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The effect of Siwak (Salvadora persica) on the color of teeth

Alaa al-Deen al-Helue1, Mohammad Sultan2
ABSTRACT Introduction: Siwak (Salvadora persica) has been used for many years. A lot of studies have been conducted in the past in to evaluate the antibacterial effect of Siwak. This study was done to assess the effect of Siwak (Salvadora persica) on the color of teeth. Methodology: The study consisted of 24 individuals (17 males. 7 females) with a mean age of 23. The subjects were advised to use Siwak 4 times a day for one month. The color of teeth (divided into three parts: cervical, middle and occlusal), Gingival Index, Plaque Index, Gingival Recession and Calculus Index were measured before and after using Siwak. We used a spectrophotometer to measure the color of teeth. Results: There were statistically significant differences in the spectrophotometer values before and after using Siwak (p=0.034, p<0.001, p<0.001 respectively). Conclusion: Siwak improves the color of teeth. Key Words: Salvadora persica, Siwak, Arak, tooth color. Introduction Salvadora persica (Siwak, Arak) is a species of Salvadora that is a genus of a tree or shrub in the plant family named Salvadoraceae [1]. Salvadaro persica is a tall shrub attaining the size of a small or middle sized tree (2-6 m high), with green leaves, drooping pale green branches, pale-greenish flowers and pink, white or red fruits [2]. Siwak is used everywhere in the world. Around 73.1% of people in Saudi Arabia use Siwak [3] of which 75% males and 66% females were regular users. Around 46% used Siwak after their meals and 14% used Siwak on the lingual and palatal surfaces of their teeth [4]. In Jordan, while around 20.5% used the toothbrush-plus-Siwak, only 3% used Siwak alone [5]. Siwak users have a significantly lower mean Gingival Index (GI) (less prevalence of gingivitis) compared to toothbrush users, but the latter have a significantly higher Mean Pocket Depth than the former [6]. The Siwak extract has a protective role for caries by raising the plaque pH [7] which is indicated by a significant difference in plaque pH between Siwak extract and a water rinse [7]. The saliva produced immediately after chewing Siwak showed a statistically significant increase in calcium and chloride, but a decrease in phosphate and pH when compared to controls. The Gingival and Plaque Indices, however, were significantly lower after brushing with Siwak [8]. Siwak has demonstrated antimicrobial activity against plaque bacteria [9]. The chemical analysis of Siwak extracts showed that Siwak contained a number of antimicrobial components such as Cl- (Chloride), SO- (Sulphate), SCN- (Thiocyanate) and NO- (Nitrate). This has been highlighted by a previous study in which Sudanese adults who regularly used Siwak had better oral health and lower levels of oral pathogens
15th

when compared to others who used modern toothbrushes regularly [10]. Teeth are typically composed of a number of colors and a gradation of color occurs from the gingival margin to the edge of each individual tooth [11]. Tooth discoloration varies in etiology, appearance, localization, severity, and adherence to the tooth structure. It may be classified as intrinsic, extrinsic, or a combination of both [12]. While, intrinsic discoloration occurs due to changes in structural composition or thickness of the dental hard tissues [11]. extrinsic discoloration has multi-factorial etiology such as smoking, tea, coffee and chlorhexidine [11]. Tooth color can be improved by a number of methods and approaches including whitening, toothpastes, professional cleaning by scaling and polishing, internal bleaching of nonvital teeth, external bleaching of vital teeth, and micro abrasion of enamel with abrasives and acids [13]. Tooth bleaching procedures are performed using materials such as sodium hypochlorite, sodium perborate, hydrogen peroxide and carbamide peroxide [12], which cause many side effects such as cervical root resorption, tooth sensitivity, mucosal irritation, enamel changes, genotoxicity and carcinogenicity [12]. This research study studies the role of Siwak, an alternative to tooth bleaching, and its effects on teeth color. Methodology A pre- and post-test methodology is used in this research study. A total of 24 (17 male, 7 female) students, with a mean age of 23 years, studying in their fifth academic year in the Faculty of Dentistry at the Aleppo University, Syria, volunteered to participate in the research study. This research study received ethical approval from the Committee of Ethics at the university. The ten anterior teeth were randomly chosen and each tooth was divided into 5 3 1 2 4 three parts namely: cervical, 4 2 1 3 5 middle and occlusal. Fresh Siwak (Salvadaro persica) from Saudi

Year Student, Faculty of Dentistry, Aleppo University, Syria; 2Department of Fixed Prosthodontics, Faculty of Dentistry, Aleppo University, Syria. Corresponding author: Alaa al-Deen al-Helue, Email: al-helue@hotmail.com

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Arabia was used in this research study because it is soft and also has a good taste (Figure 1).

