The antiplaque efficacy of white tea extract mouthrinse

Abstract

Objective
This study was conducted to assess the antiplaque efficacy of a mouthwash containing white tea. It also assessed the antibacterial properties of white tea against Prevotella intermedia (Pi), Porphyromonas gingivalis (Pg), and Aggregatibacter actinomycetemcomitans (Aa) in vitro.

Materials and Methods
Forty-five subjects with healthy periodontium were randomly chosen and were divided into three groups and advised to use mouthwashes A, B, and C (Group A, white tea; Group B, distilled water [placebo]; Group C, chlorhexidine) for 4 days. They were advised to refrain from any kind of mechanical oral hygiene techniques. Plaque index (PI) was checked on day 1 and 5. In vitro testing for against Pi, Pg, and Aa against white tea extract was undertaken.

Results
PI significantly increased from day 1 to day 5 (P < 0.01) in Groups A, B, and C. In inter-group comparison, there was a statistical significant difference between white tea mouthrinse group and placebo group, chlorhexidine group and placebo group and also chlorhexidine group and white tea mouthrinse group. However, chlohexidine showed superior antiplaque activity. In vitro test, white tea showed effective inhibition against all three bacterial strains Pi, Pg, and Aa at 1% concentration.

Conclusion
White tea mouthrinse potently inhibits plaque formation although not as comparable to chlorhexidine mouthrinse. Hence, for those preferring herbal products, white tea mouthrinse is a good option.

