Aggressive or improper toothbrushing techniques may have a detrimental implact on the gingiva. The purpose of this study was to examine the relationship between chewing sticks (Miswak) and gingival recession. Gingival recession was measured on the mid facial surfaces of the incisors, canines, and premolars in 238 patients presenting for routine dental appointments. All patients had been interviewed previously regarding their oral hygiene habits and use of Miswak. Patients were divided into three groups: Miswak group, toothbursh group, and Miswak/toothbrush group. The Miswak users had significantly more (P - .05) sites with gingival recession than did the toothbrush users. Furthermore, the severity of the recession was significantly more (P - .05) pronounced in the Miswak users than it was in the toothbrush users.