الفهرس 
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Abstract
Periodontal disease is a chronic destructive inflammatory disease affecting the tooth-supporting tissues and is one of the most prevalent chronic infections in humans. The disease is caused by dental plaque, a biofilm in which gram-negative anaerobic microorganisms dominate. Plaque-associated periodontal diseases can be divided into gingivitis and periodontitis.
Treatment of periodontal diseases principally focus on addressing the etiologicbacteria or biofilm. The bacterial biofilm is disrupted and removed via scaling and root planning (SRP) procedures. Because mechanical means alone have limitations especially in the interproximal areas, greater interest has shown in chemical means.
Therefore, chemotherapeutic agents can play a vital role as adjuncts of mechanical plaque control methods. Chlorhexidine is considered the gold standard agent largely used as a mouth rinse for its clinical efficacy in chemical plaque control. However, it is expensive and has unwanted side effects such as extrinsic tooth staining, unpleasant taste, taste disturbance, sensitivity changes in tongue, and pain. Thus, the treatment with natural products could be used.
The most common type of chewing stick, Miswak, is derived from (Arak); Salvadora persica, a small tree or shrub with a spongy stem and root, which is easy to crush between the teeth. Miswak is a chewing stick used in many developing countries as a traditional toothbrush for oral hygiene. Several studies have claimed that chewing sticks are effective in reducing plaque and gingival inflammation. The value of chewing sticks is believed to be in their mechanical cleansing action and chemical constituents. The use of Miswak has been reported to inhibit the formation of dental plaque chemically and exert antimicrobial effect against many oral bacteria.
Therefore, the goal of this study was to investigate the clinical effect of two different concentrations; 25% and 50% of aqueous extract of Salvadora persica as an adjunctive therapy to scaling and root planing in the treatment of chronic gingival and periodontal diseases.
The present study was carried out on sixty patients with chronic gingivitis and mild chronic periodontitis. They were divided into two groups, the study group included fourty patients who were subdivided into two subgroups of twenty patients who had established chronic gingivitis and chronic mild periodontitis. Those patients were instructed to rinse with 10 ml of Salvadora persica extract at two different concentrations : 25% and 50% for three weeks. The control group included twenty patients who were subdivided into two subgroups of ten patients, each. Those patients were instructed to rinse with a placebo for three weeks. All patients underwent SRP treatment before receiving their mouth rinses. Clinical evaluation was performed using plaque index, gingival index and bleeding index at the baseline and three weeks after treatment.
Clinical results revealed that there was statistical significant difference in all clinical parameters for all patients after treatment. Comparing the clinical efficacy of the two concentrations used of Salvadora persica aqueous extract on patients with chronic gingivitis, results did not yield any statistical significant difference. On the other hand, in groups of periodontitis, there was a statistical difference in all clinical parameters measured except for the bleeding index.
In conclusion, these results suggest that the Salvadora persica aqueous extract mouth-rinse adjunct to SRP was effective in the treatment of chronic gingival and periodontal diseases. Such treatment would certainly be less costly and well tolerated by patient. Additional studies are needed to investigate the effect of of other forms of Salvadora persica as periochips or topical gel on other types of periodontal diseases. Further research will be important to identify the more detailed benefits of Salvadora persica as a therapeutic and preventive agent for periodontal diseases.