Comparing The Antiplaque Efficacy of 05 Camellia Sinextract

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203]
Original Article
Comparing the antiplaque efficacy of 0.5% Camellia

sinensis extract, 0.05% sodium fluoride, and 0.2%
chlorhexidine gluconate mouthwash in children
Chaitali U. Hambire, Rashmi Jawade1, Amol Patil2, Vaibhav R. Wani3,
Ankur A. Kulkarni4, Parag B. Nehete5
Departments of Pediatric Dentistry and 2Pedodontics, SMBT Dental College, Sangamner, Ahmednagar, 1Department of
Periodontics, M.I.D.S.R Dental College, Latur, 3Departments of Pedodontics and 5Conservative Dentistry and Endodontics,
MGV’s KBH Dental College and Hospital, Panchavati, Nasik, 4Department of Pedodontics, Dr. D.Y. Patil Dental School,
Lohegaon, Pune, Maharashtra, India
Corresponding author (email: <[email protected]>)
Dr. Chaitali U. Hambire, Department of Pediatric Dentistry, SMBT Dental College, Ahmednagar, Maharashtra, India.
Abstract
Background: Dental caries is a multifactorial disease which requires a susceptible host, a cariogenic microflora, and a
suitable substrate that must be present for a sufficient length of time. Tea is prepared by the infusion of dried leaves of
the tea plant, Camellia sinensis, which contains bioactive compounds like polyphenols, flavonoids, and catechins that
are thought to be responsible for the health benefits that have traditionally been attributed to tea. These compounds
have multidimensional effects such as antibacterial action, inhibitory action on the bacterial and salivary amylase, and
inhibition of acid production. Aims: The aim of this study is to compare the antiplaque efficacy of 0.5% C. sinensis extract,
0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children. Materials and Methods: A randomized
blinded controlled trial with 60 healthy children of age group 9–14 years was carried out. The subjects were
randomly assigned to three groups, i.e. group A – 0.2% chlorhexidine gluconate, group B – 0.05% sodium fluoride,
and group C – 0.5% C. sinensis extract, with 20 subjects per group. Plaque accumulation and gingival condition were
recorded using plaque index and gingival index. Oral hygiene was assessed by simplified oral hygiene index (OHIS).
Salivary pH was assessed using indikrom pH strips. Plaque, gingival, and simplified OHI scores as well as salivary pH
were recorded at baseline, immediately after first rinse, after 1 week, and in the 2nd week. Statistical Analysis Used: The
data were analyzed using a computer software program (SPSS version 17). Analysis of variance (ANOVA) tests were used
to identify significant differences between the means of the study groups. Finally, paired t‑tests were used to assess the
significance of changes within each group between time periods. Critical P values of significance were set at 0.05 and
the confidence level set at 95%. Results: Mean plaque and gingival scores were reduced over the 2‑week trial period in
the experimental groups. Antiplaque effectiveness was observed in all groups, the highest being in group C (P < 0.05).
Chlorhexidine gluconate and tea showed comparative effectiveness on gingiva better than sodium fluoride (P < 0.05). The
salivary pH increase was sustained and significant in groups B and C compared to group A. Oral hygiene improvement was
better appreciated in groups A and C. Conclusions: The effectiveness of 0.5% C. sinensis extract was more compared to
0.05% sodium fluoride and 0.2% chlorhexidine gluconate mouth rinses. It should be explored as a cost‑effective and safe
long‑term adjunct to oral self‑care of patients as it has prophylactic benefits with minimum side effects.
Key words: 0.05% sodium fluoride, 0.2% chlorhexidine gluconate, 0.5% Camellia sinensis, antiplaque, dental caries
Access this article online INTRODUCTION

