Chewing sticks have been used for centuries as a tooth cleaning device. One of the most commonly used types is known as the miswak. Despite its wide use, few studies have examined its effects on the gingival health. The purpose of this study is to examine the relationship between miswak and gingival health in terms of pocket depths, periodontal disease severity and gingival recession. The incisors, canines and premolars were examined in a total of 264 patients who were seen for routine periodontal treatment. Information regarding the use of the miswak, oral hygiene habits, as well as clinical measurements of pocket depth, periodontal disease and gingival recession were obtained from patients charts. Patients were divided into two groups: a miswak group and a Toothbrush group. The results of this study indicated that the use of miswak may influence periodontal health and may be considered as a factor contributing to gingival recession. It is suggested that additional research is needed to examine the relationship between miswak and periodontal health.