Knowledge, Awareness, and Practice Towards the Use of Salvadora persica L. (Miswak) Chewing Stick: A Scoping Review.

Background: The benefits of Salvadora persica L. chewing stick as an oral hygiene tool have been extensively demonstrated in clinical studies worldwide. Nonetheless, there are wide variations in knowledge, awareness, and practice of these chewing sticks across different populations. This scoping review aims to synthesize current knowledge gaps and practice patterns to inform potential standardization of S. persica use. Methods: Following PRISMA-ScR guidelines, a systematic literature search was conducted by using the Web of Science, Medline, and Scopus databases, covering studies published up to June 2025. Results: Twenty-seven studies were included, involving diverse populations from Africa, the Middle East, and Asia. Knowledge, awareness, and practice of S. persica chewing sticks varied significantly by region, demographic group, and mode of use. Most studies evaluating awareness and knowledge reported that a lack of information on proper use leads to reduced practice. There was no standardized method of use reported. Behaviors varied in terms of preparation of the stick before use, frequency and duration of use, angle or technique during brushing, and storage methods after use. Conclusions: The findings emphasize the need for culturally sensitive clinical guidelines and community health education programs to inform both the public and healthcare professionals about the use of S. persica chewing sticks-particularly in populations with limited access to other oral hygiene tools.