ORIGINALSarin ARTICLE et al

Preliminary Clinical Evidence of the Antiplaque, Antigingivitis Efficacy of a Mouthwash Containing 2%  Green Tea – A Randomised Clinical Trial Srishti Sarina/Charumohan Maryab/Ruchi Nagpalc/Sukhvinder Singh Oberoid/ Amit Rekhie Purpose: To assess the efficacy of a mouthwash containing 2% green tea as compared to a placebo mouthwash for the control of plaque and gingivitis. Materials and Methods: A randomised controlled clinical trial was conducted on 110 male subjects 18–60 years of age. The inclusion criteria were having a minimum of 20 sound natural teeth, a plaque index (PI) of at least 1.5 and a gingival index (GI) of at least 1.0. The subjects were randomised into two parallel groups, test and control. Subjects in the test group and control group were instructed to rinse twice daily for 1 min with 10 ml of test (mouthwash containing 2% green tea) and placebo mouthwash, respectively. After 28 days of using the mouthwash, inter- and intragroup differences for mean plaque index and gingival index scores were analysed. Results: There was a significant (p < 0.05) reduction in mean GI and PI scores among the test group from baseline to 28 days, whereas it was not significant in the control group. A statistically significant (p < 0.05) reduction was found in the mean difference in GI scores in the test group (0.67 ± 0.22) as compared to the control group (0.05 ± 0.11) and a statistically significant (p < 0.05) reduction was observed in the mean difference in PI scores in the test group (1.65 ± 0.68) compared to the control group (0.45 ± 0.99). Conclusion: The results showed that the green tea mouthwash was effective in the reduction of plaque and gingivitis scores. Key words: gingival index, green tea, mouthwash, plaque index, randomised controlled trial Oral Health Prev Dent 2015;13:197-203 doi: 10.3290/j.ohpd.a33447

Submitted for publication: 26.03.13; accepted for publication:17.07.13

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ingival and periodontal disease affects a majority of the population worldwide. Several type of accretions occurring on the teeth are related to periodontal disease in one way or another, with dental plaque playing a major role in the aetiology

of periodontal diseases. Proper control of bacterial plaque is obtained through the mechanical removal of the biofilm by the proper use of a toothbrush and dental floss. However, several studies have shown that the mean time of brushing the teeth is less

a

Postgraduate Student, Department of Public Health Dentistry, Sudha Rustagi College Of Dental Sciences And Research, Faridabad, Haryana, India. Idea, hypothesis, experimental design, literature search, data acquisition and analysis, wrote and reviewed manuscript.

d

Senior Lecturer, Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India. Definition of intellectual content, statistical analysis, contribution to discussion, reviewed and proofread manuscript.

b

Professor and Head, Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India. Definition of intellectual content, data analysis, proofread manuscript.

e

c

Senior Lecturer, Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India. Concept and study design, definition of intellectual content, statistical analysis, contribution to discussion, reviewed and proofread manuscript.

Postgraduate Student, Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India. Idea, hypothesis, literature search, data acquisition and analysis, manuscript preparation and review, proofread manuscript.

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Correspondence: Dr. Srishti Sarin, Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, House no. 126, Sector-14, Sonipat, Haryana 131001, India. Email: [email protected]

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than that required to obtain proper cleaning3 and only 2%–10% of the patients use dental floss regularly and effectively.2 In addition, it has also been demonstrated that even after education and motivation of the patient to properly use a toothbrush and floss, compliance drops over time.28 The result is the persistence of dental plaque in some areas, particularly on the interproximal sur-

faces of teeth. Many studies have demonstrated the effectiveness and usefulness of antiseptic mouthwashes containing active ingredients such as chlorhexidine and essential oils in the prevention and control of the formation of plaque and gingivitis, when used in addition to mechanical procedures.7,10,14,20 Chlorhexidine is still considered to be the gold standard for its antimicrobial action

Assessed for eligibility (n=150) Minimum PI above 1.5 and GI above 1 Excluded: • did not meet the inclusion criteria (n=35); • declined to participate (n=5) PI and GI recorded

Randomised (n=110)