Quick Response Code:
Website: Dental caries is defined as an infectious, microbial disease
www.jispcd.org that is characterized by demineralization of the inorganic
portion and the destruction of the organic substances of
DOI: the teeth.[1] Periodontal diseases are chronic inflammatory
10.4103/2231-0762.158016 conditions characterized by loss of connective tissue,
alveolar bone resorption, and formation of periodontal
May-June 2015, Vol. 5, No. 3 Journal of International Society of Preventive and Community Dentistry 218
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Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract
pockets as a result of the complex interaction between acid, minerals such as Cr, Mn, Se, or Zn, and certain
pathogenic bacteria and the host’s immune response. phytochemical compounds. The therapeutic and biological
Periodontitis starts with inflammatory lesions of the activities of catechins reported include lower incidences
gingiva, which, if left untreated, may progress and of various pathological conditions such as cardiovascular
eventually involve and compromise the entire periodontal disease, stroke, obesity, and cancer. These effects have
apparatus of the affected teeth. Dental plaque is the been attributed, in part, to the antioxidative and free radical
primary etiologic factor in periodontal disease.[2] scavenging activities of the polyphenolic components of
green tea.[13] Studies conducted in the past have shown
Mechanical plaque control is the most dependable that the green tea polyphenolic catechins, in particular
oral hygiene measure, but mechanical oral hygiene (−)‑(EGCg) and (−)‑(ECg), can inhibit the growth of a
methods of plaque removal require time, motivation, wide range of Gram‑positive and Gram‑negative bacterial
and manual dexterity.[3] Hence, the use of the species with moderate potency. Evidence is emerging that
antimicrobial agent is warranted to limit the growth of these molecules may be useful in the control of common
cariogenic microorganisms and prevent dental caries.[4] oral infections such as dental caries and periodontal
The antiplaque agents can be delivered in the form of disease.[13] Fluoride is an established antimicrobial
mouthwashes, dentifrices, chewing gums, gels, and agent. Because of its anticariogenic and remineralization
chips. Mouthwashes, a safe and effective delivery system properties, it is extensively used in the prevention of dental
for antimicrobials, can play an important role in plaque caries. However, due to risk of ingestion and fluoride
reduction. toxicity, it is not recommended in small children.[14]
Sodium fluoride is regarded as a gold standard of caries
Chlorhexidine, triclosan, cetyl pyridinium chloride, prevention. It is extensively used to prevent and treat
essential oils, and fluoride‑based solution are some of dental caries due to its anticariogenic and remineralization
the antimicrobial agents tested against oral microbes.[5‑7] properties.[14] This study was conducted to come up with
Chlorhexidine is the gold standard chemical plaque novel and cost‑effective mouthwashes that can be used
control agent. Its ability to bind to soft and hard tissues by people for reducing the oral diseases. Tea is commonly
in the oral cavity enables it to act for a long period after used in India. What is required is promotion of the existing
application. However, brown discoloration of dentition resources to gain confidence of local people, as well as
efforts to promote oral health. The aim of the present
and restorative material, dorsum of the tongue, taste
study was to compare the effectiveness of 0.5% tea, 0.05%
perturbation, oral mucosal ulceration, unilateral/
sodium fluoride, and 0.2% chlorhexidine mouthwashes
bilateral parotid swelling, and enhanced supragingival
on oral health in children. The objective of the study was
calculus formation have been reported as the side effects
to compare the effects of three mouthwashes on plaque,
of long‑term chlorhexidine use.[8,9]
gingivitis, salivary pH, and oral hygiene status.
Tea, a product made from the leaf and bud of the plant
Camellia sinensis, is the second most consumed beverage in MATERIALS AND METHODS
the world, well ahead of coffee, beer, wine, and carbonated A randomized blinded controlled trial was conducted
soft drinks. Numerous studies have demonstrated that with 60 healthy children of age group 9–14 years
tea possesses antioxidant, antimutagenic, antidiabetic, was conducted [Figure 1]. Two hundred children of
anti‑inflammatory, antibacterial, and antiviral, as well age group 9–14 years were examined for duration of
as cancer‑preventive properties.[10‑12] Green tea is made 4 months. Sixty children meeting the eligibility criteria
solely with the leaves of C. sinensis that have undergone were selected from them and the study was conducted
minimal oxidation during processing. The most abundant for a period of 2 weeks. Children and their parents
components in green tea are polyphenols, in particular were given verbal and written information. Informed
