Prevention of dental caries has taken a great importance in the last decade. The use of herbal and natural products became mandatory to avoid the side effects of commercially available medications. Aim of the study; the aim was to investigate the anti-cariogenic effect of miswak and grape seed extract (GSE).

Patients used Miswak sticks, grape seed extract mouth wash and fluoride mouthwash twice daily for three month. Saliva samples were collected at base line and after one month and three month. Assessment of bacterial count and saliva buffering capacity were performed at base line and after one and three month.

Inclusion Criteria:

• Patients with high caries risk
• Males or females
• Medically free patients
• Patients approving to participate in the study

Exclusion Criteria:

• Patients who were on antibiotic therapy or corticosteroid therapy for 30 days before the examination
• Patients had history of professional cleaning in the last 15 days
• Patients with exposed pulp
• Evidence of parafunctional habits
• Patients with developmental dental anomalies
• Patients undergoing or will start orthodontic treatment
• Patients with removable prosthesis
• Periapical Abscess or Fistula