Full text

514 © 2017 Indian Society of Periodontology | Published by Wolters Kluwer ‑ Medknow
Original Article
Address for
correspondence:
Dr. Chirag Javerchand
Mehta,
Department of
Periodontology, TPCT’s
Terna Dental College,
Sector‑22, Phase II,
Nerul (West),
Navi Mumbai ‑ 400 706,
Maharashtra, India.
E‑mail: drcmehta07@
gmail.com
Submission: 27‑09‑2016
Accepted: 22‑10‑2016
Department of
Periodontology,
TPCT’s Terna Dental
College, Navi Mumbai,
Maharashtra, India
The antiplaque efcacy of white tea
extract mouthrinse
Dipika Kalyan Mitra, Palak Mahendra Shah, Hemang Harshad Shah,
Silvia Victor Rodrigues, Chirag Javerchand Mehta
Abstract:
Objective: This study was conducted to assess the antiplaque efcacy of a mouthwash containing white tea. It
also assessed the antibacterial properties of white tea against Prevotella intermedia (Pi), Porphyromonas gingivalis
(Pg), and Aggregatibacter actinomycetemcomitans (Aa) in vitro. Materials and Methods: Forty-ve subjects with
healthy periodontium were randomly chosen and were divided into three groups and advised to use mouthwashes
A, B, and C (Group A, white tea; Group B, distilled water [placebo]; Group C, chlorhexidine) for 4 days. They
were advised to refrain from any kind of mechanical oral hygiene techniques. Plaque index (PI) was checked
on day 1 and 5. In vitro testing for against Pi, Pg, and Aa against white tea extract was undertaken. Results: PI
signicantly increased from day 1 to day 5 (P < 0.01) in Groups A, B, and C. In inter‑group comparison, there
was a statistical signicant difference between white tea mouthrinse group and placebo group, chlorhexidine
group and placebo group and also chlorhexidine group and white tea mouthrinse group. However, chlohexidine
showed superior antiplaque activity. In vitro test, white tea showed effective inhibition against all three bacterial
strains Pi, Pg, and Aa at 1% concentration. Conclusion: White tea mouthrinse potently inhibits plaque formation
although not as comparable to chlorhexidine mouthrinse. Hence, for those preferring herbal products, white tea
mouthrinse is a good option.
Key words:
Antiplaque, mouthrinse, white tea
INTRODUCTION
Periodontal disease is a chronic inammatory
condition occurs due to the complex
interaction between the periodontopathogens
bacteria and the host’s immune response.[1,2]
Mechanical and chemical plaque control
techniques are proven methods for plaque
control.[3] Essential oils, enzymes, bisbiguanides,
and lately even herbal extracts have been
researched as potent plaque inhibitors.
Chlorhexidine, considered to be the gold
standard,[4] cannot be advised for long periods
because of its adverse effects.[5] So also essential
oils rinse, which have been extensively
researched, have side effects.[6] Therefore, the
search for other agents with equal efcacy and
fewer side effects is essential.
Tea has been reported to be a very popular
beverage among a wide range of populations.
It has shown to have many benecial effects
on our oral health. Different types of teas are
manufactured, and each has shown to have a
positive effect on the teeth. White tea goes well
with healthy white teeth and gums.[7]
White tea, green tea, and black tea originate
from the plant Camellia sinensis.[8] White tea has
a light taste and color. The origin of white tea is
mostly from Fujian Province of China and is the
least processed form of tea with least amount of
caffeine as compared to black and green tea.[9]
White tea retains its nutrients since the processing
temperature is low compared to processing
temperature of other two teas. The ingredients
of white tea are alanine, histidine, aspartic acid,
threonine, glutamic acid, and amino acids.[6] The
most important ingredients in white tea are rich in
polyphenols, which is a natural antioxidant.[10,11]
There have been studies in the past which
have shown that white tea has a major health
benet, it can kill bacteria, fungi, and viruses in
the body with more success than other teas.[12]
White tea contains a number of polyphenolic
compounds which have a wide spectrum
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DOI:
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Shah HH, Rodrigues SV, Mehta CJ. The antiplaque
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Mitra, et al.: White tea mouthrinse
Journal of Indian Society of Periodontology ‑ Vol 20, Issue 5, September‑October 2016 515
of antioxidant, antiviral, anticancer, antitoxoplasmal,
antihelmintic properties (Almajano, Carbo and Gordon
2008).[13]
It lowers cholesterol, reduces blood pressure, and fights
fatigue.[14] White tea also contains fluoride, tannins, and
avonoids.[15] Fluorides help to reduce caries.
Not much research has been done on the efcacy of white tea
as an antiplaque agent. Therefore, this study was undertaken
to evaluate the effectiveness of white tea as mouthwash in
comparison with the gold standard, i.e., chlorhexidine.
MATERIALS AND METHODS
In vivo study design
The current clinical trial was a double-blinded, randomized,
parallel, longitudinal study. Forty‑ve periodontally healthy
subjects (11 males and 34 females) between the age group of
21 to 23 years (mean age 22 years) were enrolled in the 4-day
rinsing study. Mouthwashes were labeled as A, B, and C by one
examiner and another examiner (blinded) conducted the study.
Mouthwash A (test) was a white tea extract mouthwash;
mouthwash B (placebo control) was a placebo that constituted
