|Year : 2012 | Volume
| Issue : 2 | Page : 108-112
Evaluation of intake of green tea on gingival and periodontal status: An experimental study
Neeraj Deshpande1, Anshula Deshpande2, Salma Mafoud3
1 Department of Periodontics, KM Shah Dental College and Hospital, Sumandeep Vidyapeth University, Vadodara, Gujarat, India
2 Department of Pedodontics, KM Shah Dental College and Hospital, Sumandeep Vidyapeth University, Vadodara, Gujarat, India
3 Department of Periodontics, Faculty of Dentistry, Garyounis University, Benghazi, Libya
|Date of Web Publication||4-Sep-2012|
Department of Periodontics, KM Shah Dental College and Hospital, Sumandeep Vidyapeth University, Vadodara, Gujarat
Source of Support:
, Conflict of Interest: None
| Abstract|| |
Objectives: Green tea is a popular health drink routinely consumed by many people. In the past, various studies have demonstrated the beneficial effect of green tea extracts on periodontal diseases, but very few studies have correlated the daily dietary oral intake of green tea to the periodontal status of patients. Materials and Methods: This randomized, controlled, investigator-blind trial was undertaken to correlate the periodontal status with daily dietary intake of green tea. The subjects were divided into three groups using block randomization method depending on the type of therapy received, viz., scaling and root planing alone, scaling and root planing along with green tea intake, and green tea alone. The clinical parameters were recorded at baseline, 3 and 6 months. Results: The results of the study demonstrated the positive and statistically significant (P < 0.05) effects of oral intake of green tea on periodontal disease. Conclusion: This study has reaffirmed the beneficial effects of green tea on periodontal diseases for prophylactic as well as therapeutic purpose.
Clinical Relevance to Interdisciplinary Dentistry
- Green tea is a popular drink with beneficial effect on oral mucosa.
- It has been shown to have anti-cancer properties.
- Green tea has beneficial effect on periodontal diseases as well as bone resorption.
- Future studies related to green tea may provide a new direction to research in various disciplines of dentistry due to its antioxidant properties.
- The present study highlights the beneficial effect of oral intake of green tea on periodontal diseases.
Keywords: Antioxidants, catechins, green tea, periodontal diseases, randomized clinical study
|How to cite this article:|
Deshpande N, Deshpande A, Mafoud S. Evaluation of intake of green tea on gingival and periodontal status: An experimental study. J Interdiscip Dentistry 2012;2:108-12
|How to cite this URL:|
Deshpande N, Deshpande A, Mafoud S. Evaluation of intake of green tea on gingival and periodontal status: An experimental study. J Interdiscip Dentistry [serial online] 2012 [cited 2019 Aug 22];2:108-12. Available from: http://www.jidonline.com/text.asp?2012/2/2/108/100603
| Introduction|| |
Periodontal diseases are the chronic inflammatory diseases of the periodontium, characterized by inflammatory destruction of gingiva and periodontal ligament. Most of the periodontal diseases are of microbial etiology with environmental, systemic, and other factors playing a secondary role. The destruction seen in periodontal disease is due to microorganisms as well as host inflammatory response. Earlier it was thought that the nutrition habits and dietary habits do not have a role in periodontal disease. But now it is clear that the eating habits and nutrition affect the periodontal disease. 
Green tea is one of the commonly ingested drinks in day-to-day routine. The effects of green tea on various lifestyle-related disorders such as diabetes mellitus and obesity have been widely investigated. The ingredients of green tea like epicatechin (EC), epigallocatechin (EGC), epigallocatechin gallate (EGCG), and epicatechin gallate (ECG) have also been studied for their preventive effects on cancer development  and cardiovascular diseases.  Various experimental and epidemiological studies have suggested the inhibition of periodontal pathogens and destructive periodontal diseases by green tea. ,
Epigallocatechin-3-gallate (EGCG), a major ingredient of Green tea catechins (GTC), has been reported to exert a variety of biological effects, including antioxidant, antibacterial, anti-inflammatory and anticarcinogenic activities. Additionally, it has been reported that EGCG inhibits lipopolysaccharide (LPS)-induced inflammatory cytokine production. ,,
However, there are very few studies to determine the positive effect of the dietary intake of green tea on periodontal diseases. The present study is designed to evaluate the effect of the daily intake of the green tea on the periodontal diseases.
| Materials and Methods|| |
This investigator-blind, randomized controlled trial clinical study was conducted at Department of Periodontics.
Forty-two systemically healthy patients (18 females and 12 males; age range 21-43 years; mean age: 30.50 years) with chronic periodontitis and minimum of 20 teeth were selected from the outpatient department of the faculty. The patients with history of smoking in past 1 year, scaling and root planing (SRP) for 12 months prior to baseline, as well as pregnant and lactating mothers were excluded from the study.
After evaluating these, nine patients were excluded from the study and one patient refused to participate in the study due to personal reason. To get the uniformity in the sample size at the baseline, one more patient was excluded to have a total sample size of 30 patients. The patients who were cooperative and agreed as subjects were included in this study after they signed an informed consent.
