Effects of green tea on periodontal health: A prospective clinical study

Swati Sharma; Lipsa Bhuyan; Sujatha Ramachandra; Smriti Sharma; Kailash Chandra Dash; Kanika Singh Dhull

doi:10.4103/jioh.jioh_37_17

ORIGINAL RESEARCH

Year : 2017 | Volume : 9 | Issue : 2 | Page : 39-44

Effects of green tea on periodontal health: A prospective clinical study

Swati Sharma¹, Lipsa Bhuyan², Sujatha Ramachandra², Smriti Sharma³, Kailash Chandra Dash⁴, Kanika Singh Dhull⁴
¹ Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
² Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
³ Insurance Department, Medcare Women and Children Hospital, Dubai, UAE
⁴ Department of Preventive and Pediatric Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India

Date of Web Publication

13-Apr-2017

Correspondence Address:
Sujatha Ramachandra
Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, Campus 5, KIIT University, Bhubaneswar, Odisha
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jioh.jioh_37_17

Abstract

Background: An increasing number of people all around the world are turning to the nature by using the natural herbal products in both prophylaxis and treatment of different diseases. Green tea with active chemical ingredients possesses diverse pharmacological properties that include anti-inflammatory, anticariogenic, antioxidant, and antibacterial effects. The aim of this study is to assess the protective properties of green tea on periodontal health and also to know whether any side effect of green tea prevails in terms of staining of teeth. Materials and Methods: This is a prospective randomized clinical intervention study. Three dependent variables: probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were measured to reflect periodontal diseases. Results: The three dependent variables, namely, PD, CAL, and BOP showed statistically significant reductions following introduction of green tea as a conjunct oral hygiene measure in study group as compared to control group. Conclusion: Green tea has shown the antioxidant, antimicrobial, and anticollagenase activities on periodontal health.

Keywords: Clinical attachment loss, green tea, probing depth, randomized clinical intervention study

How to cite this article:
Sharma S, Bhuyan L, Ramachandra S, Sharma S, Dash KC, Dhull KS. Effects of green tea on periodontal health: A prospective clinical study. J Int Oral Health 2017;9:39-44

How to cite this URL:
Sharma S, Bhuyan L, Ramachandra S, Sharma S, Dash KC, Dhull KS. Effects of green tea on periodontal health: A prospective clinical study. J Int Oral Health [serial online] 2017 [cited 2023 Mar 26];9:39-44. Available from: https://www.jioh.org/text.asp?2017/9/2/39/202705

Introduction

In the present decade, few of the foodstuffs can be called functional if they have beneficial effect on one or more target functions in the body, which is beyond adequate nutritional effect to maintain health or reduction of risk of diseases.^[1],[2] Tea, one of the most commonly consumed beverages, is gaining increased importance in promoting overall health and well-being.

The word “tea” has been used to describe the shrub Camellia sinensis. Tea has originated in China (2700 BC). It became very popular globally due to its enormous therapeutic benefits in many diseases.^[3] Among all the types of tea, 76%–78% of black tea is produced and consumed followed by 20%–22% of green tea and <2% oolong tea. Among all of these, however, the most significant effects on human health have been observed with the consumption of green tea.^[4] Globally, it is estimated that approximately 2.5 million tons of tea leaves are produced each year, out of which approximately 20% production were green tea.^[5] For manufacturing various types of tea, first of all, the fresh leaves of the tea plant are picked which are called as flush. Macerating and heat drying this flush produces green tea, whereas fermentation of flush before heat drying produces black tea. In specific, green tea has been proved to have many functional properties, and at present, its consumption is widely recommended.

The health-promoting effects of green tea are mainly attributed to its polyphenol (catechins). Epigaleocatechin-3-gallate and epicatechin-3-gallate are the most important catechins. The antioxidant, antimicrobial, anticollagenase, antimutagenic, and chemopreventive properties of these catechins are proved to be therapeutic and beneficial in the treatment of various chronic diseases.^[6]

Classification of tea

Tea can be broadly classified into three main types based on the manufacturing process:^{[7],[8],[9],[10],[11],[12]}

Nonfermented green tea obtained by drying and steaming the fresh leaves to inactivate the polyphenol oxidase by nonoxidation
Semi-fermented oolong tea obtained by partial fermentation of fresh leaves before drying
Fermented black and red tea obtained by postharvest fermentation before drying and steaming.

