Some traditional habits in a geographical area can be beneficial to general health or vice versa may be harmful. Smoking, alcohol consumption, addiction and even inappropriate diet containing high fat, carbohydrate, and salt are unhealthy habits in all communities, which compromise human health and decrease the life span (
1). However, some habits are unique to a specific geographical area. Some of them may enhance personal health status and others may even be harmful to human health. For example, in Baluchistan area (Southeastern Iran), Derum is used as teeth cleaning by natives. It is a proper oral habit with abundant advantages.
Derum or twig toothbrush also named as Miswak, with its antibacterial properties is safe for oral and dental health and prevents from dental caries and gum disease. However, incorrect manipulation or excessive use can lead to dental abrasion (especially on the cervical margin surface of the tooth) (
2, 3). Miswak use has a religious origin. This tool is the first toothbrush that Muslims used for cleaning their teeth, 1400 years ago ( 4). There is a native plant named Salvadora persica in Baluchistan area and Miswak is extracted from it ( 3) ( Figure 1). This traditional toothbrush has been used since ancient time; Babylonian people (dating from 3500 B.C.) used twig toothbrush for the first time ( 4). Although synthetic toothbrush usage is an easy, comfortable, and proper method for teeth cleaning, more knowledge about the advantages of Miswak (herbal tooth-cleaning twig) and biochemical analyzing of it may help to discover new useful chemicals for oral and dental health promotion. Useful chemicals can be extracted from herbal teeth cleaning and added to toothpastes and oral mouthwashes ( 3).
Figure 1. Miswak tree and Miswak teeth cleaning twig are shown.
Salvadora persica extract (Miswak) contains sulfur (4.73%) that has bactericidal activity. Also, it contains Vitamin C (cause to tissue healing), silica (removing stains from dental surfaces) and tannins (decreasing dental plaque and gingivitis with inhabitation of glucosyltransferase) (
2, 5). Miswak usage can result in saturation of calcium in saliva and promotion of enamel remineralization. It has anti-cariogenic properties and contains resin that protects dental tissue against tooth decays ( 2, 5). Al-Bayati and Sulaiman have proposed that some extracts of Miswak (methanol and aqueous) have antibacterial efficacy on oral pathogens such as Lactobacillus acidophilus, Candida albicans, Streptococcus mutans, Staphylococcus aureus, Streptococcus pyogenes and E. faecalis ( 6). However, some studies have indicated that Salvadora persica extract (Miswak) has low antibacterial activity in comparison to other anti-plaque materials and oral disinfectants such as chlorhexidine gluconate and triclosan ( 4, 7).
Snuff (smokeless tobacco) consumption is another common habit in southeastern Iran. Snuff is addictive and is high-risk behavior. It is commonly used by native residents of Southeastern Iran. Snuff is made from pulverized tobacco leaves. It contains tobacco and other products, such as lime, that are carcinogen and in a long term can cause oral cancer (
8, 9) ( Figure 2). Snuff is an important risk factor for oral cancer. People who snuffed constantly for a long time are usually affected by oral cancer at the site of snuff placement in the oral cavity ( 9). The proximity of Southeastern Iran to Pakistan and Afghanistan borders leads to snuff and other agents such as areca nut products (Pan, Supari, Guthka, etc.) are easily available, and some people use them because of no awareness about disadvantages of these products ( 8, 10). Snuff taking and the use of Areca nut products is an improper oral habit, which hurts to oral and general health. These products are entered Iran via eastern borders. The use of Areca nut products is a common habit in Asian countries, including India, Bangladesh, etc. Areca nut products can cause oral submucous fibrosis, which had the highest potential to generate an oral premalignant condition. This disease is determined by severe limitation in oral opening and oral mucosa rigidity. The risk of oral cancer is very high in those who are afflicted with this condition ( 10).
Figure 2. Snuff box and oral cancer following the use of snuff are illustrated.
In Iran, Areca nut products are often used in the south of Baluchistan. The natives often use these commercial products while they have no sufficient knowledge about the disadvantages of them; even some consumers believe that these products are beneficial to health (
10). Furthermore, some natives believe that Supari facilitates the digestion of food, so they use Supari after a meal for better digestion of food, while it has a lot of side effects. Also, females more tend to Supari consumption. They use Supari for cosmetic purposes (owing to red color that supari imparts to the lips) while they have no awareness about the carcinogenic nature of Supari ( 10). Snuff taking and Areca nut usage for a long time both can cause oral cancer; hence, a number of studies reported cases of oral cancer are relatively high in Southeastern Iran. Considering the lack of sufficient knowledge about the disadvantages of Areca nut products or snuff consumption, patients with cancerous lesion use this product even after afflicted with oral cancer. Thus most patients attend to the clinic in end stages of oral cancer when the prognosis of the disease is poor and its survival rate is low.
It is necessary to plan policies for raising public awareness about the complications of the consumption of these products throughout mass media. Also, the prevention of the entrance of these materials to the country and inaccessibility to them are very important. It is required to diagnose oral cancer in the early stages and appropriate treatment is done on affected patients. There are still many unknown habits in different regions of Iran. Epidemiological studies on common habits, the causes, advantages, and disadvantages can help to increase the awareness about their effects on the general health condition. The information about community behavioral health and studying on it can cause to discover new risk factors of cancer or illnesses. In addition, some of those behaviors or habits may be beneficial to health and researching about them may help to discover new methods for illnesses treatment and increase general human health.