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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 103-106

Effectiveness of green tea on plaque-induced gingivitis – A clinical trial


1 Associate Professor, Department of Dentistry, Silchar Medical College and Hospital, Silchar, Assam, India
2 Registrar, Department of Dentistry, Silchar Medical College and Hospital, Silchar, Assam, India

Date of Submission12-Nov-2021
Date of Acceptance30-Nov-2021
Date of Web Publication23-Dec-2021

Correspondence Address:
Dr. Purobi Choudhury
Flat No. 314, Suncity Apartment, Meherpur, Silchar, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_38_21

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  Abstract 


Background: Plant extracts have been widely used in the topical and oral applications for disease treatment. Green tea (Camellia sinensis) has been reported to be useful for the prevention of periodontal disease and maintenance of oral health.
Aim and Objectives: We aim to assess the efficacy of Green tea mouthwash on plaque-induced gingivitis as the most common form of periodontal disease.
Methodology: A single-blinded placebo-controlled clinical study will be conducted with two groups as case and control, each consisting of 40 female patients with the age group of 14–16 years. Both the groups will be equally distributed to receive either 5 ml of Green tea 5%two times/day or normal saline with the same dosage.
Results: Gingival index (Sillness and Loe), plaque index (Loe and Sillness) were recorded at baseline and five consecutive weeks and there was a decrease in score.
Conclusion: Green tea mouthwash may be a safe and feasible adjunctive treatment for inflammatory periodontal diseases. Therefore this study was conducted for evaluating the effect of green tea.

Keywords: Camellia sinensis, clinical trial, gingivitis, mouth wash


How to cite this article:
Choudhury P, Chakraborty M. Effectiveness of green tea on plaque-induced gingivitis – A clinical trial. Int J Prev Clin Dent Res 2021;8:103-6

How to cite this URL:
Choudhury P, Chakraborty M. Effectiveness of green tea on plaque-induced gingivitis – A clinical trial. Int J Prev Clin Dent Res [serial online] 2021 [cited 2022 Jul 5];8:103-6. Available from: https://www.ijpcdr.org/text.asp?2021/8/4/103/333548




  Introduction Top


Plant extracts have been widely used in topical and oral applications for gingivitis and periodontitis. Green tea comprising polyphenol components as catechin ©, epicatechin (EC), gallocatechin (GC), epigallocatechin (EGC), EC gallate (ECG), EGC gallate (EGCG). Among these, ECG and EGCG have special anticollagenase activity and hence have been said to be the most potential contents for periodontal adjunct therapies. Sole treatment with scaling and root planing may lack achievement in complete eradication of the disease hence adjunct with chemical elimination helps the disease treatment, prevention of periodontal disease, and maintenance of oral health. Gingivitis and periodontal disease are mainly derived by the invasion of bacteria and host immune response. Plaque-induced gingivitis is the most common form of gingivitis and is induced by the accumulation of microbial plaque in reducing the disease potentiality.[1],[2],[3],[4]

Aims and objectives

To investigate the effect of green tea (Camellia sinensis) mouth wash in plaque-induced gingivitis, the most common form of plaque-related periodontal disease.


  Materials and Methods Top


A single-blinded randomized placebo-controlled clinical trial was conducted among female patients in outpatient department of dentistry of Silchar Medical College and Hospital, Silchar. All procedures performed in the study were conducted in accordance with the ethical standards given in the 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. Written informed consent was obtained from each participant.

Inclusion criteria

  1. Female patient of Silchar district
  2. Age: 14–16 years
  3. Patients with chronic generalized plaque-induced gingivitis.


Exclusion criteria

  1. Systemic illness
  2. Antibiotic consumption during the last 3 months
  3. Known allergy to tea derivatives
  4. Patients under oral contraceptives, herbal medications, etc.


A total of 80 female patients were recruited and distributed into case and control groups each consisting of 40 patients. The case group will receive green tea extract mouth wash 5% and the control group will receive normal saline as the placebo. All patients were instructed to take the medications two times a day, each time 5 ml rinsed for 30 s. They were also taught to floss and brush their teeth two times daily with the bass method.

Parameters

All patients were examined and all the following parameters will be recorded at baseline and at five consecutive weeks:

  1. Plaque index (PI) (Loe and Silness)
  2. Gingival index (GI) (Silness and Loe).


Sample preparation

Green tea mouthwash was extracted from the plant C. sinensis in the laboratory of the pharmacology department of Silchar Medical College. Leaves of the plant were chopped, fragmented, and broken into small pieces, and each 100 g of leaves were soaked in 500 ml of methanol for 48 h. Thereafter, the solution was passed through a strainer and was transferred to a plate. Plates were maintained at the normal temperature of the laboratory for 3–4 days, and then the crystal powder of extract was scraped from the plates. Finally, green tea mouthwash 5% was prepared (0.5 g of extract in 100 ml distilled water) and poured into bottles each containing 100 ml. Normal saline mouthwash was prepared in the bottles with the same shape, capacity, and color. Actually, preparing an inert placebo with the exactsame color, odor, and taste as green tea was not feasible. In addition, normal saline has a very limited effect on gingivitis and it was used only because of its rinsing effect (both groups were the same in rinsing a mouthwash).