flavonoids such as the catechins, catechin gallates (Cg), and consent was obtained from the parents of children
proanthocyanidins.[13] Many of the biological properties prior to the study. The inclusion criteria for the study
of green tea have been ascribed to the catechin fraction, were: Children having normal occlusion, absence of
which constitutes up to 30% of the dry leaf weight. caries and/or restorations, a healthy periodontium,
These potent antioxidants comprise free catechins, such non‑compromised oral health (brushed their teeth
as (+)‑catechin, (+)‑gallocatechin, (−)‑epicatechin, twice a day), no history of systemic antibiotic use or
and (−)‑epigallocatechin, and the galloyl catechins, such topical fluoride treatment within 4 weeks prior to
as (−)‑epicatechin gallate (ECg), (−)‑epigallocatechin baseline, no regular use of xylitol chewing gum, tea,
gallate (EGCg), (−)‑Cg, and (−)‑gallocatechin gallate. coffee, or cocoa, no systemic diseases, and absence of
Green tea also contains carotenoids, tocopherols, ascorbic orthodontic appliances.
219 Journal of International Society of Preventive and Community Dentistry May- 2015, Vol. 5, No. 2
PRESTUDY
Preparation of mouthwash
Commercially available 0.2% chlorhexidine gluconate
mouthwash (Periogard, Colgate‑Palmolive) was
SCREENING CHILDREN
WITHIN AGE GRUOP used. Commercially available 0.05% sodium
OF9-14 fluoride mouthwash (S‑FLO, Dr. Reddy’s Laboratories
N=200
Limited) was used.
Check for inclusion & exclusion criteria
Tea was extracted by combining 31/2 oz. (about seven
ELIGIBLE
CHILDREN
tablespoons) of green tea with four cups of still (not
N=60 sparkling) mineral water. This was steeped at room
temperature for 1 h and then poured into a lidded
container, straining the tea with sieve as it is poured,
STUDY
followed by refrigeration. The loose tea is discarded.
The 500 ml concentrated tea is mixed with 1000 ml of
distilled water to get 0.5% solution of tea mouthwash.[17]
Group A - Group C -
Group B -
0.2% 0.5% Camellia
0.05% sodium
chlorhexidine
fluoride
sinensis The mouthwashes were bottled and coded in
gluconate extract
similar containers (250 ml), so that the children and
PIaque index, Gingival index, OHIS, pH of the
investigator were blinded about the kind of mouth
saliva rinse used throughout the study. The names of children
were written on small pieces of paper by a person not
involved in this study and they were shuffled and
Baseline 1st Rinse 1st Week 2nd Week randomly allocated into three groups (n = 20 subjects
per group) by lottery method. The subjects were
randomly assigned to three groups, i.e. group A – 0.2%
Collection of data
chlorhexidine gluconate, group B – 0.05% sodium
fluoride, and group C – 0.5% C. sinensis extract, with 20
Stastical analysis and subjects in each group.
Results
The children were instructed to rinse their mouth
Figure 1: Flowchart showing the steps of the study
after brushing at morning and night, with 20 ml of the
mouth rinse containing 0.2% chlorhexidine gluconate
The exclusion criteria were: Children who wore fixed or mouthwash, 0.05% sodium fluoride mouthwash, or
removable orthodontic appliances or prosthesis, having 0.5% C. sinensis extract mouthwash, for 60 s, twice a day,
any type of restorations, had been prescribed antibiotics for 2 weeks. After each application, they were requested
or other medications in the last 3 months, had undergone not to eat or drink for 1 h. Children’s proper application
periodontal treatment in the previous 6 months, having of mouth rinse was supervised by their parents. After
any systemic illness, and not willing to comply with 2 weeks of regular application, the participants were
the study protocol. Subjects who had a mean gingival
instructed to stop using mouth rinses. It must be noted
index (GI)[15,16] (by Loe and Silness in 1963) score
that the participants were given the same tooth brush
of ≥3.0 and mean plaque index (PI) (by Silness and Loe
and fluoride tooth paste to brush their teeth twice a
in 1964)[15,16] score of 1.5 were included in the study.
day during the study. The subjects were requested not
Sampling to use xylitol‑containing products, tea, coffee, cocoa,
systemic antibiotics, and topical fluoride treatment for
Based on the secondary data, the sample size was estimated 4 weeks before and during the study. They were also
to be 60. The sample size is calculated using the formula: asked to report any change in health status or medicine
being used. Any participant violating the rules was
2
2(Z0.95 + Z 0.80 ) 2(1.645+ 0.84) excluded.
n + = 30
2 2
Δ (0.64) Before starting the first phase, professional oral hygiene,
Δ Confidence interval – 95% (0.95), power = 80% which included scaling and root planing with polishing,
(0.80), Z0.95 = 1.645, Z0.80 = 0.84, μ (mean) = 3.8, μ0 was done and the plaque score was brought to zero.
(mean) = 3.0, and Δ2 = 0.64. Single trained and calibrated investigator assessed
the baseline plaque by PI, gingival status by GI, and RESULTS

