ORIGINAL ARTICLE
TS Hrishi PP Kundapur A Naha BS Thomas S Kamath GS Bhat
Effect of adjunctive use of green tea dentifrice in periodontitis patients – A Randomized Controlled Pilot Study
Authors’ affiliations: TS Hrishi, Department of Dentistry, P K Das Institute of Medical Sciences, Vaniyamkulam, Palakkad, Kerala PP Kundapur, BS Thomas, Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, India A Naha, Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India S Kamath, Department of Biochemistry, Kasturba Medical College, Manipal University, Manipal, India GS Bhat, PDS Division, Periodontics, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
Abstract: Objectives: Green tea is known to possess antiinflammatory, antibacterial and antioxidant activities. This study evaluated the effect of a locally prepared green tea dentifrice on specific parameters assessing gingival inflammation and severity of periodontal disease, when used as an adjunct to scaling and root planing (SRP) in the management of chronic periodontitis by comparing with a fluoride–triclosan-containing control dentifrice. Materials and methods: Thirty patients, with mild to moderate chronic periodontitis, were randomly allocated into two treatment groups, ‘test’ and ‘control’ after initial SRP. The test group was given green tea dentifrice with instructions on method of brushing, while the control group received a commercially available fluoride and triclosan containing dentifrice. Clinical parameters of Gingival Index (GI), Plaque Index (PI), percentage of sites with bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) along with biochemical parameters of total antioxidant capacity (TAOC) and glutathione-S-transferase (GST) activity in gingival crevicular fluid (GCF) were recorded at baseline line and 4 weeks post-SRP. Results: Intragroup analysis at 4 weeks showed statistically significant improvements of GI, PI, BOP, PD, CAL and TAOC in both groups. GST activity however, was increased only in the test group. At the end of the study period, the test group showed statistically significant improvements in GI, BOP, CAL, TAOC and GST levels compared to the control group. Conclusion: On comparison with fluoride–triclosan dentifrice, green tea showed greater reduction of gingival inflammation and improved periodontal parameters. Green tea dentifrice may serve as a beneficial adjunct to non-surgical periodontal therapy.
Correspondence to: PP Kundapur Department of Periodontology Manipal College of Dental Sciences Manipal University Manipal, India Tel.: (91820)2922173 Fax: (91820)2571966 E-mail: [email protected]
Key words: antioxidants; dentifrice; green tea; periodontitis Dates: Accepted 29 December 2014
Introduction To cite this article: Int J Dent Hygiene DOI: 10.1111/idh.12131 Hrishi TS, Kundapur PP, Naha A, Thomas BS, Kamath S, Bhat GS. Effect of adjunctive use of green tea dentifrice in periodontitis patients – A Randomized Controlled Pilot Study. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Periodontitis is characterized by chronic gingival inflammation, changes in microbial composition, altered immune–inflammatory response and increase in oxidative stress. Release of bacterial enzymes as well as inflammatory mediators produced by the body in response to the bacterial insult leads to connective tissue breakdown and progression of periodontal disease (1, 2). The role of oxidative stress in the pathogenesis of periodontitis has been postulated recently (3). In healthy individuals, there exists equilibrium between free-oxygen radicals and antioxidants. This Int J Dent Hygiene |
1
Hrishi et al. Green tea dentifrice in periodontal therapy
balance is disrupted in periodontitis as the body produces more reactive oxygen species against micro-organisms, and this can be deleterious to the periodontal tissues (3). Hence, along with removal of the bacterial plaque, which serves as the corner stone of treatment of periodontitis, adjunctive treatments with local and systemic chemotherapeutics, antioxidants and micronutrients are advocated to enhance the effects of periodontal therapy (4, 5). There is an increasing interest among the research community on the beneficial effect of antioxidants on periodontal diseases. Antioxidants have a protective effect on periodontal tissues by reducing the oxidative stress in periodontal tissues (3). Green tea is a herbal product undergoing considerable research in the field of medicine and dentistry (6). Green tea is a non-fermented product of tea (Camellina sinensis) leaves that is consumed as a beverage worldwide. It is a rich source of flavonoids, mainly catechins. The four major catechins include epigallocatechin-3-gallate (EGCG), which represents approximately 59% of the total of catechins, epigallocatechin (EGC) (19%), epicatechin-3-gallate (ECG) (13.6%) and epicatechin (EC). Green tea extract is documented to have antibacterial (7–9), antioxidant (10, 11), anti-inflammatory (12, 13) and anticarcinogenic properties (14). Human studies have shown that consumption of green tea is associated with beneficial effects on hypertension (15), cardiovascular diseases (16, 17), body weight control, glucose tolerance and insulin sensitivity (18). Green tea also has useful implications in oral health. Green tea catechins possess anticariogenic activity through a direct bactericidal effect against Streptococcus mutans and Streptococcus sobrinus and also indirectly by prevention of bacterial adherence to teeth (19). In addition, green tea mouthwashes are observed to reduce halitosis, plaque accumulation and gingival inflammation (20, 21). Furthermore, an epidemiological study by Kushiyama et al. (22) 2009 concluded that there was a modest inverse association between the intake of green tea and periodontal disease. Local drug delivery of green tea extract has also shown promising results in treating periodontal diseases (8, 23), but professional help is needed for delivering green tea catechins to periodontal pockets. Dentifrice and mouthwashes can be contemplated as vehicles for self-application of chemotherapeutics. Recently, the addition of green tea catechins to dentifrice has shown reduction of periodontal inflammation in the rat model, by decreasing gingival oxidative stress and expression of pro-inflammatory cytokines (24). This study intended to evaluate the effect of a locally prepared green tea dentifrice in combination with scaling and root planing SRP for treating patients with mild to moderate chronic periodontitis.
