IT has been established that dental caries (tooth decay) and gum disease significantly impact a person’s oral health status. Unfortunately, such diseases are so common that eventually, every adult in the world will have one or both. Therefore, these two diseases can be considered a significant public health problem, and indeed, they are among the most common ailments that humans suffer from.

Although I cannot sincerely dispel the importance of alternative medicine (including dentistry), I am not a consummate user nor a supporter of its widespread use. For example, why is it that in Jordan, Saudi Arabia, and the United Arab Emirates, there is no significant water fluoridation nor a comprehensive preventive programme, yet the population enjoys relatively good oral health? The answer to that question involves a practice that most of the world probably considers to be primitive – the use of neem chewsticks as the preferred toothbrush.

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 Western scientific systems typically hold views on the prevention of oral and general diseases that differ significantly 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 efforts to invent and encourage the use of effective tools to prevent and control these two diseases effectively, the profession has fallen into 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. Recently, on a visit to the USA, I observed various brands of neem chewsticks selling in some major supermarkets in New York and Miami. In fact, as I am writing this, I am in Miami, Florida, checking out those unconventional “toothbrushes.”

At home, the chew stick was popular in some rural areas several years ago. Black sage 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 Acacia arabica. Research was conducted mainly in Nigeria, where 90% of the population uses the chew stick. In India, one can buy a neem chewstick in numerous stores.

The World Health Organization (WHO) has recommended and encouraged the use of these sticks as an effective tool for oral hygiene. Experts have confirmed that the toothbrush is not superior to the chew stick in terms of its ability to remove dental plaque.

The juice extracted from most chew sticks has 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 Approach (PHCA) principles, focusing on prevention, community participation and the use of appropriate technology. By utilising it, the notion of self-reliance can be encouraged and implemented in impoverished countries where it is readily available and does not require technology, expertise, or additional resources to manufacture. Both children and adults can use it; thus, it is appropriate for all societies. Incidentally, some years ago, the Minister of Health told me he was seriously contemplating introducing the chew sticks informally as part of our oral health programme.