For centuries, chewing sticks have been used as a tooth-cleaning device. One of the most commonly used types is known as the Miswak. Despite its common use, few studies have examined possible effects on the gingiva and the surrounding structures. The purpose of this study was to examine the relationship between Miswak and periodontal health. The incisors, canines, and premolars were examined in 236 patients. All patients were interviewed regarding their demographic data, oral hygiene habits, and use of Miswak, Clinical examination included scoring of plaque, gingival inflammation, pocket depths, attachment loss, and gingival recession. Patients were divided into three groups: a Miswak group, a toothbrush group, and a Miswak/toothbrush group. The results of this study indicated that use of the Miswak may influence plaque accumulation and periodontal health.