Efficacy of Green and White Tea Extract Mouthwashes in the Management of Plaque-induced Gingivitis: A Clinical and Biochemical Study
Condition: Gingivitis; Chronic; Oxidative Stress; Inflammation
MeSH terms: Gingivitis; Inflammation
Study type: Interventional

Summary: 
      Background and objective: Tea is the second most consumed drink in the world after water.
      Gingivitis is among the most common infectious diseases. In this clinical study,
      Chlorhexidine Gluconate (CHX) was chosen as the positive control group and the clinical and
      biochemical efficacy of mouthwashes with green tea, white tea and essential oil (EO) as the
      active ingredients were aimed to be examined comprehensively.

      Methods: 112 participants with gingivitis were randomly assigned to 4 different groups that
      different mouthwashes were used for 4 weeks. CHX-MW group (0.12% CHX, as a positive control
      group), EO-MW group (Listerine), GT-MW group (5% Green tea), and WT-MW group (5% White tea).
      The effects of the mouthwashes on plaque, inflammation, and dental staining were evaluated by
      indexed scores at the beginning and the end of the 4th week. In addition, markers related to
      gingival inflammation (IL-1beta, MMP-8) and oxidative stress (TOS, TAS, OSI (TOS/TAS)) were
      evaluated on samples from the gingival crevicular fluid.
    

Detailed description: 
      Chronic gingivitis patients aged 18-32 years whose mechanical plaque control was supported
      with different mouthwashes were randomly assigned into 4 groups of 28 people each: CHX-MW
      group (0.12% CHX, as a positive control group), EO-MW group (Listerine mouthrinse), GT-MW
      group (5% Green tea), and WT-MW group (5% White tea). The inclusion criteria was as follows:
      presence of all primary teeth without a restoration, except the third molars; papillary
      bleeding index of 2 or 3 in at least 30% of papillae; no clinical attachment loss; being
      systemically healthy; and being normal weight according to body-mass index (BMI, 18,5-24,9
      kg/m2). The exclusion criteria was as follows: usage of non steroidal analgesics or
      antibiotics in last 6 months; usage of fixed or removable orthodontic appliance; presence of
      a intraoral soft tissue pathology; mouth breathing; smoking; a physical or mental disability
      that could prevent daily plaque control; and usage of any mouthwash in last 6 months.

      All patients were given verbal and written motivational advice and modified bass brushing
      technique was taught on mouth models and in front of mirror. All patients were advised on
      brushes and toothpaste to use during the study period. Dental polishing was carried out if
      indicated. Subsequently, each patient was instructed to use 15 mL of the mouthwash delivered
      to them for 60 seconds 30 minutes after brushing in the morning and evening for a week. For
      the next 3 weeks, at the beginning of each week (8th, 15th and 22nd days), patients were
      invited to the clinic, oral hygiene instruction was repeated, and the mouthwashes to be used
      the following week were delivered to them.

      Measurement of the clinical parameters and gingival crevicular fluid sample collection
      Clinical measurements ve gingival crevicular fluid (GCF) sample collection was carried out on
      each patient at the beginning of the study and at the end of the 4th week by a periodontist
      who was blinded about study group assignment.

      Level of gingival inflammation was scored by mean of the following measurements: probing
      pocket depth (PPD) measured with a Williams type periodontal probe (Hu-Friedy, Chicago,
      Illionis, USA) on 6 different points (mesio-buccal, mid-buccal, disto-buccal, mesio-lingual,
      mid-lingual, disto-lingual) around each tooth; plaque index (PI) ; and papillary bleeding
      index (PBI). In addition, the staining related to the mouthwash on the surface of the teeth
      and tongue was evaluated by gingival modification of the tooth staining index and tongue
      staining index in natural light environment. According to the tooth staining index, each
      tooth surface was divided into 4 separate regions and the staining intensity for each region
      was scored as; 0 = no staining, 1 = light staining (yellow), 2 = medium staining (brown), and
      3 = intense staining (black). The staining index of the tongue was scored on the dorsal 2/3
      front part of the tongue as; 0 = no staining, 1 = light staining (yellow), 2 = medium
      staining (brown), and 3 = intense staining (black). In the areas where two different colors
      were detected, the highest score was taken into account.