the oral hygiene status was assessed by simplified
oral hygiene index (OHIS; John C Greene and Jack Sixty children were recruited in this study. The study
R Vermillion, 1964) before the mouthwashes were was completed without any dropouts. The subjects
distributed.[15,16] The pH of the saliva was checked by were within the age group of 9–14 years, with a mean
using commercially available pH strips, i.e. indikrom age of 10.94 ± 0.26 years. Age and gender did not
papers, with pH ranging from 2–4.5 to 5.0–7.5.[18] show any statistically significant difference between
The color changes on the pH strips were noted after groups and within group, as shown in Table 1. The
keeping the strip in the unstimulated saliva for 1 min intra‑examiner error was within acceptable limits (kappa
and matching with the color of standardized color chart coefficient = 0.7) and the power of the study was found
given by the manufacturer to represent the pH of saliva. to be 0.985 using power and sample size program
The results of this research indicated that before any software. There were no reports of adverse reactions to
intervention, there were no significant differences in the any of the mouth rinses used.
baseline values between three groups. So, it was possible
to make a comparison between the effectiveness of three Table 2 shows the distribution and comparison of
different mouth rinses on the plaque, gingival status, baseline characteristics of the four study groups. No
oral hygiene status, and salivary pH. statistical difference was observed within as well as
between groups in plaque scores, salivary pH, OHIS,
Exactly 250 ml of 0.2% chlorhexidine gluconate and gingival scores. The mean plaque score for group A
mouthwash, 0.05% sodium fluoride mouthwash, and and group C after the first rinse was 1.45 ± 0.03. The
0.5% C. sinensis extract mouthwash were provided salivary pH was low in group B when compared to
to each subject in group A, group B, and group C, others, as shown in Table 3. The least OHIS score was
respectively, in a bottle. Data were collected at baseline, seen with group B, which when compared to others
immediately after first rinse, and every week until the was highly significant (P = 0.002). When comparison
second week of study, and assessed for gingival status, was carried out between group A and group C
plaque, oral hygiene, and salivary pH. Any side effects for OHIS scores, the difference was found to be
and acceptability of mouthwashes was recorded with non‑significant (P = 8. 55 Error‑06, NS) at baseline.
a questionnaire. The questionnaire consisted of four
questions (three close‑ended and one open‑ended) The mean plaque score (0.81 ± 0.05) and
on acceptability or non‑acceptability, reason for OHIS (1.11 ± 0.45) were low in group C. The
non‑acceptability, any recommendations to change gingival score was high (2.1 ± 0.45) and the pH was
the mouthwashes, and how do they rate the present
low (5.90 ± 0.60) after 1st week in group B when
mouthwash.
compared to others, as shown in Table 4. The difference
in oral hygiene between group B and group C was found
Statistical analyses
to be significant (P = 0.031, S), but no significance was
The data were analyzed using a computer software found with groups A and C (P = 0.711). After 2nd week,
program (SPSS version 17; SPSS Inc., Chicago, IL, the lowest plaque was recorded in group C (0.56 ± 0.40)
USA). Analysis of variance (ANOVA) tests were used followed by group A (0.64 ± 0.46). The highest
to identify significant differences between the means salivary pH (6.50 ± 0.8) along with good oral
of the study groups. Finally, paired t‑tests were used to hygiene (0.51 ± 0.54) was found in group C followed
assess the significance of changes within each group by group A (0.88 ± 0.54). Gingival health improved
between time periods. Critical P values of significance in all the three groups after 2nd week, with least scores
were set at 0.05 and the confidence level set at 95%. recorded in group C (1.10 ± 0.5) as shown in Table 5.
Table 1: Distribution of study subjects by age and gender

