Background: Oral hygiene practices are deeply rooted in cultural, religious, and socioeconomic contexts. In Yemen, the use of the miswak—a traditional chewing stick—remains prevalent despite the global rise in modern dental care tools. This study compares the oral hygiene behaviors, perceptions, and outcomes among individuals who primarily use miswak versus those who use toothbrushes in Ibb City, Yemen.

Methods: A cross-sectional survey was conducted with 300 patients (150 miswak users and 150 toothbrush users) attending dental clinics in Ibb City. Participants completed structured questionnaires assessing demographics, cleaning behaviors, oral health perceptions, dental visit frequency, use of supplementary cleaning tools, and knowledge sources. Descriptive and comparative analyses were performed to identify behavioral trends and health-related outcomes.

Results: Miswak users were more likely to reside in rural areas (39.3% vs. 32.7%) and cite religious leaders or family as their primary sources of hygiene knowledge. In contrast, toothbrush users more frequently report guidance from dentists or digital media. Toothbrush users were more likely to visit a dentist regularly (64% visited at least once a year vs. 44.7% of miswak users) and showed higher use of modern adjuncts such as dental floss and mouthwash. Miswak users perceived their cleaning method as more effective (63.3% vs. 34.0%) yet reported slightly higher rates of bad breath and gum bleeding. Use timing and technique varies significantly, with toothbrush users more likely to clean both morning and night and demonstrate consistent circular or vertical brushing motions.

Conclusions: The findings highlight distinct behavioral and cultural patterns between miswak and toothbrush users in Yemen. While miswak use remains tied to traditional knowledge and is perceived as effective by its users, there is a need for enhanced oral health education integrating both traditional practices and modern dental care strategies. Tailored public health campaigns—respectful of cultural norms—could help bridge gaps in awareness and preventive care utilization.