Green Tea and Periodontal Health: A Literature Review

David Pham Dental Hygiene Class of 2021

University of the Pacific Arthur A. Dugoni School of Dentistry

Periodontal diseases are complex, multifactorial, and polymicrobial infections that result in inflammation of the periodontium. Left untreated the chronic inflammation could lead to loss of tissue attachment, bone loss and eventually loss of teeth. Because the antioxidants in green tea have been known for its health promoting benefits, the goal of this study is to determine if green tea can be used as adjunctive therapy for patients with periodontal disease. A PICO question was devised to guide the research as follows: For a population of patients with periodontal disease, does antioxidants from green tea serve as good adjuvant as compared to standard periodontal therapy in treating or preventing the progression of periodontal diseases? Overall, the antioxidants in green tea serve as a good adjuvant in treating patients with periodontal disease. However, due to the heterogeneity in the data and small sample sizes from all the studies conducted on this topic, this conclusion must be viewed with caution. Therefore, more randomized control studies with large sample sizes are needed to further validate this to be the gold standard of care in periodontal treatment.

Castro, M., Duarte, N. N., Nascimento, P. C., Magno, M. B., Fagundes, N., Flores-Mir, C., Monteiro, M. C., Rösing, C. K., Maia, L. C., & Lima, R. R. (2019). Antioxidants as Adjuvants in Periodontitis Treatment: A Systematic Review and Meta-Analysis. Oxidative medicine and cellular longevity, 2019(3), 1-24. https://doi.org/10.1155/2019/9187978Gartenmann, S. J., Weydlich, Y. V., Steppacher, S. L., Heumann, C., Attin, T., & Schmidlin, P. R. (2019). The effect of green tea as an adjunct to scaling and root planning in non-surgical periodontitis therapy: a systematic review. Clinical oral investigations, 23(1), 1–20. https://doi.org/10.1007/s00784-018-2684-7Hattarki, S. A., Pushpa, S. P., & Bhat, K. (2013). Evaluation of the efficacy of green tea catechins as an adjunct to scaling and root planing in the management of chronic periodontitis using PCR analysis: A clinical and microbiological study. Journal of Indian Society of Periodontology, 17(2), 204–209. https://doi.org/10.4103/0972-124X.113071Hrishi, T. S., Kundapur, P. P., Naha, A., Thomas, B. S., Kamath, S., & Bhat, G. S. (2016). Effect of adjunctive use of green tea dentifrice in periodontitis patients - A Randomized Controlled Pilot Study. International journal of dental hygiene, 14(3), 178–183. https://doi.org/10.1111/idh.12131Kushiyama, M., Shimazaki, Y., Murakami, M., & Yamashita, Y. (2009). Relationship between intake of green tea and periodontal disease. Journal of periodontology, 80(3), 372–377. https://doi.org/10.1902/jop.2009.080510Mathur, A., Gopalakrishnan, D., Mehta, V., Rizwan, S. A., Shetiya, S. H., & Bagwe, S. (2018). Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis. Indian journal of dental research: official publication of Indian Society for Dental Research, 29(2), 225–232. https://doi.org/10.4103/ijdr.IJDR_493_17Mazur, M., Ndokaj, A., Jedlinski, M., Ardan, R., Bietolini, S., & Ottolenghi, L. (2021). Impact of Green Tea (Camellia Sinensis) on periodontitis and caries. Systematic review and meta-analysis. Japanese Dental Science Review, 2021(57), 1-11. https://doi.org/10.1016/j.jdsr.2020.11.003.Nugala, B., Namasi, A., Emmadi, P., & Krishna, P. M. (2012). Role of green tea as an antioxidant in periodontal disease: The Asian paradox. Journal of Indian Society of Periodontology, 16(3), 313–316. https://doi.org/10.4103/0972-124X.100902 Rattanasuwan, K., Rassameemasmaung, S., Sangalungkarn, V., & Komoltri, C. (2016). Clinical effect of locally delivered gel containing green tea extract as an adjunct to non-surgical periodontal treatment. Odontology, 104(1), 89–97. https://doi.org/10.1007/s10266-014-0190-1 Taleghani, F., Rezvani, G., Birjandi, M., & Valizadeh, M. (2018). Impact of green tea intake on clinical improvement in chronic periodontitis: A randomized clinical trial. Journal of stomatology, oral and maxillofacial surgery, 119(5), 365–368. https://doi.org/10.1016/j.jormas.2018.04.010

Image Sources:[bamboo-bamboo-whisk-board-bowls] Pexels.https://www.pexels.com/photo/bamboo-bamboo-whisk-board-bowls-461428/ [Camellia sinensis plant] Artful tea.https://www.artfultea.com/tea-wisdom-1/2017/6/3/types-of-tea-camellia-sinensis

