by Fekadu Fullas, Ph.D.
How did people clean their teeth and maintain oral hygiene before the advent of modern toothbrush, paste and the whole gamut of other techniques? Obviously, in olden times modern techniques were not known. Dentistry as we know today didn’t exist then. Even today, many people in different parts of the world, especially in rural areas, rely on plant-based toothbrush sticks to clean their teeth. This brief article will examine plants and parts thereof that are used for this purpose in Ethiopia. It will also provide a glimpse into some studies on the possible efficacy of this traditional method of cleaning teeth.
The World Health Organization (WHO) puts the global prevalence of dental caries among school children at 60-90%. In some African countries, it ranges from 24-43%. According to a couple of studies, the prevalence of dental caries in Ethiopia is in the range 36.3-47.8%. The high prevalence has been attributed to poor oral hygiene coupled with lack of, or inconsistent tooth brushing habits, and the type of diet. In a study done by Amare Teshome et al. (2016), it was shown that there was clear association between tooth brushing and the incidence of dental caries among school children in Finote Selam town, Ethiopia.
The use of toothbrush sticks (in many cases also known as chewing sticks) is widespread in Ethiopia, both for esthetic and hygienic purposes. While preparing this article, the writer was reminded (after a few inquiries) of a couplet which runs something like:
Ye Harar mefaqia t’rs yane’tal alu
Endtlikilgn lemime’taw hulu
Although the focus is not per se on ‘ye Harar mefaqia,” the couplet puts the write-up in a broad context.
In 1999, Kassu et al reported on the antibacterial activities of 20 plants that are used commonly as toothbrush sticks in Ethiopia. These plants are listed below along with their scientific names:
Chifrig (Sida cunefolia); keret (Osyris abyssinica); limitch (Clausena anisata); ambil–baye, kofra (Pittosporum viridiflorum); zana (Stereospermum kunthianum); wawate (Rhamnus sp); adeya (Salvadora persica); akeya (Salix subserrata); amja ((Hypericum revolutum); dingetegna (Taverniera abyssinica); hidakiltu (Cadaba sp.); kacha (Agave sisolana); kechemo (Myrsine africana); mefaqia (Ligustrum vulgare); mito (Jasminum stans); tife (Olinia rochetiana); weira (Olea africana); wulkifa (Dombeya geotzenii); zembaba (Phoenix reclinata) and birbira.
Most of the plants listed have also folk medicinal uses. In the majority, the stems are used as toothbrush sticks. The roots are used in the case of chifrig and dingetegna, while the stem-bark is used in the case of zana and wulkifa. Some have an alleged power as mestefaqr, meaning their use has the “magic” of drawing women to men. The three most common toothbrush sticks in decreasing order of preference are derived from zana, adeya and kacha.
South African researchers Vuuren and Viljoen (2006) studied chfrig, keret, limitch, zana, ambil-baye (from the above listed plants) in addition to Maerua oblongifolia (identified also as wawate by the authors) and kosher ser (Dovyalis abyssinica).
According to Kassu et al, all crude extracts they examined showed weak antimicrobial activity when tested against two selected bacteria. However, on further test (serial dilution assay) kacha, akeya and wulkifa showed significant inhibition of bacterial growth.
A more detailed study by Vuuren and Viljoen reported moderate to good antibacterial activity for the seven plants that they examined (wawate, chfrig, kosher ser, ambilbaye, keret, limich and zana). In this study, a wider range of test micro-organisms was used, inclusive of four Gram-positive, two Gram-negative bacterial strains, two yeast species and a clinical isolate from the oral mucosa. The authors selected the test organisms based on the potential role the latter play in causing dental diseases. The most efficacious stick was found to be the roots of chifrig. The conventional antimicrobial ciprofloxacin was used as a control.
It has been speculated that the mere mechanical action of the toothbrush sticks may remove plaques contributing to the reduction of dental caries. The antibacterial properties of the plants may also contribute towards the reduction of pathogenic bacterial flora. However, extrapolation of in vitro results to the actual oral environment may not always be rational. The nature of compounds in the plants studied responsible for the observed antimicrobial activities has not been determined. More conclusive studies are needed to establish the efficacy of Ethiopian traditional toothbrush sticks.
- Teshome A, Yitayeh A, Gizachew M. Prevalence of dental caries and associated factors among Finote Selam primary school students aged 12-20, Finote Selam town , Ethiopia. OHDM. 2016; 15 (1): 36-41.
- Ayele FA, Taye BW, Ayele TA, Gelaye KA. Predictors of dental caries among children 7-14 years old in Northwest Ethiopia: a community-based cross-sectional study. BMC Oral Health. 2013; 13: 7
- Kassu A, Dagne E, Abate D, Castro A et al. Ethnomedical aspects of the commonly used toothbrush sticks in Ethiopia. East Afr Med J. 1999; 11: 651-653.
- Vuuren v SF, Viljoen AM. The in vitro antimicrobial activity of toothbrush sticks used in Ethiopia. S Afr J Bot. 2006; 72: 646-648.