These 30 patients were randomly divided into three groups using block randomization method. The first group received professional scaling and root planing alone (SRP). The second group (SRP + GT) received scaling and root planing at baseline along with green tea for a period of 6 months. The third group received only green tea (GT) for a period of 6 months without any professional SRP.
The Plaque Index (Silness and Loe), Papillary Bleeding Index (Muhlemann and Son),  and Periodontal Index (Rusell)  were recorded at baseline, 3 months, and 6 months to evaluate the effect of dietary intake of green tea on dental plaque, gingival inflammation, and periodontal disease, respectively.
The professional for performing the SRP as well as examiner for recording the data were completely blinded of the different groups in the study. The same professional was deployed for performing SRP in all the patients. The single examiner used for examining all the groups was calibrated to reduce any examiner bias. The statistician performing the analysis was also blinded of the details of the group and the data were provided only as Group A, B, and C.
Green tea (Camellia sinensis) without any additional flavors like lemon or mint was used in the study. The green tea was provided to the subjects in the form of tea bags, each weighing 1.75 g. The patients were asked to have four cups of green tea per day. No attempt was made to quantify the type of additives as sugar or honey as the main focus of the study was to study the effect of green tea on periodontal status.
The green tea in readily available in the market and the benefits of the green tea are well known. It is absolutely safe for use with no hazardous effects. No invasive procedures were undertaken in the study and the research protocol was approved by the institutional ethical committee.
The data collected from the experimental group were analyzed statistically by using repeated-measures of Analysis of Variance (ANOVA) test for comparison of three groups with statistical significance at P <0.05.
| Results|| |
It was observed that the regular oral intake of the green tea led to the improvement of oral health status. All the three groups showed significant (P < 0.01) improvement in all the parameters measured at baseline and compared at 3 and 6 months.
The comparison of Plaque Index at baseline and 3 months was highly significant (P < 0.01) for all the three groups. The SRP + GT group showed the highest mean difference of 0.204 ± 0.128 as compared to the other two groups, suggestive of the highest reduction in Plaque Index score among the given groups at 3 months [Table 1]. The analysis of the Plaque Index score using mean difference in scores at baseline and 6 months also demonstrated similar results with SRP + GT group showing reduction in scores by 0.150 ± 0.104 [Table 2]. But the comparison among the three groups at 3 and 6 months did not show any statistically significant results (P > 0.05) [Table 3]. These results suggest significant improvement in the oral hygiene status in the SRP and SRP + GT groups as compared to baseline.
The Bleeding Index comparisons of baseline scores showed statistically significant outcomes at 3 months as well as 6 months (P < 0.01). The mean difference as compared to baseline in SRP + GT group was 1.223 ± 0.324 at 3 months [Table 1] and 1.152 ± 0.281 at 6 months [Table 2]. These results were highest in their respective groups at 3 and 6 months, suggestive of the best outcomes among the three compared groups. The comparison of Bleeding Index at 3 and 6 months also showed high statistically significant results (P < 0.01) suggestive of the possible role of green tea in improvement of clinical parameters [Table 3], with the highest reduction in scores by 0.300 ± 0.752 in GT group.
The Periodontal Index of 2.301 ± 0.502 at baseline in SRP + GT group was reduced to 1.315 ± 0.332 at 3 months, with mean difference of 0.989 ± 0.306 as compared to 0.609 ± 0.404 for SRP group and 0.148 ± 0.176 for GT group [Table 1]. All the results were having high statistical significance (P < 0.01). The comparison of these scores shows that the results are best when the green tea is used as an adjunct to professional plaque control as compared to professional plaque control alone or green tea alone. The results of the comparison at 6 months were also statistically significant (P < 0.01). The SRP + GT group demonstrated better results when Periodontal Index scores were compared among the three groups, with a mean difference of 0.906 ± 0.281 [Table 2]. The comparison of the mean scores for Periodontal Index at 3 and 6 months showed better results in the GT group with a mean difference of 0.007 ± 0.106. These results are suggestive of the positive effects of green tea on the clinical parameters irrespective of whether professional plaque control is performed or not.
| Discussion|| |
Various studies on green tea in the past have shown the beneficial effects of green tea as a health drink. In recent times, there have been reports of beneficial effects of the ingredients of green tea on the physiologic process of the body.  Green tea extracts have been shown to possess anti-inflammatory, anti-carcinogenic, antioxidant, and anti-microbial properties. ,,
In this study, we have focused on the oral intake of the green tea as a healthy drink and its effects on periodontium, as the extracts are not widely available and are difficult to administer on a daily basis. The daily intake of green tea is a routine practice amongst many.
Microbial plaque present on the teeth plays a very important role in the pathogenesis of periodontal disease. Some of the in vitro studies have shown that green catechin inhibits the growth of Porphyromonas gingivalis, Prevotella intermedia, and Prevotella nigrescens , , as well as affects the adherence of P. gingivalis onto the human buccal epithelial cells.  The polyphenols present in green tea have shown to inhibit the production of toxic metabolites of P. gingivalis. 
