This study compares the immediate plaque removal efficacy of the natural Miswak versus a traditional manual toothbrush using the Modified Bass technique among orthodontic patients. The main question it aims to answer is: Are there statistically significant differences in the post-brushing plaque index reduction between the dental arch side cleaned with Miswak and the contralateral side cleaned with a manual toothbrush?

The maintaining of excellent oral hygiene is a significant challenge for patients undergoing orthodontic treatment due to the presence of fixed brackets and archwires, which act as retentive areas for dental biofilm accumulation. While the conventional manual toothbrush is widely prescribed, the natural Miswak (Salvadora persica) serves as a popular traditional oral hygiene tool with documented mechanical and antimicrobial properties. However, there is a lack of split-mouth clinical trials directly evaluating and comparing their immediate mechanical efficacy in the presence of orthodontic appliances.

This study utilizes a split-mouth experimental design to minimize inter-individual variability, where each participant serves as their own control. The mouth of each patient is randomized to use the natural Miswak on one side and the conventional manual toothbrush on the contralateral side during a single clinical session with no subsequent follow-up.

Aim: To evaluate and compare the immediate efficacy of the natural Miswak versus a manual toothbrush (using the Modified Bass technique) in reducing dental plaque scores among a sample of patients with fixed orthodontic appliances at Al-Hawash Private University.

Inclusion Criteria:

• Patients aged between 18 and 30 years old.
• Presence of fixed orthodontic appliances (brackets and wires) on both upper and lower arches.
• Good general systemic health with the absence of any medical conditions that might affect oral health status.

Exclusion Criteria:

• Presence of advanced or aggressive periodontal diseases.
• Current smokers.
• Use of antimicrobial or antibacterial mouthwashes within 24 hours prior to the study session.
• Systemic antibiotic intake within the past 2 weeks preceding the experiment.
• Any physical or motor disability that could hinder the patient's capacity to perform proper tooth brushing.