Allocation Test group (n=55): Received green tea mouthwash

Control group (n=55): Received placebo mouthwash

Lost to follow-up (n=5) • 3 subjects were not present on the day of examination • 2 subjects did not use the mouthwash at all

Lost to follow-up (n=3) • 2 subjects were not present on the day of examination • 1 subject did not use the mouthwash at all

Analysed (n=50)

Analysed (n=52)

Clinical parameters (PI and GI) recorded after 28 days and compared with baseline

Fig 1  Study design

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and high substantiveness, but side-effects such as staining, taste alteration, desquamation of oral mucosa and formation of supragingival calculus limits its prolonged use.4,19 Alternative agents based on herbal extracts are therefore of particular interest. There is some evidence indicating the beneficial effects of plant extracts on gingival inflammation and plaque accumulation11,21,25,30 or subgingival periodontopathic microorganisms.13 Thus, an increasing number of people around the world are turning to natural herbal products for both prophylaxis and treatment of different diseases. Green tea with active chemical ingredients possesses different pharmacological properties that include anti-inflammatory, anticariogenic, antioxidant and antibacterial effects. Cathechins, the major bio-active component of green tea, possess an antibacterial action and have demonstrated utility in the treatment of oral and topical infection. Researchers have observed that consumption of green tea has effected reduction in three indicators of periodontal disease: periodontal pocket depth, clinical attachment loss and bleeding on probing of the gingival tissue. Several green tea polyphenols also have preventive effects on caries.22-24 Thus, the present clinical trial was conducted with the objective to compare the baseline and postintervention gingival and plaque status of industrial workers to evaluate the anti-gingivitis and anti-plaque efficacy of a mouthwash containing 2% green tea.

MATERIALS AND METHODS The present study, conducted to evaluate the efficacy of green tea mouthrinse as compared to a placebo mouthrinse, was a triple-blinded, placebocontrolled, parallel group randomised controlled clinical trial with balanced randomisation. Ethical approval was obtained from the Institutional Review Board after explaining the purpose and procedures of the trial. The subjects, outcome assessors and data analyst were kept blinded to the allocation. The study design is shown in Fig 1.

Subjects The study was conducted among 110 industrial workers aged between 18–60 years. The eligibility

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criteria used to recruit the participants in the study were derived from the Acceptance Programme Guidelines for chemotherapeutic products for control of gingivitis given by the American Dental Association.1 To be included, subjects had to be in good general health, possess a minimum of 20 sound natural teeth with a mean plaque and gingival index of 1.5 and 1.0, respectively, and not have undergone periodontal treatment within last 3 months. All subjects had to give their written informed consent before they were included. The exclusion criteria were: presence of periodontal pockets of 5 mm or more in 3 or more sites, use of antibiotic therapy during the last 1 month, use of antimicrobial mouthrinses, presence of smoking habits and periodontal therapy during the last 3 months.

Intervention The subjects were randomly assigned to one of the two parallel groups in a 1:1 allocation ratio, to receive either green tea mouthrinse or placebo mouthrinse. Both types of mouthrinses were specially prepared for this study by a qualified pharmacist. The green tea mouthrinse used in this clinical trial was an extract of leaves of Camellia sinensis. The leaves of Camellia sinensis were dried in sunlight, crushed into fine pieces and brewed to attain the required formulation (2%) of the green tea mouthrinse. The placebo mouthrinse used in this trial was distilled water coloured with food colouring to match the green tea mouthrinse in colour; it was brownish and lacked odour and any distinct taste. The subjects in the test group were given the green tea mouthwash and those in the control group were given the placebo mouthwash. The study population was instructed to rinse twice daily for 30 s, once in the morning after brushing and at night before going to bed, with 10 ml of test mouthwash/placebo mouthwash.

Compliance A bottle containing 700 ml of solution was dispensed to each subject. They were told to return the bottle along with the remaining quantity at the end of the study. To check the compliance of subjects for a given mouthrinse, the remaining quantity

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of mouthrinse was measured in each bottle at the end of the study. It was found to be satisfactory.

numbered from 1–55 and 56–110, respectively. Each subject was assigned a number using a random number list and received a corresponding prepacked bottle.