Group M F n Mean age SD Min. age Max. age Mean age of M SD Mean age of F SD
A 10 10 20 10.7 1.87 9 14 10.6 1.14 10.8 0.84
B 10 10 20 10.9 0.78 10 13 10.6 1.14 10.8 0.84
C 10 10 20 11.2 1.86 9 14 11 1.58 10.6 2.15
ANOVA
P value 0.759 0.929 0.509
Significant NS¦ NS¦ NS¦
M=Male, F=Female, n=Number, SD=Standard deviation. ¦Non‑significant (NS) = P>0.05
Table 2: Distribution and comparison of baseline characteristics of subjects

Baseline Group A Group B Group C F P Inference
characteristics (mean±SD) (mean±SD) (mean±SD) (ANOVA)
Plaque index 1.51±0.04 1.50±0.07 1.52±0.05 0.615751 0.547649 NS†
Salivary pH 5.18±0.5 4.84±0.80 5.10±0.6 0.539432 0.589233 NS†
OHIS 4.11±1.10 4.36±1.77 4.11±1.45 0.064401 0.937773 NS†
Gingival index 2.68±1.00 2.54±0.85 2.34±0.65 0.210526 0.811475 NS†
OHIS=Simplified oral hygiene index, SD=Standard deviation. †non‑significant (NS) = P>0.05
Table 3: Distribution and comparison of mean values immediately after first rinse
Plaque index 1.42±0.14 1.47±0.07 1.45±0.05 0.371661 0.774098 NS†
Salivary pH 6.38±0.5 5.88±0.80 6.40±0.6 1.565217 0.227425 NS†
OHIS 2.36±1.77 0.70±1.10 2.11±1.45 8.065404 0.001793 S*
OHIS=Simplified oral hygiene index, SD=Standard deviation. *Significant (S) = P<0.05, †non‑significant (NS) = P>0.05
Table 4: Distribution and comparison of mean values after 1 week

Characteristics Group A Group B Group C F P Inference
(mean±SD) (mean±SD) (mean±SD) (ANOVA)
Plaque index 0.84±0.14 1.20±0.07 0.81±0.05 0.271345 0.8317 NS†
Salivary pH 6.30±0.5 5.90±0.60 6.42±0.8 1.665317 0.2280 NS†
OHIS 1.36±1.54 2.70±0.11 1.11±0.45 9.705304 0.001993 S*
OHIS=Simplified oral hygiene index, SD=Standard deviation. *Significant (S) = P<0.05, †non‑significant (NS) = P>0.05
Table 5: Distribution and comparison of mean values after 2nd week

Characteristics Group A Group B Group C F P df Inference
(mean±SD) (mean±SD) (mean±SD) (ANOVA)
Plaque index 0.64±0.46 1.08±0.5 0.56±0.40 4.865145 0.01690 3 S*
Salivary pH 6.45±0.45 5.95±0.48 6.50±0.8 1.765897 0.205698 3 NS†
OHIS 0.88±0.54 1.88±0.51 0.51±0.54 1.670542 0.2326 3 NS†
Gingival index 1.17±0.45 1.5±0.65 1.10±0.50 0,67469 0.4625 3 NS†
OHIS=Simplified oral hygiene index, SD=Standard deviation.. *Significant (S) = P<0.05, †non‑significant (NS) = P>0.05
The salivary pH was high in group C (6.50 ± 0.8) fluoride toxicity, it is not recommended in small
followed by group A (6.45 ± 0.45) [Graphs 1-4] children.[14] Chlorhexidine is known to be the “gold
[Tables 6-9]. standard” mouth rinse against cariogenic flora. Many
clinical trials have shown that the taste of chlorhexidine
DISCUSSION mouth rinse is not well accepted by children.[8,9] It
also produces brown staining of teeth and affects the
Mouth rinses are widely used as an adjunct to mucus membrane and tongue.[8,9] The most commonly
mechanical oral hygiene procedures for their analgesic, prescribed concentration is 0.2%, which was, therefore,
anti‑inflammatory, antimicrobial and anticariogenic used in the study.
activity. The most commonly used mouth rinses
in children for therapeutic purposes are 0.05% There is always a quest for new and improved
sodium fluoride and 0.02% chlorhexidine gluconate. products, with emphasis being placed on natural/
Fluoride is an established antimicrobial agent; nature identical products. Scaling and root planing are
because of its anticariogenic and remineralization effective in altering the flora; green tea catechin has
properties, it is extensively used in prevention of also been shown to be effective in altering the flora
dental caries. However, due to risk of ingestion and and acting as an adjunct to scaling and root planing.[19]
Graph 2: Comparison of salivary pH between groups A, B, and C
Graph 1: Comparison of plaque scores between groups A, B, and C
Graph 3: Comparison of OHIS between groups A, B, and C Graph 4: Comparison of gingival index between groups A, B, and C
Table 6: Comparison of plaque index within groups A, B, and C