Beneficial effects of various tea components (catechins)

Antioxidative effect

The antioxidative effects of green tea are due to scavenging of reactive oxygen, nitrogen species, and chelating redox-active transition of metal ions such as iron and copper or by inhibition of pro-oxidant enzymes' redox-sensitive transcription factors, and induction of antioxidant enzymes.^[13],[14]

Effect of green tea by modulating the physical structure of cell membranes

This process is due to the influence of catechins with the cellular phospholipid palisade.^{[15],[16],[17],[18]}

Antimicrobial effect

Epigallocatechin, epicatechin gallate, and epigallocatechin gallate are the three most important antibacterial agents which exert their antimicrobial effect on methicillin-resistant Staphylococcus aureus, Helicobacter pylori, and α-hemolytic Streptococcus.^{[19],[20],[21],[22],[23],[24],[25],[26],[27],[28]}

Anticariogenic effect

Catechins exert anticariogenic effect by inhibitory action against Streptococcus mutans and Streptococcus sobrin at very minimum concentration between 50 and 1000 μg/ml.^[29]

Periodontal diseases are infectious diseases involving gingival inflammation and destruction of periodontal tissue. Its incidence and progression are dependent on the type of periodontal pathogens and various host as well as environmental factors. Very few studies have been carried out in the past to know the beneficial effects of green tea on periodontal health.

Therefore, this study is specially aimed to focus the antimicrobial, antioxidant, and anticollagenase effects of green tea on periodontal health in patients attending outpatient department at School of Dental Sciences with the chief complaint of chronic periodontitis or suffering from chronic periodontitis.

Aim of the study

An increasing number of people all around the world are turning to the nature by using the natural herbal products in both prophylaxis and treatment of different diseases. Green tea with active chemical ingredients possesses diverse pharmacological properties that include anti-inflammatory, anticariogenic, antioxidant, and antibacterial effects. The aim of this study is to assess the protective properties of green tea on periodontal health and also to know whether any side effect of green tea prevails in terms of staining of teeth.

Materials and Methods

A total of 840 patients who were suffering from chronic periodontitis and who reported to the outpatient department at School of Dental Sciences for seeking treatment were included in the study.

The study was carried out at the Department of Public Health Dentistry, School of Dental Sciences from January 2012 to June 2012. The Ethical Committee of School of Dental Sciences has given approval. All the patients signed written informed consent.

Inclusion criteria

Patients suffering from chronic periodontitis who reported to outpatient department at School of Dental Sciences for seeking dental treatment
Nonsmokers and not suffering from any systemic disease
Willing to participate.

Exclusion criteria

Patients who received antibiotic therapy from the last 3 weeks
Had topical fluoride application.

This is a prospective randomized clinical intervention study. The study comprised 840 patients who were nonsmokers with chronic periodontitis ≥20 teeth and without systemic diseases such as uncontrolled diabetes, cardiovascular diseases, and medically compromised patients. Patients who were pregnant, nursing, or using antibiotics or anti-inflammatory drugs were also excluded from the study.

All the patients who participated in the study were subjected to a self-administered questionnaire consisting of personal history, medical history, and toothbrushing history. The frequency of toothbrushing was divided and coded into five categories as follows: 1 = never; 2 = sometimes; 3 = once a day; 4 = twice a day; and 5 = three or more times a day. All the patients received clinical monitoring and periodontal status examination at baseline, 1 month, and 3 months' time intervals.

All the patients who participated in the study were subjected to a full supra-gingival prophylaxis. All the patients were then randomly allocated into two groups as study group and control group. In the study group, the patients were asked to be on normal oral hygiene instructions and then they were instructed to rinse with 10–20 ml of 2% green tea 3 times/day (packets from Himalaya group, using warm water, prepared directly before use), whereas in control group, the patients were asked to be on normal oral hygiene without rinsing with green tea. After random allocation of patients, complete dental examination was carried out using sterilized mirrors, explorers, and periodontal probes.

Periodontal parameters were assessed and measured clinically by evaluating plaque index (PI) (Silness and Loe 1964) and gingival index (GI) (Loe and Silness 1963) at baseline, 1 month, and 3 months in both study and control groups. Three dependent variables such as probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were also assessed at baseline, 1 month, and 3 months in both study and control groups to reflect periodontal disease status.

PD and CAL were measured using periodontal probe at the mesio-buccal and buccal sites, whereas BOP was evaluated by calculating the percentage of teeth exhibiting gingival bleeding within few seconds of probing the periodontal ligament. The examiner reliability of periodontal examination was verified by an intra-examiner calibration of volunteers.

All the patients were then re-called after a period of 1 month and 3 months. All the clinical parameters were measured again to determine the status of periodontal health in both the groups.