Outcome measures The primary outcome measure used for this study was Turesky-Gilmore-Glickman modification of the Quigley-Hein Plaque Index29 and the Löe and Silness Gingival Index.15 The indices were measured at baseline and after 28 days of administration of the mouthwash. Any adverse or unintended effects of the intervention were taken as secondary outcome measures. The gingival index was examined for six index teeth: maxillary right first molar, maxillary right lateral incisor, maxillary left first bicuspid, mandibular left first molar, mandibular left lateral incisor and mandibular right first bicuspid. Each gingival unit (buccal, lingual, mesial and distal) of the individual tooth was given a score from 0–3, called the GI score for the area. The scores from the four areas of each tooth were added and divided by four to give mean GI for the tooth. Finally, by adding the GI scores for all teeth and dividing it by number of teeth scored, the mean GI for the subject was obtained. The index for the subject was thus an average score for the areas examined. The plaque index was scored according to the Turesky-Gilmore-Glickman modification of the Quigley-Hein Plaque index on six sites per tooth (mesiobuccal, midbuccal, distobuccal, and mesiolingual, midlingual, distolingual) and was recorded after application of disclosing solution. The scores from all six sites of the tooth were added to give the score for the tooth. Thus, by adding all the tooth scores and dividing it by the number of teeth scored, the mean PI for the subject was obtained. All examinations and scoring were performed by a single trained and calibrated examiner who did not know to which group the subjects had been assigned.

Randomisation The subjects were randomly assigned to one of two parallel groups in a 1:1 ratio to receive either green tea mouthrinse or placebo mouthrinse. Randomisation was done by a computer-generated random numbers list prepared by an investigator who had no clinical involvement in the trial. All the dispensed bottles of green tea and placebo mouthrinse were

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Blinding Subjects, outcome assessor and data analyst were kept blinded to the allocation.

Statistical analysis The data were entered into an Excel sheet (MS Office 2007) and then analysed using SPSS software version 11.5 (SPSS; Chicago, IL, USA). At baseline, the test and control groups were compared with respect to mean age, oral hygiene habits (type, frequency, material), tobacco chewing habit (presence, duration and frequency), mean GI scores and mean PI scores. The differences in categorical variables (oral hygiene habits and tobacco chewing habits) between the test and control groups were assessed using the chi-square test. The continuous variables (mean age, GI score and PI score) between both groups were compared using Student’s t-test. Postintervention, two primary outcome variables, i.e. GI score and PI scores, were compared among the test and control groups to evaluate the interand intragroup differences. For each of the outcome variables, intragroup differences were analysed using a paired t-test and intergroup differences were analysed using Student’s t-test. All results were examined for statistical significance at the 0.05 level and using a two-tailed test.

RESULTS A convenience sampling method was used in which 110 industrial workers were included. The mean age of the industrial workers was 36.4 ± 5.5 years in the test group and 34.2 ± 5.4 years in the control group. The age range of the study population was 18–60 years. Of 110 participants enrolled in the study, 102 participants successfully completed the study. The overall dropout rate for the trial was 7.3%, with 5 dropouts in the test group and 3 in the control. None of the subjects experienced any adverse event such as irritation, burning sensation, vesicle

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Table 1 Mean reduction in GI score (0–28 days) among test and control groups Groups

Mean GI (SD) at baseline

Mean GI (SD) at 28 days

Mean reduction in GI

p-value

Test

1.50 (0.34)

0.82 (0.24)

0.67 (0.22)

0.000*

Control

1.47 (0.3)

1.42 (0.35)

0.05 (0.11)

0.080, NS

p-value

0.679

0.000*

0.000*

*Statistically significant.