Plaque index (baseline) 1.51 1.50 1.52 0.615751 0.547649 NS†
Plaque index (1st rinse) 1.42 1.47 1.45 0.371661 0.774098 NS†
Plaque index (1st week) 0.84 1.20 0.81 0.271345 0.8317 NS†
Plaque index (2nd week) 0.64 1.08 0.56 4.865145 0.01690 S*
†
Non‑significant (NS) = P>0.05, *significant (S) = P<0.05. SD=Standard deviation
Table 7: Comparison of salivary pH within groups A, B, and C

Salivary pH (baseline) 5.18 4.84 5.10 0.539432 0.589233 NS†
Salivary pH (1st rinse) 6.38 5.88 6.40 1.565217 0.227425 NS†
Salivary pH (1st week) 6.30 5.90 6.42 1.665317 0.2280 NS†
Salivary pH (2nd week) 6.45 5.95 6.50 1.765897 0.205698 NS†
†
Table 8: Comparison of OHIS within groups A, B, and C

OHIS (baseline) 4.11 4.36 4.11 0.064401 0.937773 NS†
OHIS (1st rinse) 2.36 0.70 2.11 8.065404 0.001793 S*
OHIS (1st week) 1.36 2.70 1.11 9.705304 0.001993 S*
OHIS (2nd week) 0.88 1.88 0.51 1.670542 0.2326 NS†
†
Oxidative stress plays a vital role in the pathogenesis of green tea and its constituents have been reported.
of periodontal disease as well as many other disorders, It is a powerful antioxidant and has anti‑inflammatory
and it is believed that antioxidants can defend against properties. Catechin was found to have antiplaque
inflammatory diseases.[20] Numerous health benefits and antibacterial properties and contributed in caries
Table 9: Comparison of gingival index within groups A, B, and C