Statistical analysis

The data so obtained were then put for SPSS Software for Windows Version 18 (IBM SPSS, Chicago, IL:SPSS Inc.), and the mean values of observed dependent and independent variables were put to the following statistical tests: paired t-test, Wilcoxon's test, Chi-square test, and Spearman's correlation coefficient, where P< 0.05 was considered statistically significant. Spearman's correlation coefficient was mainly calculated among each periodontal parameter, intake of green tea, and other study variables.

Results

The present study was conducted to know the protective properties of green tea on periodontal health as an adjunct to oral prophylaxis followed by routine oral hygiene instructions by assessing the periodontal parameters.

[Table 1] shows the details of periodontal parameters of all patients (study and control groups) taking part in the study. [Table 2] shows the comparison of clinical parameters in both study and control groups. In both study and control groups, there is a reduction in PI as well as GI at baseline, 3 and 6 months. Percentage of teeth which are bleeding also shows reduction in both study and control groups at baseline, 1 and 3 months. [Table 3],[Table 4],[Table 5] show the mean reduction of clinical parameters at baseline, 1 and 3 months in both study and control groups. The mean reduction in PI, GI, and PD from baseline to 1 month and baseline to 3 months was statistically significant (P < 0.001) in both study and control groups. [Table 6] shows Spearman's correlation coefficient of the study variable and clinical parameters. [Table 7] and [Table 8] depict statistical significant differences among indices PI and GI between both the groups (study and control) at baseline, 1 and 3 months.

Table 1: Details of periodontal parameters of all patients taking part in the study

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Table 2: Comparison of clinical parameters in the study and control groups

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Table 3: Mean reduction of plaque index in study and control groups at various time intervals

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Table 4: Mean reduction of gingival index in study and control groups at various time intervals

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Table 5: Mean reduction of probing depth in study and control groups at various time intervals

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Table 6: Characteristics of variables and Spearman's correlation coefficients

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Table 7: Comparison of reduction of gingival index between study and control groups at various time intervals

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Table 8: Comparison of reduction of plaque index between study and control groups at various time intervals

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Discussion

Green tea is a popular health drink which has demonstrated beneficial and protective effects on periodontium. Various studies on green tea have shown its therapeutic effects, but very few studies have correlated the daily dietary oral intake of green tea on periodontal health. Green tea extracts possess anti-inflammatory, antioxidant, and antimicrobial properties. In the present study, we have focused on the beneficial effects of green tea on periodontium as an adjunct to mechanical periodontal therapy. Green tea extracts are not widely available and are difficult to administer on a daily basis, especially in the Indian rural and peri-urban population.

Periodontal pathogens such as Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans produce matrix metalloproteinases, exhibit collagenase activity, and ultimately breakdown collagen and gelatin that make up the extracellular matrix of periodontal tissue. Nonsurgical periodontal therapy has long been documented to preserve the natural dentition by achieving and maintaining a healthy periodontium.^[29],[30] The gold standard of periodontal treatment has been scaling and root planing procedure, but various adjunctive such as local drug delivery have also been used in conjunction to this to improve the therapeutic results. Scaling and root planing procedures alone are difficult in eliminating complete subgingival bacteria and calculus due to complex anatomy of teeth and mechanical limitations due to the size of instrument to reach in deep pockets.

Local drug delivery systems are specially designed to deliver therapeutic agents into the base of deep periodontal pockets for a pronged time period.^[31] This kind of a nonsurgical therapy can halt the periodontal disease and also reduce the chances of surgical intervention. This particular aspect of using green tea extracts such as catechins in local drug delivery systems has not been discussed in the present study.

Many studies have shown that green tea polyphenols, mainly catechins, inactivate P. gingivalis-induced collagenase.^[32] In the present study, the three dependent variables, namely, PD, CAL, BOP as well as PI and GI showed statistically significant reductions following introduction of green tea as a conjunct oral hygiene measure in study group as compared to control group.^[33],[34]

In the present study, a significant reduction in both PI and GI scores was seen. The mean reduction from baseline to 3 months in PI was 0.8 ± 0.45 and for GI it was 1.15 ± 0.58 in study group. This mean reduction in PI and GI scores was in accordance with the study done by Ramfjord et al.^[35]

Statistical significant reductions in probing pocket depth (PPD) from baseline to 3 months was observed in both study and control groups. The decrease in PPD was due to decrease in inflammation of adjacent gingival tissues. This reduced inflammation can be due to the property of green tea catechins to inhibit collagenase activity.^[36]

Periodontitis is an infectious disease of bacterial etiology, immunological response, and tissue destruction, thus stating that green tea has a putative effect on periodontal pathogens. In the present study, along with monitoring of clinical parameters, microbiological analysis was not carried out. Hence, no effect on bacterial species monitoring could be carried out in both study and control groups. In addition, green tea has been advised as an adjunct to routine oral hygiene instructions rather as a local drug delivery system.