Table 2 Mean reduction in PI score (0–28 Days) among test and control groups Mean PI (SD) at baseline

Mean PI (SD) at 28 days

Mean reduction in PI

p-value

Test Group

3.43 (0.99)

1.77 (0.57

1.65 (0.68)

0.000*

Control Group

3.59 (1.01)

3.46 (1.00)

0.45 (0.99)

0.150

0.410

0.000*

0.000*

p-value *Statistically significant.

formation or mucosal disturbance during the study. Furthermore, no serious adverse events occurred during the study or the 30 days following the last application of the study treatment. A toothbrush was used for cleaning teeth among 62.0% subjects in the test group and 57.7% subjects in the control group. In the test group, 22% used a finger and 8% a neem stick; in the control group, 23.07% and 5.7% used a finger and a neem stick, respectively. Among the study subjects, 82% of the industrial workers in the test group and 73.07% in the control group brushed once a day. A majority of subjects (70.8%) in the test group used toothpaste for cleaning their teeth, followed by 12.5% that used toothpowder and 2.0% used sand and charcoal. In the control group, 73.8% used toothpaste, 4.8% used toothpowder and 21.9% used other methods. No statistically significant difference was observed in oral hygiene habits and tobacco chewing habit (type, duration, frequency). The tobacco chewing habit was found among 72% subjects in the test group and 69.2% in the control group. Among the test group, 28.5% chewed tobacco for 0–5 years, 42.8% chewed tobacco for 5–10 years and 28.5% for more than 10 years. In the control group, 37.5% chewed tobacco for 0–5 years, 31.25% chewed for 5–10 years and 31.25% for more than 10 years. The data concerning oral hygiene and tobacco chewing habits are not shown in the Tables.

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Gingival index scores (Table 1) The test group had a mean (± SD) GI score of 1.50 ± 0.34 at baseline and 0.82 ± 0.24 at 28 days, which represented a statistically significant (p < 0.05) reduction. The control group had a mean GI score of 1.47 ± 0.30 at baseline and 1.42 ± 0.35 after 28 days, which was not statistically significant. There was no statistically significant difference in mean GI score for the test and control group at baseline, whereas there was a statistically significant (p < 0.05) difference in the mean GI score of test and control groups after 28 days. There was a mean reduction in GI scores from baseline to 28 days for the test and control groups, 0.67 ± 0.22 and 0.05 ± 0.11, respectively, which was statistically significant (p < 0.05).

Plaque index score (Table 2) The test group had a mean PI of 3.43 ± 0.99 at baseline and 1.77 ± 0.57 at 28 days, which was a statistically significant (p < 0.05) reduction. The control group had a mean PI (±SD) of 3.59 ± 1.01 at baseline and 3.46 ± 1.00 at 28 days, which was not statistically significant. There was no statistically significant difference in mean PI score between the test and control groups at baseline, whereas after 28 days, the mean PI score of test and control groups were significantly (p < 0.05) different.

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The mean reduction in PI score from baseline to 28 days for the test and control groups was 1.65 ± 0.68 and 0.44 ± 0.99, respectively, which was statistically significant (p < 0.05).

DISCUSSION Gingivitis affects 100% of the adult population at some point during their lives, and, in some cases, it can lead to the development of periodontitis, although this can occur in individuals without any gingivitis. This inflammatory process leads to gingival attachment loss, a condition causing major discomfort and tooth loss, as well as necessitating extensive and costly dental treatment. The plaque biofilm on the tooth surface at the gingival margin can cause inflammation.18 Several bacterial species have been implicated as aetiological agents of this disease. These include Actinomyces israelii, A. naeslundii, A. odontolyticus, Lactobacillus spp., Prevotella spp., Treponema spp., and Fusobacterium nucleatum.27 This is a reversible condition, since the return to meticulous dental hygiene practices will restore gingival health. The inability of the adult population to perform adequate mechanical plaque control has stimulated the search for various chemotherapeutic agents in mouthrinses or added to dentifrices to improve plaque control and prevent gingivitis. During the last decade, the interest has been shifted to the use of more and more foods/beverages as natural products with beneficial effects on health. Green tea is one such beverage, which possesses anti-inflammatory, anticarcinogenic, antioxidant and antimicrobial properties.26 It has also shown promising effects on oral health in various in vitro studies. In contrast to its well-documented anticaries effects, there is considerably less information available regarding the effects of green tea on periodontal diseases, including gingivitis.5,6 Thus, a parallel, double-blind, placebo controlled clinical trial was designed to assess the antiplaque and antigingivitis efficacy of a green tea mouthrinse. The 2% green tea mouthrinse produced significant reductions in supragingival plaque formation and gingivitis development as an adjunct to the oral hygiene procedures when compared to a placebo mouthrinse after 28 days of use. These reductions could probably be explained by the antimicrobial and anti-inflammatory effects of green tea. A few studies9,17 using green tea formulations demonstrated their antimicrobial activity. The antimicrobi-

