Influence of Hadiths and Islamic Scholars’ Opinions on Current Miswak Practice

*Corresponding author: Ahmad Zharif Ibrahim, Faculty of Dentistry, Universiti Sains Islam Malaysia, Level 15, Tower B, Persiaran MPAJ, Jalan Pandan Utama,55100 Kuala Lumpur, Malaysia Email: ahmadzharif@usim.edu.my Abstract: Following the introduction of toothbrush, the usage of miswak, a thousandyear-old tooth-cleaning tool, worldwide is declining but still exists, especially amongst Muslims. Muslims are using miswak because it is a part of sunnah and highly recommended by the Prophet Peace Be Upon Him (P.B.U.H). Although numerous hadiths on the importance of miswak exist, authentic resources on the methods of its usage are limited. Current techniques may be different from the method recommended in the resources. This study aims to investigate the practice of miswak amongst current users and according to hadiths and Islamic scholars. This work adopted a crosssectional descriptive design with purposive sampling amongst miswak users in Sri Petaling, Selangor. Questionnaires on the various aspects of using miswak as an oral hygiene tool were distributed amongst consenting participants. Results were analysed descriptively and compared with miswak practice mentioned in hadiths and scholars’ recommendations. Thirty-seven subjects participated in this study. Several miswak practices explained in the resources were practised by the participants. The use of miswak before ablution/prayer was highly recommended by the Prophet P.B.U.H. and was practised by all participants (100%). All participants used miswak that was not too dry or too wet as suggested by an Islamic scholar. Most current miswak users utilised miswak by following the guidelines mentioned in hadiths and recommendations by Islamic scholars. However, some aspects of miswak practice in Islamic resources were not practised by the subjects and vice versa.


INTRODUCTION
Miswak, or chewing stick, is made from the twigs, stems and roots of various plants and has been used as a toothcleaning tool throughout the world, especially in Asia, Africa, the Middle East and South America (Al Sadhan & Almas, 1999) for thousands of years (More, 2008). Miswak was used by ancient Babylonians, Greeks, Romans (Wu, Darout, & Skaug, 2001) and pre-Islamic Arabs (Rings, 1985). 'Miswak' or 'arak' in Arabic is also known by various other names, such as 'koyoji' in Japanese, 'mastic' in Latin, 'qesam' in Hebrew, 'qisa' in Aramaic (Bos, 1993), 'peelu' in Urdu (Husain & Khan, 2015) and 'kayu sugi' in Malaysia and Indonesia. Following the introduction of toothbrush in the late 15th century (Fischman, 1997), the usage of miswak has declined but still exists, especially amongst Muslims. Muslims are still using miswak because it is part of sunnah and is highly recommended by Prophet Peace Be Upon Him (P.B.U.H.).
Many authentic hadiths regarding miswak are mentioned in six authentic books of hadith's collection (Nordin, Mohsain, Tamizi, & Abdul Razzak, 2012). Thirty-six of these hadiths were mentioned in Sahih Bukhari and Sahih Muslim alone (Nordin, Mohsain, Tamizi, & Abdul Razzak, 2013). Prophet Muhammad P.B.U.H. highly recommended the use of miswak on the basis of a hadith narrated in Sahih Bukhari and Sahih Muslim: 'But for my fear that it would be hard for my followers, I would have ordered them to clean their teeth with miswak on every performance of ablution' (Sahih Bukhari,Hadith No. 887 & 7240 and Sahih Muslim,Hadith No. 589). Miswak is also one of the common sunnah of previous prophets as mentioned in a hadith by At-Tirmizi: 'Four things are from the sunnah of the prophets: Shy, well perfumed, use miswak and married' (Alias, Mohamed Ibrahim, & Mokhtar, 2016).
Prophet P.B.U.H. mentioned his preference on using miswak as explained in several authentic hadiths: 'Ten are the acts according to fitrah; clipping the mustache, letting the beard grow, using the miswak, snuffing up water in the nose, cutting the nails, washing the finger joints, plucking the hair under the armpits, shaving the pubes and cleaning one's private parts with water. The narrator said: I have forgotten the tenth, but it may have been rinsing the mouth"' (Sahih Muslim,Book of Purification,Characteristics of Fitra,Hadith No. 502). 'The Prophet P.B.U.H. said, it (miswak) is a purification for the mouth and it is a way of seeking Allah's pleasures' (Sahih Bukhari,Hadith No. 154).
Ibnu Qayyim said that miswak is useful for various reasons, which include refreshing the breath, strengthening the gums, clearing phlegm and the sight and preventing tooth cavities. He also said that miswak can maintain the health of the stomach; assist in digestion; clear the voice; make speaking fluent and motivate people to read the Quran, remember Allah and pray. Miswak also fights drowsiness and tiredness, pleases Allah, gratifies the angels and improves the practice of good deeds (Ibnu Qayyim, 2003).
Although numerous hadiths on the importance of miswak use exist, authentic resources on the methods of its usage are limited. Some of those hadiths mentioned the specific times on which the Prophet P.B.U.H. used miswak; these instances include before every prayer or ablution, when he woke up at night, when he entered his house, after waking and when reading the Quran (Ar-Rasyhid, 2014; Nordin et al., 2012;Wan Ahmad, Nik Saleh, & Wan Ismail, 2015).
A hadith that explained the method of using miswak by the prophet P.B.U.H. is narrated in Sahih Bukhari and Sunan Abu Daud, 'I came to the Prophet P.B.U.H. and I saw him carrying a miswak in his hand and cleaning his teeth, saying, "u' u', as if he was retching while the miswak was in his mouth" (Sahih Bukhari,Hadith No. 245 and Sunan Abu Daud,Hadith No. 49).
Some Islamic scholars have given their opinion to clarify the method for using miswak; these scholars include Ibnu Hajar Asqalani, who suggested brushing from the upper to the lower side of the teeth to prevent gum bleeding (Nordin et al., 2012). Alternatively, Imam Nawawi recommended that the best method for cleaning teeth is to use a brush horizontally starting from the right side of the mouth (Al-Nawawi, 1996. The technique of using miswak nowadays may be different from the method recommended in authentic resources. Therefore, this study aims to investigate the practice of miswak use amongst current users and according to hadiths and Islamic scholars.

