ミスワックの使用は成人の歯垢と歯肉炎を減少させるか？

Does the use of miswak reduce plaque and gingivitis among adults?

抄録

データソース 電子データベースPubMed（米国国立図書館アーカイブ）、EBSCOHost（Dentistry and Oral Sciences）（米国企業研究データベース）、Scopus（Elsevierアーカイブ）、Cochrane Database for Systematic Reviewsで、幅広い検索用語と適切なブール演算子、医学主題見出し語を用いて検索し、期間制限なく実施した。主要アウトカムは歯周病への影響とし、副次的アウトカムとして口腔衛生習慣を検討した。データ抽出と統合 データ抽出は1人の著者が行い、必要に応じてさらに著者が正確さと適切さを評価した。抽出されたデータは、筆頭著者、出版年、研究デザインと設定、サンプルサイズ、参加者の説明、介入と比較、臨床測定、評価間隔、ウォッシュアウト期間など。信頼区間を用いたI2検定が実施され、含まれる研究が方法論とアウトカム指標において異質性を示すことが示された。そのため、効果量のメタ分析にはランダム効果モデルを使用した。さらに、対象論文のサブグループ分析を行い、フォレストプロット形式で提示した。結果は、合計150の抄録がスクリーニングされ、10本のRCTが含まれ、9本が記述的メタ分析に利用された。その結果、平均歯垢スコア（p = 0.08; SMD: 0.39, 95% CI: 0.05-0.83） と平均歯肉炎スコア（p = 0.37; SMD: 0.13, 95% CI: 0.16-0.43） について考えると、ミスワックは歯磨きと同様の結果を提供すると主張した。結論 ミスワックスティックを歯磨きの補助として使用した場合、歯磨きと同様のプラーク低減効果が期待でき、プラークによる歯肉炎を低減できる可能性がある。しかし、この分野ではより多くのエビデンスが必要である。

Data sources Searches were performed using broad search terms and suitable Boolean operators and Medical Subject Headings terms on the electronic databases PubMed (US National Library archive), EBSCOHost (Dentistry and Oral Sciences) (US Corporate Research Database), Scopus (Elsevier Archive) and the Cochrane Database for Systematic Reviews with no relevant time limit.Study selection Randomised control trials were included where adults were participants and using miswak sticks to brush was the independent variable. The primary outcome reviewed was the effect on periodontal health, with secondary outcomes including oral health practices. Exclusion criteria were applied to studies including patients with orthodontic appliances.Data extraction and synthesis Data extraction was led by a single author, with further authors (where necessary) assessing accuracy and appropriateness. Data extracted included first author, publication year, study design and setting, sample size, description of the participant, the intervention and comparison, clinical measurements, assessment interval and wash-out period. An I2 test with confidence intervals was performed, showing the included studies to display heterogeneity in methodology and outcome measures. As such, a random effects model was used for the meta-analysis of effect size. Further subgroup analysis of the included papers was completed and presented in a forest plot format. The Cochrane risk of bias tool was employed.Results In total, 150 abstracts were screened, with ten RCTs included and nine utilised in a descriptive meta-analysis. The findings claimed that miswak offered similar outcomes to toothbrushing when considering mean plaque score (p = 0.08; SMD: 0.39 and 95% CI: 0.05-0.83) and mean gingivitis score (p = 0.37; SMD: 0.13, and 95% CI: 0.16-0.43). A further significant secondary outcome was noted, showing reduced mean plaque scores (p = 0.01; SMD: 0.68, and 95% CI: 0.14-1.22) and reduced gingivitis score (p = 0.04; SMD: 0.66, and 95% CI: 0.03-1.29) when miswak was used in addition to toothbrushing.Conclusions Miswak sticks may offer similar plaque reduction to brushing and may reduce plaque-induced gingivitis when used as an adjunct to toothbrushing. However, more evidence is required in this area.