Materials and methods Preparation of green tea dentifrice
Green tea extract containing 60–90 percentage of epigallocatechin-3-gallate (EGCG) (obtained from Infra drug industries, 2
| Int J Dent Hygiene
Bangalore, India) was used in this study. Green tea dentifrice was prepared in the Department of Pharmaceutics, Manipal College of Pharmacy, Manipal using prescribed methods (Table 1). Briefly, the procedure consisted of triturating sodium lauryl sulphate and tragacanth in a mortar using a little quantity of water. Glycerine was then added followed by precipitated chalk and triturated till a smooth paste was formed, and water was added to get the desired consistency. Finally, flavours, preservating agent, sweetening agents and green tea extract were combined together and triturated to form a uniform paste. The concentration of green tea was confirmed by UV spectrophotometry by plotting a standard graph of green tea at 273 nm. Study design
Thirty patients reporting to the Department of Periodontology, Manipal College of Dental Sciences, Manipal, with mild to moderate periodontitis were enrolled in this pilot study. Patients of both sexes, within the age group of 18–60 years, having at least six sites with probing pocket depth (PPD) of >4 mm with clinical attachment loss (CAL) of 1–2 mm (mild periodontitis) or CAL of 3–4 mm (moderate periodontitis) were included in the study (25). Exclusion criteria included those patients who had undergone any surgical or non-surgical periodontal therapy in the past 6 months or patients with diabetes mellitus, rheumatoid arthritis, osteoporosis and bleeding disorders, pregnant and lactating women, smokers and patients with
TS Hrishi PP Kundapur A Naha BS Thomas S Kamath GS Bhat
Effect of adjunctive use of green tea dentifrice in periodontitis patients – A Randomized Controlled Pilot Study
Authors’ affiliations: TS Hrishi, Department of Dentistry, P K Das Institute of Medical Sciences, Vaniyamkulam, Palakkad, Kerala PP Kundapur, BS Thomas, Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, India A Naha, Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India S Kamath, Department of Biochemistry, Kasturba Medical College, Manipal University, Manipal, India GS Bhat, PDS Division, Periodontics, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
Abstract: Objectives: Green tea is known to possess antiinflammatory, antibacterial and antioxidant activities. This study evaluated the effect of a locally prepared green tea dentifrice on specific parameters assessing gingival inflammation and severity of periodontal disease, when used as an adjunct to scaling and root planing (SRP) in the management of chronic periodontitis by comparing with a fluoride–triclosan-containing control dentifrice. Materials and methods: Thirty patients, with mild to moderate chronic periodontitis, were randomly allocated into two treatment groups, ‘test’ and ‘control’ after initial SRP. The test group was given green tea dentifrice with instructions on method of brushing, while the control group received a commercially available fluoride and triclosan containing dentifrice. Clinical parameters of Gingival Index (GI), Plaque Index (PI), percentage of sites with bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) along with biochemical parameters of total antioxidant capacity (TAOC) and glutathione-S-transferase (GST) activity in gingival crevicular fluid (GCF) were recorded at baseline line and 4 weeks post-SRP. Results: Intragroup analysis at 4 weeks showed statistically significant improvements of GI, PI, BOP, PD, CAL and TAOC in both groups. GST activity however, was increased only in the test group. At the end of the study period, the test group showed statistically significant improvements in GI, BOP, CAL, TAOC and GST levels compared to the control group. Conclusion: On comparison with fluoride–triclosan dentifrice, green tea showed greater reduction of gingival inflammation and improved periodontal parameters. Green tea dentifrice may serve as a beneficial adjunct to non-surgical periodontal therapy.