METHODOLOGY
The study adopted a cross-sectional descriptive design amongst miswak users in Sri Petaling, Selangor. The location was selected based on a high number of Muslim miswak users available, especially in one particular mosque where Muslims from all over the country would gather for religious activities. Subjects were recruited using purposive sampling after ethical approval was obtained (USIM/FPg-MEC/2013/No. 3).
A questionnaire focusing on various aspects of using miswak as an oral hygiene tool was developed. The questionnaire included demographic data, the time using miswak, storage method and routines performed prior to miswak use. Content validation was performed by dental specialists and miswak users. The questionnaire was pretested amongst miswak users. The questionnaire was then distributed amongst consenting participants. The results were analysed descriptively by using IBM's Statistical Package for Social Sciences version 22 and compared with miswak practice mentioned in hadiths and scholars' recommendations.

RESULTS AND DISCUSSION
Thirty-seven subjects participated in this study. The sociodemographic data of the participants are provided in Table 1. The participants were all males comprising age groups of 18-25 years old (24.3%), 26-35 years old (32.4%), 36-45 years old (18.9%) and 46-60 years old (24.3%). Almost all of the participants, except for one Bidayuh participant, were Malays. They came from various educational backgrounds. Most had completed tertiary education (45.9%) and secondary school (32.4%). Tertiary education 17 45.9 Informal education 5 13.5 Comparisons between various aspects of miswak practice amongst current users and miswak practice described in hadiths and Islamic scholars' recommendations are tabulated in Table 2. Several routines and practices explained in hadiths and recommendations were practised by the participants.
All the participants (100%) used miswak before ablution or prayer. This practice was highly recommended by the Prophet P.B.U.H. and was explained in authentic hadiths as listed in Table 2. Half of the participants used miswak upon waking (59%), which was done by the Prophet P.B.U.H according to the hadith narrated by Imam Ahmad, Abu Ya'la and Tabrani (Ar-Rasyhid, 2014).
None of the participants used miswak when they entered houses and during qiamullail (night prayer). These specific times were mentioned in hadiths narrated in Sahih Muslim and Sahih Bukhari. Other than that, all participants washed the miswak prior to use (100%). Amongst the participants, 83.8% cut the bristles of the miswak and 91.9% removed the outer layer of the miswak before they used it. Aishah R.A. and Ibnu Qayyim Jawziyah recommended cutting and soaking the miswak prior to use for it to become soft and appropriate (Al-Asqalani, 1993;Ibnu Qayyim, 2003). This practice might be suggested because dry miswak may damage the gums (Almas & Al-Lafi, 1995). In the present study, the majority of the participants (83.8%) cut the miswak before they used it, and only 35% soaked the miswak before use.
Moreover, 75.5% of the participants used the miswak to clean their tongue in addition to their teeth. The Prophet P.B.U.H. was seen by their companion to clean his tongue with a miswak. This sunnah was followed by more than two-thirds of miswak users in this study. He also recommended cleaning the teeth with a miswak before reciting the Al-Quran as a way of respect for the Holy Book (Wan Ahmad et al., 2015). Nevertheless, only four of the participants used a miswak before Quran recitation.
The use of miswak as an oral hygiene tool amongst the participants was also influenced by recommendations from several Islamic scholars. All the participants used miswak that was not too dry or too wet by washing or wetting it before use as mentioned in the hadith by Abu Daud (Alias et al., 2016) and as suggested by Al-'Allamah As-San'ani and Syeikh Utsaimin (Ar-Rasyhid 2014). Almas and Al-Lafi (1995) suggested soaking miswak in fresh water for 24 h to soften natural fibres. However, soaking for more than 24 h can result in the loss of active ingredients and reduce it's the therapeutic effects. Various types of miswak are available in the market nowadays. Vacuum-packed miswak is usually soft and hence can be used directly without soaking.
Several aspects of miswak practice amongst current users were unavailable in hadiths and recommendations from Islamic scholars. Some of the participants used miswak prior to sleeping (48.6%) and before (18.9%) and after eating (32.4%). These habits might be influenced by their daily routine of oral hygiene with the modern toothbrush.
The participants stored miswak sticks in different ways (Table 3). Most of them stored miswak sticks inside their clothes' pocket (86.5%) after use. During storage, miswak was mostly placed vertically with the end facing upward (89.2%). As shown in Table  3, the participants used various sizes of miswak sticks. The most commonly used miswak sticks were 15-20 cm in length (65%) and 1.5 cm (43.2%) in diameter. A miswak should be 20 cm in length to be held adequately and controlled easily, and the best diameter for an adequately flexible and firm miswak should be 1 cm (Almas & Al-Lafi, 1995). Despite this recommendation, only 32.4% of the participants used miswak that was 1 cm in diameter. The guidelines for the holding technique, movement and starting side of miswak during brushing were not assessed in this study but were mentioned in hadiths and recommendations by Islamic scholars (Table  4). A study on miswak practice identified the two most common methods for holding a miswak. A total of 78.4% of miswak users in the study held a miswak with two of their fingers on its lower side and their other fingers on its upper side (Baharin, Ibrahim, Asa & Ramli, 2016). This method is the same as the holding technique described in the hadith narrated by Abdullah Ibnu Mas'ud (Abidin, 1992). However, this hadith is considered as 'gharib' or strange (Al-Dubyan, 2005). This holding method also has several variations, wherein the number and positions of the fingers on the upper and lower sides of the miswak are interchanged. Only 13.5% of the study participants used the other five-finger grip method. "And the sunnah in the method of using it is to hold the miswak in the right hand so that the small finger is below the miswak and the thumb is below the tip, and the other fingers are on top of the miswak". narrated by Abdullah Ibnu Mas'ud. (Abidin, 1992)