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al property of green tea is attributed to the presence of catechins and polyphenols. Reducing the number of microorganisms in dental plaque results in the reduction of products released by them, which act as a trigger of gingival inflammation. Thus, reduction in GI scores could be attributed to green tea’s antimicrobial effect. In spite of conducting an extended literature search, only one clinical trial evaluating the antiplaque and antigingivitis efficacy of green tea mouthwash was found. The study conducted by Deshpande et al8 demonstrated the efficacy of drinking green tea in reducing plaque deposition and gingival bleeding. Although there were methodological differences between this study and our clinical trial, the results of the two studies agree. A study by Hirasawa et al12 demonstrated bactericidal activity of green tea catechins at 1 mg/l against species of Prevotella and P. gingivalis. They also found a significant reduction in markers of gingivitis after the use of a slow-release buccal delivery system applied over a period of 8 weeks. Possible ways in which green tea could prevent or reduce gingivitis would be by directly killing the causative organisms, interfering with the formation of plaque at the gingival margin, disrupting preformed plaque, preventing adhesion to and invasion of gingival epithelial cells by causative organisms and inhibiting bacteria-induced host cell pro-inflammatory cytokine production, thereby reducing the plaqueinduced inflammation. The absence of adverse effects using the green tea mouthrinse showed that it was well tolerated, supporting safety for clinical use. This finding is in accordance with other studies.9,16,17 These results provide clinical proof of the hypothesis that a mouthrinse containing green tea demonstrated antiplaque and antigingivitis efficacy.

CONCLUSION The results of this trial demonstrated a decrease in the plaque and gingival scores in the subjects using a green tea mouthrinse, showing the antiplaque and antigingivitis effect of green tea. Therefore, the present study suggested an association between the use of green tea and control of plaque formation and gingivitis. A habit of green tea consumption at meals and breaks is relatively easy to establish, which could help to maintain a healthy oral environment.

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Therefore, dental professionals should consider the use of green tea mouthrinse in conjunction with conventional oral hygiene methods for maintenance of good oral health.

REFERENCES 1. American Dental Association. Chemotherapeutic products for control of gingivitis. Available at http://www.ada.org/ sections/scienceAndResearch/pdfs/guide_chemo_ging. pdf, Accessed on 24 November 2012. 2. Bader HI. Floss or die. Implications for dental professionals. Dent Today 1998;17:76–82. 3. Beals D, Ngo T, Feng Y, Cook D, Grau DG, Weber DA. Development and laboratory evaluation of a new toothbrush with a novel brush head design. Am J Dent 2000;13:5A–14A. 4. Charles CH, Sharma NC, Galustians HJ, Qaqish J, McGuire JA, Vincent JW. Comparative efficacy of an antiseptic mouthrinse and an antiplaque/ antigingivitis dentifrice. A sixmonth clinical trial. J Am Dent Assoc 2001;132:670–675. 5. Connors SK, Choronokur G, Kumar NB. New insights into the mechanisms of green tea catechins in the chemoprevention of Prostate cancer. Nutr Cancer 2012;62:4–22. 6. Cooper R. Green tea and theanine: Health benefits. Int J Food Nutr 2012:63 Suppl 1:90–97. 7. DePaola LG, Overholser CD, Meiller TF, Minah GE, Niehaus C. Chemotherapeutic inhibition of supragingival dental plaque and gingivitis development. J Clin Periodontol 1989;16:311–315. 8. Deshpande N, Deshpande A, Mafoud S. Evaluation of intake of green tea on gingival and periodontal status: An experimental study. J Interdiscip Dent 2012:2;108–111. 9. Ebrahimi M. Effect of green tea mouthwash on gingival indices in patients with generalized marginal gingivitis. D.D.S. dissertation, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran 2011. 10. Fine DH, Markowitz K, Furgang D, Goldsmith D, Charles CH, Lisante TA, Lynch MC. Effect of an essential oil-containing antimicrobial mouthrinse on specific plaque bacteria in vivo. J Clin Periodontol 2007;34:652–657. 11. Flotra L, Gjermo P, Rolla G, Waerhaug J. Side effects of chlorhexidine mouthwashes. Scand. J Dent Res 1971;79:119–125 12. 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;37:433–438. 13. Kaim JM, Gultz J, Do L, Scherer W. An in vitro investigation of the antimicrobial activity of an herbal mouthrinse. J Clin Dent 1998;9:46–48. 14. Lang NP, Hotz P, Graf H, Geering AH, Saxer UP, Sturzenberger OP, Mecker AH. Effects of supervised chlorhexidine mouthrinses in children. A longitudinal clinical trial. J Periodontal Res 1982;17:101–111.