Results
Table 1 Descriptive characteristic of the study participants n % Mean

SD 0.92752 0.37796

Male Female

17 7

70.83 29.17

23.1176 22.8571

Table 2 showed that there were statistically significant differences in the value of teeth (cervical, middle and occlusal) before and after using Siwak (p=0.034, p<0.001, p<0.001 respectively).
Figure 1: Fresh Siwak Table 2 Statistical differences in value of tooth color as measured by spectrophotometer before and after using Siwak Mean Teeth, SD p n Cervical Before 2.6771 240 .83397 0.034 After 2.6083 240 .78608 Middle Before After Occlusal Before After 2.3312 2.1875 2.3917 2.2896 240 240 240 240 .69492 .64543 .62441 .60203 0.000 0.000

Tooth color (value parameter) was measured using a spectrophotometer (Vita EasyShade Compact) [14] (Figure 2 and 3).

Discussion
Figure 2: Vita Easy-shade Compact

The appearance and color of teeth are of concern to a large number of people [11]. In addition, around 50% of people in United Kingdom perceived they had tooth discoloration [18]. There has been a recent increase in interest in the treatment of tooth staining and discoloration [11,18]. The color and appearance of teeth are a complex phenomenon, with many influencing factors such as, lighting, translucency, opacity, light scattering, gloss, and the human eye and brain influencing the overall perception of tooth color [19]. The measurement of tooth color is possible via a number of methods including visual assessment with shade guides, spectrophotometery, colorimetery and computer analysis of digital images [19]. The results showed that the Siwak improves the value of tooth color as measured by a spectrophotometer by a mechanical effect (micro abrasion), because it contains silica grains and sodium bicarbonate which act as abrasive agents which remove stains and provide whiteness to the teeth. Also, Siwak has a chemical effect, because it contains chloride [9,20]. Micro abrasion was indicated for the removal of isolated discolorations [21], stains from the outer layer of enamel [22] and improved the appearance of teeth [22,23]. There weren't any side effects for using Siwak because GI, PI, Calculus Indices after using it were lower than before [6, 7]. We also didn't notice any gingival recession for volunteers which disagrees with the findings of another study [6]. These findings suggest that there are no side effects of Siwak usage.

Figure 3: Demonstration of measurement of color using Vita Easy-shade Compact

The Gingival Index (GI) [15], Plaque Index (PI) [16], Gingival Recession and Calculus Index [17] were measured to determine the side effects of Siwak usage such as gingivitis or gingival recession. Tooth color, GI, PI, Gingival Recession and Calculus Indices were measured before and after the intervention i.e., Siwak usage. Detailed information about Siwak, its usage (4 times a day for one month) and side effects was provided to the volunteers. The post test values were calculated 30 days after the Siwak use to assess the effect of Siwak (Salvadaro persica) on the color of teeth. The data was analyzed using SPSS 16, and calculated for paired t-test results. P<0.05 was considered statistically significant.

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Conclusion We conclude that the Siwak changes the color of teeth by changing the value without any side effect. The chemical components of Siwak suggest that Siwak can improve tooth color by micro abrasion and a chemical effect. Because of the limitations (number of volunteers and period of intervention) of this research study, we need further studies to support our hypothesis. References
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Competing Interest The authors declare that they have no competing interests. Funding Siurces of funding: None Please cite this paper as: al-Helue AA, Sultan M. The effect of Siwak (Salvadora persica) on the color of teeth. Int J Stud Res 2011;1(4):138-40. doi: http://dx.doi.org/10.5549/IJSR.1.4.138-140 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Authors Contributions All authors contributed in research design, data collection, drafting article and analysis of data. al-Helue et al. Int J Stud Res 2011;1(4):138-40

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