      GCF samples were collected between 09.00 and 12.00, 24 hours after clinical periodontal
      parameters were recorded in order not to affect the current periodontal status of the
      patients. The samples were taken from a total of 4 teeth that each was with the most PPD in a
      seperate quadrant. Care was taken not to sample a tooth with caries or restoration on it
      and/or neighboring teeth. Samples were obtained by following steps: Supragingival plaque
      found in the region before sampling was removed by sterile curette. After isolating saliva
      with sterile cotton roll tampons, the region was dried with an air spray for 10 seconds
      without mechanical trauma. Paper strips in standard sizes (Periopaper; ProFlow, Inc.,
      Amityville, NY, USA) was placed in 1mm depth in the sulcus and GCF was collected for 30
      seconds (with the orifice technique). This step was repeated to collect a sufficient amount
      of samples. Strips contaminated with blood and saliva were not included in the study. The
      volume of GCF on each paper strip was measured by electronic impedance method (Periotron
      8010, Oraflow Inc., NY, USA) in μl. 8 paper strips from the same patient were placed in a
      single ependorf tube with 250 μl of phosphate buffer (Phosphate Buffer Saline; PBS, pH = 7.4)
      and isolated from external environment by wrapping with parafilm (ISOLAB, Akron, Ohio, USA).
      The tubes were maintained at -80 oC (Thermo Fisher Scientific, Waltham, MA, USA) until the
      time of analysis.

      Biochemical analysis IL-1beta and MMP-8 levels GCF IL-1beta and MMP-8 levels were determined
      in ng/ml using human-specific commercial ELISA kits (Elabscience Co, Ltd., Texas,
      USA).(Catalog no: H-0149 and H-1450, respectively) according to manufacturer instructions.

      Measurement of TOS and TAS levels and Oxsidative Stres İndex (OSI) TOS and TAS levels were
      determined by automatic measurement method, using kits (Rel Assay Diagnostics, Gaziantep,
      Turkey) that were developed by Erel The results were expressed as μmol hydrogen peroxide
      (H2O2) equivalent/L and μmol Trolox equivalent/L. OSI was calculated by TOS/ TAS rate in
      percentage [(TOS (μmol H2O2 equivalents/L) / (TAS(μmol Trolox equivalent/L)].

      Statistical analysis Statistical analyses were made with the help of IBM SPSS Statistics
      software (SPSS Inc., Chicago, USA) The normality of distribution was tested with Shapiro Wilk
      test. Inter group comparisons were made applying Kruskal Wallis, Mann Whitney U test, and
      Bonferroni correction. Wilcoxon test was applied for time-dependent changes within the
      groups. Differences in the level of p<0.05 were regarded as statistically significant.
    

Intervention name(s): GT-MW group (5% Green tea), WT-MW group (5% White tea),EO-MW group (Listerine mouthrinse); CHX-MW group (0.12% CHX, as a positive control group)
Intervention type(s): Other; Other
Intervention description(s): Subsequently, each patient was instructed to use 15 mL of the mouthwash (5% Green tea, 5% White tea or Listerine mouthrinse) delivered to them for 60 seconds 30 minutes after brushing in the morning and evening for a week. For the next 3 weeks, at the beginning of each week (8th, 15th and 22nd days), patients were invited to the clinic, oral hygiene instruction was repeated, and the mouthwashes to be used the following week were delivered to them.; Subsequently, each patient was instructed to use 15 mL of the mouthwash (0.12% CHX) delivered to them for 60 seconds 30 minutes after brushing in the morning and evening for a week. For the next 3 weeks, at the beginning of each week (8th, 15th and 22nd days), patients were invited to the clinic, oral hygiene instruction was repeated, and the mouthwashes to be used the following week were delivered to them.
Intervention MeSH terms: Listerine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The inclusion criteria was as follows: presence of all primary teeth without a restoration, except the third molars; papillary bleeding index of 2 or 3 in at least 30% of papillae; no clinical attachment loss; being systemically healthy; and being normal weight according to body-mass index (BMI, 18,5-24,9 kg/m2). The exclusion criteria was as follows: usage of non steroidal anlgesics or antibiotics in last 6 months; usage of fixed or removable orthodontic appliance; presence of a intraoral soft tissue pathology; mouth breathing; smoking; a physical or mental disability that could prevent daily plaque control; and usage of any mouthwash in last 6 months.Chronic gingivitis patients aged 18-32 years whose mechanical plaque control was supported with different mouthwashes were randomly assigned into 4 groups of 28 people each: CHX-MW group (0.12% CHX, as a positive control group), EO-MW group (Listerine mouthrinse), GT-MW group (5% Green tea), and WT-MW group (5% White tea).
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Green tea; White tea; Inflammation; Gingivitis; Oxidative stress