Movement of miswak
"Brush from the right side of the mouth and horizontally." (Al-Nawawi) "Used from the upper side to the downside of the teeth to prevent gum bleeding" (Ibnu Hajar Asqalani) Start miswak from the right side From 'Aishah R.A.:" The Prophet P.B.U.H used to like to start from the right side when he wears shoes, combs his hair, and cleans or washes himself and when he does anything else." (Al-Bukhari & Muslim) Islamic scholars provided two recommendations for miswak movement during brushing. Imam Al-Nawawi (2003) suggested using miswak horizontally (side to side), whereas Ibnu Hajar Al-Asqalani (1993) suggested using it vertically (up and down) to prevent gum injury. In the same study by Baharin et al. (2016), more than half of miswak users moved the miswak vertically during brushing, whereas only one-quarter used horizontal movement. A randomised control trial found that toothbrushing with vertical movement is better for tooth cleaning and less traumatic to the gums than toothbrushing with horizontal movements (Mastroberardino et al., 2014). This finding contradicts previous studies that found no correlation between movement and gum abrasion (Terézhalmy, Biesbrock, Walters, Grender, & Bartizek, 2008;Danser et al., 1998). However, modern toothbrushes were used in these studies.
As narrated by Aisyah R.A, the Prophet P.B.U.H would always start from the right side when he was wearing shoes, combing his hair and washing himself (Alias et al., 2016;Wan Ahmad et al., 2015). Miswak users may also be inspired by this sunnah of the Prophet P.B.U.H and adopted it in their miswak practice. This notion is supported by a previous study wherein 64.9% of miswak users were found to start brushing with a miswak from the right side (Baharin et al., 2016).
We acknowledge the limitations of this study. Nonrandomised purposive sampling used in this work might have allowed particular biases, such as the domination of the male gender over the female gender and that of the Malay ethnicity over others amongst the participants. Some aspects of miswak practice were not assessed although they were mentioned in hadiths and recommendations by Islamic scholars. These practices, namely, the movements of the miswak and the starting side of the miswak during brushing, may also influence miswak practice amongst current users. The small sample size in this study is not indicative of the whole population of current miswak users in Malaysia. However, the descriptions of miswak practice for oral hygiene care and Islamic influence on miswak practice may be useful for developing confidence in miswak practice according to sunnah and Islamic scholars amongst Muslims.

CONCLUSION
Most current miswak users are using miswak as an oral hygiene tool by following the guidelines mentioned in hadiths and recommendations by Islamic scholars. However, some miswak practices mentioned in hadiths and scholars' recommendations were not practised by the subjects and vice versa. Nevertheless, as long as the practice of miswak use is not different from the sunnah, specifically, not inflicting any injuries and achieving the objective of oral cleaning, the use of miswak as an oral hygiene tool can be beneficial. This practice will help in prevention of oral diseases and maintenance of oral health while obtaining spiritual benefits mentioned by the Prophet P.B.U.H. The use of miswak should not be limited to spiritual purposes but is also an alternative to the use of modern toothbrush.