Further detailed researches with comparatively larger sample size, long follow-up, and use of new local drug delivery systems are needed for further in-depth study of efficacy of green tea as an adjunct not only to routine oral hygiene instructions but also with the standard treatment of periodontitis (scaling and root planing procedures). The correlation coefficients in this study were generally small, suggesting that it is difficult to explain periodontal disease using only few variables because periodontitis is a multifactorial disease. The sample size in our study was sufficiently large to show the significance between the intake of green tea and periodontal disease, but the factors considered in this study were not sufficient to account for periodontal disease. Our periodontal examination at the mesio-buccal and mid-buccal sites of each tooth may have led to bias because we did not examine the periodontal condition at six sites per tooth.

Conclusion

The present study has shown the beneficial and protective properties of green tea on periodontal health. The study is also suggestive of the positive effect of daily oral intake of green tea as an adjunct to mechanical periodontal therapy. There is a need for long term follow up studies with comparatively larger sample size before green can be advised for routine use for the prophylactic and therapeutic effects in various periodontal diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Wu CD, Wei GX. Tea as a functional food for oral health. Nutrition 2002;18:443-4.
2.	Diplock AT, Aggett PJ, Ashwell M, Bornet F, Fern EB, Roberfroid MB. Scientific concepts of functional foods in Europe consensus document. Br J Nutr 1999;81:1-27.
3.	Taylor PW, Hamilton-Miller JM, Stapleton PD. Antimicrobial properties of green tea catechins. Food Sci Technol Bull 2005;2:71-81.
4.	Cabrera C, Artacho R, Giménez R. Beneficial effects of green tea – A review. J Am Coll Nutr 2006;25:79-99.
5.	Available from: http://www.japanesegreenteaonline.com. [Last accessed on 2016 Nov].
6.	Venkateswara B, Sirisha K, Chava VK. Green tea extract for periodontal health. J Indian Soc Periodontol 2011;15:18-22. [PUBMED] [Full text]
7.	McKay DL, Blumberg JB. The role of tea in human health: An update. J Am Coll Nutr 2002;21:1-13.
8.	Rietveld A, Wiseman S. Antioxidant effects of tea: Evidence from human clinical trials. J Nutr 2003;133:3285S-92S.
9.	Belitz DH, Grosch W, Schieberle P. Food Chemistry. 4^th revised and extended edition. Springer-Verlag Berlin Heidelberg; 2009.
10.	Vinson JA, Dabbagh YA, Serrya MM, Jang J. Plant flavonoids, especially tea flavonols, are powerful using an in vitro oxidation model for heart disease. J Agric Food Chem 1995;43:2800-2.
11.	USDA. USDA Database for the Flavonoid Contents of Selected Foods. Beltsville: US Department of Agriculture; 2003.
12.	Lin YS, Tsai YJ, Tsay JS, Lin JK. Factors affecting the levels of tea polyphenols and caffeine in tea leaves. J Agric Food Chem 2003;51:1864-73.
13.	Kim JH, Kanh BH, Jeong JM. Antioxidant antimutagenic and chemopreventive activities of a phyto-extract mixture derived from various vegetables, fruits and oriental herbs. Food Sci Biotechnol 2003;12:631-8.
14.	Skrzydlewsja E, Augustyniak A, Ostrowska J, Luczaj W, Tarasiuk E. Green tea protection against aging induced oxidative stress. Free Radic Biol Med 2002;33:555.
15.	Chung JY, Huang C, Meng X, Dong Z, Yang CS. Inhibition of activator protein 1 activity and cell growth by purified green tea and black tea polyphenols in H-ras-transformed cells: Structure-activity relationship and mechanisms involved. Cancer Res 1999;59:4610-7.
16.	Agarwal R, Katiyar SK, Zaidi SI, Mukhtar H. Inhibition of skin tumor promoter-caused induction of epidermal ornithine decarboxylase in SENCAR mice by polyphenolic fraction isolated from green tea and its individual epicatechin derivatives. Cancer Res 1992;52:3582-8.