Gingival index (baseline) 2.68 2.54 2.34 0.210526 0.811475 NS†
Gingival index (1st rinse) 0.68 2.04 2.14 1.3 0.28905 NS†
Gingival index (1st week) 1.78 2.1 1.6 1.7813 0.16415 NS†
Gingival index (2nd week) 1.17 1.5 1.10 0.67469 0.4625 NS†
†
prevention and gingival enhancement. Rasheed and role in the disruption of the collagen component
Haider described the antibacterial effect of green tea in the gingival tissues of patients with periodontal
catechins against Streptococcus mutans bacteria and stated disease.[22,23] Catechin derivatives have been reported
that catechins are of great value in the reduction of to inhibit certain proteases of P. gingivalis and may
S. mutans and caries prevalence.[21] reduce periodontal breakdown.[24] Green tea catechins
have also been shown to inhibit protein tyrosine
The purpose of the study was to assess and compare phosphatase in Prevotella intermedia.[25] EGCg has been
the effectiveness of 0.5% C. sinensis extract, 0.05% reported to inhibit the production of toxic metabolites
sodium fluoride, and 0.2% chlorhexidine mouthwashes of P. gingivalis. A study has shown that purified
on the oral health of children. This was a triple‑blind tea polyphenols inhibited in vitro growth and H2S
study wherein the investigator, study subjects, as well production of P. gingivalis and Fusobacterium nucleatum
as the statistician were not aware to which group the associated with human halitosis.[26]
subjects belonged and coding was done for each group
and individual. The results of this research indicated Fluoride is an established antimicrobial agent and has
that before any intervention, there were no significant anticariogenic and remineralization properties. So, it is
differences in the baseline values between three groups. extensively used in prevention of dental caries. Fluoride
So, it was possible to make a comparison between the prevents dental caries through different processes. It
effectiveness of the three different mouth rinses on the inhibits adhesion of S. mutans to the tooth structure
plaque, gingival status, oral hygiene status, and salivary and, therefore, inhibits insoluble dextran production
pH. No side effects or mishappenings were observed by the bacteria. It inhibits tooth demineralization and
during the study procedure. also remineralizes incipient carious lesions. However,
due to risk of ingestion and fluoride toxicity, it is not
0.5% tea was used, so that the concentration does not recommended in small children.[14] Chlorhexidine is
change the taste but should cause maximum inhibition known to be the “gold standard” mouth rinse against
of variables. In the present study, 0.5% C. sinensis extract cariogenic flora. Its ability to bind with soft and hard
had the maximum desired effect when compared tissues in the oral cavity enables it to act for a long
to 0.05% sodium fluoride and 0.2% chlorhexidine period after application. However, brown discoloration
gluconate. The plaque level was brought to 0.56 at the of dentition and restorative material, dorsum of the
end of 2nd week from baseline (1.52), when compared tongue, taste perturbation, oral mucosal ulceration,
to chlorhexidine. The salivary pH increase was more in unilateral/bilateral parotid swelling, and enhanced
tea group. The oral hygiene status improved from poor supragingival calculus formation have been reported as
to good. Tea group had an upper hand when it came to the side effects of long‑term chlorhexidine use. Many
gingival status, as the response was very good and quick clinical trials have shown that the taste of chlorhexidine
when compared to sodium fluoride or chlorhexidine, mouth rinse is not well accepted by children.[8,9] The
which also showed significant effects. most commonly prescribed concentration is 0.2%;
hence, this was considered in the study.
Various mechanisms have been explained for the
effect of tea on gingival health. Green tea catechin has The findings of a study on 6–16‑year‑old children
been shown to be bactericidal against Porphyromonas showed that regular daily consumption of green tea
gingivalis and Prevotella spp. in vitro. Tea catechins rich in catechin (576 mg per can) had no side effect on
containing galloyl radicals possess the ability to children’s health. However, it can decrease obesity and
inhibit both eukaryotic and prokaryotic cell‑derived cardiovascular risk factors in fat children.[27] There have
collagenase, an enzyme that plays an important been other studies on the safety of catechin and no side
effects have been found.[28-30] Whereas high amount has better taste and no known side effects that are
of fluoride ingestion may lead to acute poisoning and found with fluoride and chlorhexidine mouthwashes.
its low repeated ingestion causes fluorosis, especially So, it can be used on a daily basis as an alternative for
in children. So, sodium fluoride mouth rinse is not chlorhexidine gluconate and sodium fluoride as an
recommended for children younger than 6 years as they antiplaque, anticariogenic, and remineralizing agent.
may swallow it.[4] Hence, this study is conducted on More studies with bigger sample sizes and different
8–12‑year‑old children. variables are required to explore the role of extract of
C. sinensis as an adjunct to oral health care.
It has been shown that the earlier the colonization
of S. mutans in the mouths of children, the higher the REFERENCES
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transmission of S. mutans occurs, the higher the caries 1. Shafer WG, Hine MK, levy BM. A text book of oral pathology.
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2. Page RC, Kornman KS. The pathogenesis of human
and harmless antibacterial agent in children has an periodontitis: An introduction. Periodontol 2000 1997;14:9‑11.
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Comparing the antiplaque efficacy of 0.5% Camellia

Access this article online INTRODUCTION

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

the baseline plaque by PI, gingival status by GI, and RESULTS

Table 1: Distribution of study subjects by age and gender

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

Table 2: Distribution and comparison of baseline characteristics of subjects

Table 4: Distribution and comparison of mean values after 1 week

Table 5: Distribution and comparison of mean values after 2nd week

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

Graph 2: Comparison of salivary pH between groups A, B, and C

Graph 1: Comparison of plaque scores between groups A, B, and C

Table 6: Comparison of plaque index within groups A, B, and C

Table 7: Comparison of salivary pH within groups A, B, and C

Table 8: Comparison of OHIS within groups A, B, and C

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

Table 9: Comparison of gingival index within groups A, B, and C

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

Hambire, et al.: Antiplaque efficacy of 0.5% Camellia sinensis extract

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