The majority of periodontal diseases are of infectious nature leading to gingival inflammation and destruction of periodontal ligament. The destruction seen in periodontal disease is broadly classified as microbial plaque mediated and host-mediated destruction. The periodontal pathogens produce matrix metalloproteinases (MMPs) and exhibit collagenase activity.  The host responds to this by production of cytokines like interleukin-1, interleukin-6, and tumor necrosis factor-α. These inflammatory mediators play a direct role in periodontal tissue destruction and stimulate fibroblasts, macrophages, and osteoclasts for increased production of MMPs, leading to further progression of periodontal disease.  The green tea catechins have been shown to inhibit the collagenase activity. EGCG has been shown to inhibit the expression of MMP-9 and formation of osteoclasts. Nakamura et al. (2009) have demonstrated that green tea catechins had inhibitory effect on osteoclastic bone resorption and osteoclast formation either by suppression of LPS-induced alveolar bone resorption or by blocking interleukin-1β production. 
In various previous studies, the antioxidants have been shown to have beneficial effects on various inflammatory diseases including periodontal diseases.  Various antioxidants like vitamin C have been shown to have beneficial effects on periodontal diseases.  The green tea catechins have also been demonstrated to have an antioxidant property with regards to prevention of cancer and cardiovascular diseases. 
All these properties of the green tea are responsible for the beneficial effects on periodontium. The same in reflected in the results of the present study. Daily oral intake of green tea has been found to have effectively reduced the gingival inflammation as well as periodontal disease activity. But since the microbial plaque is a primary initiating factor for most of the periodontal diseases, the intake of green tea as an adjunct to routine professional and personal plaque control is advisable.
| Conclusion|| |
The present study has affirmed the earlier studies showing beneficial effects of green tea to some extent and is also suggestive of the positive effect of daily oral intake of green tea on periodontal diseases. There is a need for the long-term studies with larger sample size before the green tea can be advocated for the prophylactic as well as therapeutic benefits in various periodontal diseases.
| References|| |
|1.||Schifferle RE. Periodontal disease and nutrition: Separating the evidence from current fads. Periodontol 2000 2009;50:78-89. |
|2.||Lambert JD, Elias RJ. The antioxidant and pro-oxidant activities of green tea polyphenols: A role in cancer prevention. Arch Biochem Biophys 2010;1;501:65-72. |
|3.||Wang ZM, Zhou B, Wang YS, Gong QY, Wang QM, Yan JJ, et al. Black and green tea consumption and the risk of coronary artery disease: A meta-analysis. Am J Clin Nutr 2011;93:506-15. |
|4.||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;37:437-8. |
|5.||Kushiyama M, Shimazaki Y, Murakami M, Yamashita Y. Relationship between intake of green tea and periodontal disease. J Periodontol 2009;80:372-7. |
|6.||Singh BN, Shankar S, Srivastava RK. Green tea catechin, epigallocatechin-3-gallate (EGCG): Mechanisms, perspectives and clinical applications. Biochem Pharmacol 2011;82:1807-21. |
|7.||Cooper R. Green tea and theanine: Health benefits. Int J Food Sci Nutr 2012;63 Suppl 1:90-7. |
|8.||Connors SK, Chornokur G, Kumar NB. New Insights into the Mechanisms of Green Tea Catechins in the Chemoprevention of Prostate Cancer. Nutr Cancer 2012;64:4-22. |
|9.||Loe H, Silness J. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1963;21:533-51. |
|10.||Mühlemann HR, Son S. Gingival sulcus bleeding--a leading symptom in initial gingivitis. Helv Odontol Acta 1971;15:107-13. |
|11.||Russell AL. A system of classification and scoring for prevalence surveys of periodontal disease. J Dent Res 1956;35:350-9. |
|12.||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. |
|13.||Sakanaka S, Okada Y. Inhibitory effects of green tea polyphenols on the production of a virulence factor of the periodontal-disease-causing anaerobic bacterium Porphyromonas gingivalis. J Agric Food Chem 2004;52:1688-92. |
|14.||Robertson PB, Lantz M, Marucha PT, Kornman KS, Trummel CL, Holt SC. Collagenolytic activity associated with Bacteroides species and Actinobacillus actinomycetemcomitans. J Periodontal Res 1982;17:275-83. |
|15.||Schwartz Z, Goultschin J, Dean DD, Boyan BD. Mechanisms of alveolar bone destruction in periodontitis. Periodontol 2000 1997;14:158-72. |
|16.||Nakamura H, Ukai T, Yoshimura A, Kozuka Y, Yoshioka H, Yoshinaga Y, et al. Green tea catechin inhibits lipopolysaccharide-induced bone resorption in vivo. J Periodontal Res 2010;45:23-30. |
|17.||Chapple IL. Reactive oxygen species and antioxidants in inflammatory diseases. J Clin Periodontol 1997;24:287-96. |
|18.||Amaliya, Timmerman MF, Abbas F, Loos BG, Van der Weijden GA, Van Winkelhoff AJ, et al. Java project on periodontal diseases: The relationship between Vitamin C and the severity of periodontitis. J Clin Periodontol 2007;34:299-304. |
[Table 1], [Table 2], [Table 3]