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15. Loe H, Silness J. Periodontal Disease in Pregnancy: Prevelance and severity. Acta Odontol Scand 1963;21:533–551. 16. Maroofian A. Formulation of green tea mouthwash as an effervescent tablet from dried green tea leaf of North Iran. Doctoral dissertation, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran 2011. 17. Moghbel AH, Farajzadeh A, Aghel N, Raisi N. Formulation and evaluation of green tea antibacterial mouthwash effect on the aerobic mouth bacterial load. Sci Med J 2010;9:317–330. 18. Nogueira GR Filho, Toledo S, Cury JA. Effect of three dentifrices containing triclosan and various additives: an experimental gingivitis study. J Clin Periodontol 2000;27: 494–498. 19. Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C. Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingival dental plaque and gingivitis. J Clin Periodontol 1990;17:575–579. 20. Paraskevas S. Randomized controlled clinical trials on agents used for chemical plaque control. Int J Dent Hyg 2005;3:162–178. 21. Rengli HH. The effects of parodontax mouthwash and its constituents on the microorganisms of subgingival plaque. J Clin Dent 1988;1:A30–A33. 22. Sakanaka S, Kim M, Taniguchi M, Yamamoto T. Antibacterial substances 88 Liao S, Kao YH AND Hiipakka RA in Japanese green tea extract against Streptococcus mutans, a cariogenic bacterium. Agric Biol Chem 1989;53: 2307–2311. 23. Sakanaka S, Sate T, Kim M, Yamamoto T. Inhibitory effects of green tea polyphenols on glucan synthesis and cellular adherence of cariogenic streptococci. Agric Biol Chem 1990;54:2925–2929. 24. Sakanaka S. Green tea polyphenols for prevention of dental caries. In: Yamamoto T, Juneja LR, Chu D-C, Kim M (eds). Chemical applications of green tea. CRC Press: Boca Raton, FL, 1997:87–101. 25. Saxer U, Jaschouz V, Ley F. the effect of Paradontax dentifrice on gingival bleeding. J Clin Dent 1994;5:63–64. 26. Singh BN, Shankar S, Srivastava RK. Green tea catechin, epigallocatechin -3-gallate (EGCG): Mechanisms, perspectives and clinical applications. Biochem Pharmacol 2011;82:1807–1821. 27. Spratt DA, Daglia M, Papetti A, Stauder M, O’Donnell D, Ciric L, Tymon A, Repetto B, Signoretto C, Houri-Haddad Y, Feldman M, Steinberg D, Lawton S, Lingstrom P, Pratten J, Zaura E, Gazzani G, Pruzzo C, Wilson M. Evaluation of plant and fungal extracts for their potential antigingivitis and anticaries activity. J Biomed Biotechnol 2012, 2012: Article ID 510198. 28. Stewart JE, Wolfe GR. The retention of newly-acquired brushing and flossing skills. J Clin Periodontol 1989;16: 331–332. 29. Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of Vitamin C. J Periodontol 1970;41:41–43. 30. Willershausen B, Gruber I, Hamm G. The influence of herbal ingredients on plaque index and bleeding tendency of the gingival. J Clin Dent 1991;2:75–78.

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Preliminary Clinical Evidence of the Antiplaque, Antigingivitis Efficacy of a Mouthwash Containing 2% Green Tea - A Randomised Clinical Trial.

To assess the efficacy of a mouthwash containing 2% green tea as compared to a placebo mouthwash for the control of plaque and gingivitis...
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