This study consisted of two trials. Trial 1 compared the meswak with the toothbrush when used twice and five times a day. Trial 2 compared habitual meswak users with toothbrush users. Under experimental conditions, a significant reduction in gingivitis was found both buccally (p less than 0.01) and lingually (p less than 0.05) after using a meswak five times a day compared with a conventional toothbrush. Twice a day brushing with a meswak produced a significant reduction in gingivitis buccally (p less than 0.005) compared with toothbrushing, but lingually the difference was insignificant. There were no significant differences in plaque scores between a meswak and a conventional toothbrush when brushing was continued five times a day. Plaque scores became significantly higher when a meswak was used only twice a day compared with toothbrushing, specifically on the lingual surfaces of the teeth (p less than 0.01). Habitual meswak users showed a significant reduction in gingival bleeding (p less than 0.05) and interproximal bone height (p less than 0.02) compared with toothbrush users. The differences in plaque scores and pocket depth measurements between the two groups were insignificant. The results imply that a meswak, used five times a day, may offer a suitable alternative to a toothbrush for reducing plaque and gingivitis. However, meswak may not be sufficient for maintaining interproximal dental health when used without the support of other oral hygiene aids.