA) principles, and in particular that of a focus on prevention, community participation 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. The use of chew-sticks is catching on in industrialized countries.
Recently, I personally purchased in New York a pound packet of peppermint flavoured African/Jamaican chew-sticks. Ironically, many years ago when Dr. Cheddi Jagan was Prime Minister, as a dentist he mooted the idea of introducing chew-sticks on a national basis. The extent to which he was ridiculed is well known.