Abstract

Introduction

Methodology continued... Conclusion

References

Periodontal disease is complex, multifactorial, and polymicrobial infections that lead to inflammation of the periodontium. Left untreated the chronic inflammation could lead to loss of tissue attachment, bone loss and eventually tooth loss (Castro et al., 2019). Because the antioxidants in green tea have been known for its health promoting benefits, the goal of this study is to determine if green tea can be used as adjunctive therapy for patients with periodontal disease. A PICO question was devised to guide the research as follows: For a population of patients with periodontal disease, does antioxidants from green tea serve as good adjuvant as compared to standard periodontal therapy in treating or preventing the progression of periodontal disease? Overall, the antioxidants in green tea serve as a good adjuvant in treating patients with periodontal disease. However, due to the heterogeneity in the data and small sample sizes from all the studies conducted on this topic, this conclusion must be viewed with caution. Therefore, more randomized control studies with large sample sizes are needed to further validate this to be considered the gold standard of care in non-surgical periodontal treatment.

• Periodontal disease is a chronic inflammatory manifestation in the tissues surrounding the teeth caused by an imbalance between oral biofilms and the host’s response and left untreated could lead to loss of tissue attachment and eventually tooth loss (Castro et al., 2019).

• In the search for an adjuvant to conventional periodontal treatment without the unwanted side effects, green tea has been of great interest.

• The increasing popularity of green tea or Camellia sinensishas been mostly due to scientific reports of its health promoting benefits (Gartenmann et al., 2019).

• In vitro studies have shown that the antioxidants in green tea have anti-inflammatory, antibacterial, antiviral, and anti-aging properties (Rattanasuwan et al., 2016).

• In 2006 a cross sectional study through the usage of questionnaires revealed that one or more cups of green tea per day was significantly associated with decreased odds for tooth loss (Rattanasuwan et al., 2016).

To determine whether patients with periodontal disease undergoing adjunctive therapy with antioxidants from green tea as compared to standard periodontal therapy will lead to better prognosis by way of literature review through PubMed and Google Scholar.

The antioxidants from green tea can be used as an adjunctive therapy in treating patients with periodontal disease. Daily consumption of green tea herbals after periodontal treatment can help reduce bleeding and improve probing pocket depth index. Strip or gel containing catechins can help with the healing process by reducing bleeding on probing and gingival inflammation. The antioxidants containing strip is a good alternative to using antibiotics to treat patients undergoing periodontal therapy due to the concern of microbial resistance, gastrointestinal intolerance and microbiome alterations. In addition, green tea-based mouthwashes are as effective as chlorhexidine in treating patients with periodontitis, which serves as a good alternative when side effects due to the long-term usage of chlorhexidine may cause patients’ restorative materials to discolor, as well as oral dryness, soreness and taste perturbation. However, due to the heterogeneity in the data and small sample sizes from all the studies conducted on this topic, this conclusion must be viewed with caution. As such, more randomized control studies with large sample sizes are needed to validate these findings for it to be considered the standard of care in non-surgical periodontal therapy.

Discussion

Fig 1. Plaque Index (PI) after green tea treatment and control therapy. Standardized mean differences (SMD) and 95% CI are given. Values below or above 0 indicate reduced and increased values in green tea treatment versus control, respectively (Mazur et al., 2021).

Fig 4. Gingiva Index (GI) after green tea treatment and control therapy. Standardized mean differences (SMD) and 95% CI are given. Values below or above 0 indicate reduced and increased values in green tea treatment versus control group, respectively (Mazur et al., (2021).

• The use of antioxidants derived from green tea can be good adjuvant to periodontal therapy because it has been shown to improve periodontal parameters (PPD, GI, PI, CAL and BOP).

• The use of antioxidants in green tea did not exhibit any negative side effects, which makes it an ideal adjuvant for periodontal disease.

• Although antioxidants from green tea show improved periodontal parameters without any unwanted side effects, the sample size in each of the study is quite small and may impact the validity of these findings.

Fig 3. Probing Pocket Depth Index (PPD) after green tea treatment and control therapy. Standardized mean differences (SMD) and 95% CI are given. Values below or above 0 indicate reduced and increased values in green tea treatment versus control group, respectively (Mazur et al., 2021).

Fig 2. Bleeding on probing Index (BOP) after green tea treatment and control therapy. Standardized mean differences (SMD) and 95% CI are given. Values below or above 0 indicate reduced and increased values in green tea treatment versus control, respectively (Mazur et al., 2021).

Fig 5. Clinical Attachment Loss Index (CAL) after green tea treatment and control therapy. Standardized mean differences (SMD) and 95% CI are given. Values below or above 0 indicate reduced and increased values in green tea treatment versus control group, respectively (Mazur et al., (2021).

Contact

David PhamEmail: d_pham24@u.pacific.edu