Enamel demineralization and white spot lesion (WSL) development are prevalent side effects seen in almost half the patients undergoing fixed orthodontic appliance treatment The aim of the current study was to investigate the effect of miswak varnish on the incidence and severity of enamel demineralization around orthodontic brackets compared to fluoride varnish, and to investigate the combined effect of both miswak and fluoride varnishes together on enamel demineralization around orthodontic brackets.Eligible participants were equally allocated in one of 3 groups at random.• (FV group): Fluoride varnish (Fluoro-protector, Ivoclar-Vivadent, Schaan, Liechtenstein) was applied to teeth surface around orthodontic brackets.
• (MV group): Freeze dried aqueous miswak extract varnish was applied to teeth surface around orthodontic brackets.
• (CG group): Both fluoride and miswak varnishes were applied to teeth surface around orthodontic brackets.
The mean of microhardness tested at the distances of 10, 20, 30, 50,70 and 90 μm from the enamel surface in different test groups is shown in table 2. Statistically significant difference between test groups in enamel demineralization was observed at 10µm, 20µm and 30µm from enamel surface. Less demineralization was found in enamel in groups CG and FV in comparison with group MV. Statistically significant differences between the three groups were found at distances of 10, 20 and 30 μm from the enamel surface. The combined group showed the highest microhardness values (least demineralization) followed by the fluoride group. The miswak group had the least microhardness values indicating the greatest amount of enamel demineralization.