  Results Top


According to the recorded gingival indices, a significant improvement was observed in both groups (F [2.52] =166.82, P < 0.001, observered power = 1). Overall changing trend in GI was different between the study groups (F [2.52] =18.44, P < 0.001, observed power = 1), yet the mean difference from baseline to the 6th week was not statistically significant (mean difference = 0.07, P = 0.54, observed power = 0.09). The week-to-week comparison revealed a remarkable decrease for all the comparisons (P < 0.001) except for differences between 2nd and 3rd week (P = 0.27). Analysis clarified a significant decrease in plaque index [PI], bleeding index [BI] of both groups' patient (PI: F [2.5] =221.67, P < 0.001, observered power = 1, BI: F (3.48) =373.03, P < 0.001, observered power = 1) and a contrasting pattern of recovery was observed between the study groups (PI: F [2.5] =2.74, P = 0.02, observed power = 0.82, BI: F (3.48) = 5.33, P = 0.001, observed power = 0.98). Nevertheless the total baseline-to-6th week difference was not significant (PI: mean difference = 0.06, P = 0.46, observed power = 0.11, BI: Mean difference = 0.03, P = 0.63, observed power = 0.07). All inter-week comparisons were exceptional (P < 0.001). Despite unpleasant taste, no adverse effects were reported during the study. [Figure 1] shows decrease of GI and PI over 6 weeks among green tea users.
Figure 1: Decrease of gingival index and plaque index over 6 weeks among green tea users

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  Discussion Top


The present research investigated the effect of mouth wash containing green tea 5% on chronic generalized plaque-induced gingivitis. Our findings support the beneficial effect of green tea to improve inflammatory periodontal indices after 5 weeks of treatment. Furthermore, improvement of indices in the control group is because of the positive effects of saline in increasing oral hygiene. Recently, Kuvda et al. (2011) investigated the adjunct effect of SRP and locally delivered catechin via inserted strips into the surrounding pocket for 21 days.[5],[6],[7],[8],[9],[10] They reported a significant decrease in pocket probing depth (P < 0.001), yet PI and GI decreased insignificantly when compared to the SRP group (P < 0.05). In addition, a considerable reduction of causative bacteria was observed. This may point that those visible periodontal indices improvements are slightly behind the elimination of bacterial. In our study, intercomparisons of GI revealed no differences (power = 0.09). In commitment with Kuvda et al., remarkable changes did not occur during the first 3 weeks. The lesser effect size of our investigation when compared to those of Kuvda et al. and Hirsawa et al. (2002) may be sought in different modes of medication delivery. The continuous flow of gingival crevicular fluid and saliva wash out indeed decreases the efficacy of mouthwashes. On the contrary, Kuvda and Hirsawa applied a direct delivery system by means of the implantation of drug strips into the depth of the pocket. Improvements in plaque and bleeding indices applying green tea mouth wash are in commitment with many previous researches[10],[11],[12],[13],[14],[15],[16],[17] Intercamparisons for BI and PI did not reach a statistically significant level, yet changing trends were different between the study arms. Low achieved powers (PI: 0.11, BI: 07) indicate that larger sample size may magnify such small differences. Moreover, methanol was used during drug preparation, however, the final prepared medication was dried and a water-based solution was prescribed. Consequently, the proportion of methanol is low with no considerable effect on the periodontium and with probable anti-plaque effect preventing adhesion to tooth' surface.

Porphyromonas gingivalis, similar to other causative periopathogens, is proved to play a key role initiating periodontal destruction. This microbe exerts its destructive characteristics by means of various protease including amionopeptidase, gingipains, and collagenase (i.e., most potent). Indeed, oxidative-antioxidative capacity imbalance in favor of excessive oxidative stresses and inflammatory mediators would lead to advanced periodontal impairment.[18],[19] Catechin contents especially, ECG, EGCG within green tea inhibits peptidase and collagenase activity. In addition, they may subside proinflammatory cytokines such as interleukin (IL-1 β) and tumor necrotic factor α.[20] Moreover, by lowering IL-6 and decreasing expression of Cyr61, it inhibits bone resorption and thus osteolysis is observed. Otake et al. suggested that green tea has an antiplaque effect due to the polyphenolic compositions and tannin compounds.[21],[22] A small amount of tannin and Vitamin K within green tea may improve the bleeding index during the study.[23] Kushiyama et al. concluded that additive drinking of each cup of green tea would decrease 0.023 mm of pocket depth, 0.028 mm of clinical attachment loss, and would improve bleeding upon probing by 63%. The main goal of the present research was to test the efficacy of sole treatment with green tea, as a convenient and self-applicable means, in addition to reminding the proper method of brushing and flossing. It seems that such reminding and motivation served positively in treating gingivitis. In comparison to normal saline, green tea showed better effects, however, this was not statistically significant. This may be discussed as the lack of sensitivity of periodontal indices to detect the milder degree of periodontium inflammation at the final weeks of intervention, compared to more sensitive and specific biomarkers (e.g., interleukins). Concurrent assessment of microbiologic and inflammatory biomarker would also better reveal the differences between interventional and control groups that are suggested for future researches.


  Conclusion Top


This study supports that the daily consumption of green tea mouthwash may be beneficial to cure or prevent gingival inflammation. Its prescription may be beneficial and of value in certain community groups such as adolescent students who are more affected by periodontal inflammation. It should be avoided in patients on anticoagulants and with advanced renal failure due to its Vitamin K and aluminum content, respectively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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