17.	Spencer JP, Schroeter H, Kuhnle G, Srai SK, Tyrrell RM, Hahn U, et al. Epicatechin and its in vivo metabolite, 3'-O-methyl epicatechin, protect human fibroblasts from oxidative-stress-induced cell death involving caspase-3 activation. Biochem J 2001;354(Pt 3):493-500.
18.	Caturla N, Vera-Samper E, Villalaín J, Mateo CR, Micol V. The relationship between the antioxidant and the antibacterial properties of galloylated catechins and the structure of phospholipid model membranes. Free Radic Biol Med 2003;34:648-62.
19.	McNaught JG. On the action of cold or lukewarm tea on Bacillus typhosus. J Army Med Corps 1996;7:372-3.
20.	Yam TS, Shah S, Hamilton-Miller JM. Microbiological activity of whole and fractionated crude extracts of tea (Camellia sinensis), and of tea components. FEMS Microbiol Lett 1997;152:169-74.
21.	Fournier-Larente J, Morin MP, Grenier D. Green tea catechins potentiate the effect of antibiotics and modulate adherence and gene expression in Porphyromonas gingivalis. Arch Oral Biol 2016;65:35-43.
22.	Lombardo Bedran TB, Feghali K, Zhao L, Palomari Spolidorio DM, Grenier D. Green tea extract and its major constituent, epigallocatechin-3-gallate, induce epithelial beta-defensin secretion and prevent beta-defensin degradation by Porphyromonas gingivalis. J Periodontal Res 2014;49:615-23.
23.	Lombardo Bedran TB, Palomari Spolidorio D, Grenier D. Green tea polyphenol epigallocatechin-3-gallate and cranberry proanthocyanidins act in synergy with cathelicidin (LL-37) to reduce the LPS-induced inflammatory response in a three-dimensional co-culture model of gingival epithelial cells and fibroblasts. Arch Oral Biol 2015;60:845-53.
24.	Nadeem M, Datoo F, Bugti AA, Ayaz A, Mahfooz M. Effects of black tea and green tea on periodontal health status among dental students at Pakistan. Int J Dent Clin 2014;6:1-3.
25.	Priya M, Ramamurthy J. Effects of green tea in the treatment of periodontal disease. J Pharm Res Clin Pract 2014;4:79-83.
26.	Narotzki B, Reznick AZ, Mitki T, Aizenbud D, Levy Y. Green Tea Drinking Improves Erythrocytes and Saliva Oxidative Status in the Elderly. Oxidative stress and cardio-respiratory function. Vol. 1. Switzerland: Springer International Publishing; 2015. p. 25-33.
27.	Palwankar P, Gopal L, Verma A. Green tea-a magical therapy. Int J Oral Health Dent 2015;1:16-9.
28.	Pradita AU, Dhartono AP, Ramadhany CA, Taqwim A. Periodontal dressing-containing green tea epigallocatechin gallate increases fibroblasts number in gingival artificial wound model. J Dent Indones 2013;20:68-72.
29.	Claffey N, Polyzois I, Ziaka P. An overview of nonsurgical and surgical therapy. Periodontol 2000 2004;36:35-44.
30.	Sakanaka S, Kim M, Taniguchi M, Yamamoto T. Antibacterial substances in Japanese green tea extract against Streptococcus mutans, a cariogenic bacterium. Agric Biol Chem 1989;53:2307-11.
31.	Gupta SC. Local drug delivery in periodontitis. Indian J Dent Sci 2010;2:55-68.
32.	Hirasawa M, Takada K, Makimura M, Otake S. Improvement of periodontal status by green tea catechin using a local delivery system: A clinical pilot study. J Periodontal Res 2002;37:433-8.
33.	Sakanaka S, Aizawa M, Kim M, Yamamoto T. Inhibitory effects of green tea polyphenols on growth and cellular adherence of an oral bacterium, Porphyromonas gingivalis. Biosci Biotechnol Biochem 1996;60:745-9.
34.	Wolfram S. Effects of green tea and EGCG on cardiovascular and metabolic health. J Am Coll Nutr 2007;26:373S-88S.
35.	Ramfjord SP, Caffesse RG, Morrison EC, Hill RW, Kerry GJ, Appleberry EA, et al. 4 modalities of periodontal treatment compared over 5 years. J Clin Periodontol 1987;14:445-52.
36.	Hong J, Smith TJ, Ho CT, August DA, Yang CS. Effects of purified green and black tea polyphenols on cyclooxygenase- and lipoxygenase-dependent metabolism of arachidonic acid in human colon mucosa and colon tumor tissues. Biochem Pharmacol 2001;62:1175-83.