Correspondence to: PP Kundapur Department of Periodontology Manipal College of Dental Sciences Manipal University Manipal, India Tel.: (91820)2922173 Fax: (91820)2571966 E-mail: [email protected]
Key words: antioxidants; dentifrice; green tea; periodontitis Dates: Accepted 29 December 2014
Introduction To cite this article: Int J Dent Hygiene DOI: 10.1111/idh.12131 Hrishi TS, Kundapur PP, Naha A, Thomas BS, Kamath S, Bhat GS. Effect of adjunctive use of green tea dentifrice in periodontitis patients – A Randomized Controlled Pilot Study. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Periodontitis is characterized by chronic gingival inflammation, changes in microbial composition, altered immune–inflammatory response and increase in oxidative stress. Release of bacterial enzymes as well as inflammatory mediators produced by the body in response to the bacterial insult leads to connective tissue breakdown and progression of periodontal disease (1, 2). The role of oxidative stress in the pathogenesis of periodontitis has been postulated recently (3). In healthy individuals, there exists equilibrium between free-oxygen radicals and antioxidants. This Int J Dent Hygiene |
1
Hrishi et al. Green tea dentifrice in periodontal therapy
balance is disrupted in periodontitis as the body produces more reactive oxygen species against micro-organisms, and this can be deleterious to the periodontal tissues (3). Hence, along with removal of the bacterial plaque, which serves as the corner stone of treatment of periodontitis, adjunctive treatments with local and systemic chemotherapeutics, antioxidants and micronutrients are advocated to enhance the effects of periodontal therapy (4, 5). There is an increasing interest among the research community on the beneficial effect of antioxidants on periodontal diseases. Antioxidants have a protective effect on periodontal tissues by reducing the oxidative stress in periodontal tissues (3). Green tea is a herbal product undergoing considerable research in the field of medicine and dentistry (6). Green tea is a non-fermented product of tea (Camellina sinensis) leaves that is consumed as a beverage worldwide. It is a rich source of flavonoids, mainly catechins. The four major catechins include epigallocatechin-3-gallate (EGCG), which represents approximately 59% of the total of catechins, epigallocatechin (EGC) (19%), epicatechin-3-gallate (ECG) (13.6%) and epicatechin (EC). Green tea extract is documented to have antibacterial (7–9), antioxidant (10, 11), anti-inflammatory (12, 13) and anticarcinogenic properties (14). Human studies have shown that consumption of green tea is associated with beneficial effects on hypertension (15), cardiovascular diseases (16, 17), body weight control, glucose tolerance and insulin sensitivity (18). Green tea also has useful implications in oral health. Green tea catechins possess anticariogenic activity through a direct bactericidal effect against Streptococcus mutans and Streptococcus sobrinus and also indirectly by prevention of bacterial adherence to teeth (19). In addition, green tea mouthwashes are observed to reduce halitosis, plaque accumulation and gingival inflammation (20, 21). Furthermore, an epidemiological study by Kushiyama et al. (22) 2009 concluded that there was a modest inverse association between the intake of green tea and periodontal disease. Local drug delivery of green tea extract has also shown promising results in treating periodontal diseases (8, 23), but professional help is needed for delivering green tea catechins to periodontal pockets. Dentifrice and mouthwashes can be contemplated as vehicles for self-application of chemotherapeutics. Recently, the addition of green tea catechins to dentifrice has shown reduction of periodontal inflammation in the rat model, by decreasing gingival oxidative stress and expression of pro-inflammatory cytokines (24). This study intended to evaluate the effect of a locally prepared green tea dentifrice in combination with scaling and root planing SRP for treating patients with mild to moderate chronic periodontitis.
Materials and methods Preparation of green tea dentifrice
Green tea extract containing 60–90 percentage of epigallocatechin-3-gallate (EGCG) (obtained from Infra drug industries, 2
| Int J Dent Hygiene
Bangalore, India) was used in this study. Green tea dentifrice was prepared in the Department of Pharmaceutics, Manipal College of Pharmacy, Manipal using prescribed methods (Table 1). Briefly, the procedure consisted of triturating sodium lauryl sulphate and tragacanth in a mortar using a little quantity of water. Glycerine was then added followed by precipitated chalk and triturated till a smooth paste was formed, and water was added to get the desired consistency. Finally, flavours, preservating agent, sweetening agents and green tea extract were combined together and triturated to form a uniform paste. The concentration of green tea was confirmed by UV spectrophotometry by plotting a standard graph of green tea at 273 nm. Study design
Thirty patients reporting to the Department of Periodontology, Manipal College of Dental Sciences, Manipal, with mild to moderate periodontitis were enrolled in this pilot study. Patients of both sexes, within the age group of 18–60 years, having at least six sites with probing pocket depth (PPD) of >4 mm with clinical attachment loss (CAL) of 1–2 mm (mild periodontitis) or CAL of 3–4 mm (moderate periodontitis) were included in the study (25). Exclusion criteria included those patients who had undergone any surgical or non-surgical periodontal therapy in the past 6 months or patients with diabetes mellitus, rheumatoid arthritis, osteoporosis and bleeding disorders, pregnant and lactating women, smokers and patients with
