Toothbrushes - the Miswak Tree, by Mary Beth Spina
Money doesn't grow on trees, but toothbrushes do! At least they do in parts of East Africa and the Middle East, says UB dentist and researcher William Carl. Properly chewed into "brushes" and used correctly, the ends of sticks plucked from the desert's ever-green miswak tree have been effective natural toothbrushes for more than 1,000 years. The sticks contain chemicals that are helpful in fighting oral bacteria associated with dental decay and gum disease. "Oral health is generally good among the Rendille and Samburu nomads who call the Kaisut desert of northern Kenya home," says Carl, a senior cancer dental surgeon at Roswell Park Cancer Institute and clinical associate professor of fixed prosthodontics at the UB School of Dental Medicine. Carl was the dental member of a UB medical team that provided treatment to these desert-dwellers during two visits to Kenya.
Practicing "tree-side dentistry" and armed with very basic dental instruments, Carl collected information on the oral health and diet of the wandering population, extracting diseased teeth when necessary. "An appointed village elder routinely extracts the mandibular central incisors, or two lower front teeth, of members of these tribes in order for them to take nourishment should lockjaw (tetanus) develop later in life," he notes. The ritual is performed, without benefit of anesthesia, when tribe members reach their early teens. After the extractions, males receive a cow or camel; women are rewarded with a goat. Miswak sticks not only serve as natural toothbrushes when used correctly, but they contain oral health promoters such as chlorides, fluoride, silica, Vitamin C and flavenoids.
Carl says it's important to note that oral health is not equal throughout the Third World. "Members of the Mende tribe in Sierra Leone, for example, generally don't have the same high level of oral health and require more extractions due to a decay-causing diet and lack of natural sources to clean teeth and gums," he points out. Among the more than 100 Kenyan nomads Carl examined, he randomly selected and persuaded 37 to allow him to take plaque samples from around key teeth. Placing the samples in sterile containers, Carl brought them to the UB dental school for analysis by Joseph Zambon, an oral biologist and periodontist. Zambon's comparison of bacterial samples from the Kenyans and 37 Western New York adults in a control group showed virtually no difference in the kinds of disease-causing oral bacteria. Porphyromonas gingivalis and Prevotella intermedia were the predominant periodontal disease-causing organisms present in both groups. Among the control group, 62 percent was found to have p. gingivalis, as opposed to 64 percent of the nomads; 81 percent of both groups exhibited p. intermedia. However, there was a greater incidence of Fusobacterium nucleatum: 55% among the nomads vs. 22% percent in the control group. While this is believed to be the first sampling of oral bacteria from these nomadic tribes of Kenya, Zambon said other risk factors that contribute to periodontal disease, a major cause of adult tooth loss, could not be assessed. "The transient lifestyle of the nomads and lack of a setting in which to do refined scientific studies impairs our ability to do controlled research," says Zambon. Carl emphasizes that Western dentists should not try to impose impractical solutions in Third World nations, but instead should encourage the use of natural resources for good oral health. Attempts to force Western products for preventive dental health on poor or transient populations are doomed to fail. "Many clinics are short of supplies or are located in rural areas, miles from many of the people who would utilize their services," he says. Carl has received three international service awards from the American Dental Association. He is a longtime volunteer in dental projects that have taken him to Sierra Leone, Haiti and Honduras, in addition to Kenya.