I lived in Mali for a few years maybe thirty years ago, and in that time there were no toothbrushes anywhere. People brushed their teeth and gums with a short green stick (max 20 cm) from a neem tree. One end was chewed to form a sort of brush from the fibers, and there you go–no toothpaste, but the oils and sap from the fibers were a bit astringent and brushing teeth and gums did a great job.
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