distilled water, and mouthwash C (positive control) was a
commercially available 0.2% chlorhexidine mouthwash (ICPA
Health Care Products, Ankleshwar, Gujarat).
For mouthwash A, white tea extract powder (Changsha
Nutra-Y Biotechnology, Hunan, China) was used. The
solubility of the mouthwash was 1 mg/100 ml of water. It was
dissolved in distilled water for an effective concentration of 1%.
Subjects with good systemic health with at least 24 scorable
teeth (not including third molars or crowned teeth) were
included in the study. Subjects who consumed a high
polyphenolic diet (including green tea or soya diet), wore
appliances, or prostheses (xed or removable) were prescribed
antibiotics or other medications in the previous 3 months or had
undergone treatment for periodontal problems were excluded
from the study. Subjects having diseases that would increase
oxidative stress such as diabetics and subjects not cooperating
with the study protocol were excluded from the study.
Forty‑ve students, studying in Terna Dental College, Nerul,
Navi Mumbai, India, who complied inclusion criteria, were
selected. This study was approved by the Ethical Committee of
the same institution and was conducted in accordance with the
Declaration of Helsinki and principles of good clinical practice.
The subjects were randomly assigned into three equal groups
Group A, B, and C (15 subjects per group).
At baseline, thorough oral prophylaxis was done for all the
subjects by the investigator. Plaque was disclosed using Two
Tone Plaque Disclosing Agent (Dento Plac, India) to ensure
that all deposits had been removed. Subjects were told not
to use toothbrushes, toothpaste, or any other interdental
cleaning aid or chewing gum for the next 4 days. Instead,
subjects were asked to use one of the assigned mouthwash
two times a day.
At a particular specied time during the day, all subjects
were instructed to rinse two times a day for 1 min with 10 mL
of the randomly allocated rinse. At each rinsing, 10 mL of
the solution was swished around the mouth for about 60 s
and then expectorated. On day 5, the subjects were recalled;
plaque index (PI; Turesky et al. modication of Quigley PI) was
recorded, and subjects were allowed to resume their routine
oral hygiene regimens.
Data collection
The amount of plaque was checked on days 0 and day 5.
Adverse effects such as burning sensation, altered taste, and
desquamation of gingival epithelium if any were also evaluated
on the 5th day.
In vitro study design
The white tea extract was tested against three organisms:
Porphyromonas gingivalis (Pg), Porphyromonas intermedia (Pi)
and Aggregatibacter actinomycetemcomitans (Aa).
Media used
The brain heart infusion (BHI) agar was used; agar plates were
brought to room temperature before use.
Inoculum preparation
Nine dilutions of each drug (white tea extract mouthwash,
chlorhexidine mouthwash, and distilled water) were done
with BHI for minimal inhibitory concentration. In the rst
tube, 20 µl of the drug was added into the 380 µl of BHI broth.
For dilutions, 200 µl of BHI broth was put in the other 9 tubes
separately. Then, from the rst tube, 200 µl was put into the
rst tube containing 200 µl of BHI broth. This was said to be
as 10:1 dilution.
From 10:1 diluted tube 200 µl was put to the second tube to
make 10:2 dilution. The serial dilution was repeated up to
10:9 dilution for each drug. From the maintained stock cultures
of required organisms, 5 µl was taken and was put into 2 ml of
BHI broth. In each serially diluted tube, 200 µl of above culture
suspension was added. The tubes were incubated for 24 h and
observed for turbidity.
Statistical analysis
After the indices were calculated and the mouthwash order was
decoded, further testing was done with SPSS version 17 software
(SPSS Inc., Chicago, IL, USA). The mean was calculated for each
mouthwash. The analysis of variance (ANOVA) was done.
Differences between the mouthwash solutions and distilled water
were determined via the Bonferroni multiple comparison test.
RESULTS
Forty‑ve subjects, 11 males, and 34 females, completed
the study. In all groups, PI showed signicant (P <0.01)
increase from the baseline to the 5th day. The in vivo results
demonstrated that the mean PI values were the highest
for the distilled water mouthwash (2.55) and the least for
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Mitra, et al.: White tea mouthrinse
516 Journal of Indian Society of Periodontology ‑ Vol 20, Issue 5, September‑October 2016
chlorhexidine mouthwash (1.94). The mean PI value for
distilled water (2.55) was higher than the white tea group
(2.21). ANOVA showed a statistically signicant difference
between the PI scores (P = 0.001).
Differences between the individual mouthwashes and distilled
water, determined through the Bonferroni multiple comparison
test, showed signicantly less plaque regrowth in case of both
chlorhexidine (P =1.94) and white tea (P = 2.21) as compared
to distilled water.
The results of the ANOVA test are given in Table 1 while those
of the Bonferroni multiple comparison test are given in Table 2.
There was no burning sensation or taste alteration reported by
any of the subjects at the end of the study period. In addition,
there was no evidence of gingival epithelial desquamation on
intraoral examination in any of the subjects.
The in vitro study showed that Pg, Pi, and Aa was inhibited at
the concentration of 1%.
DISCUSSION
This present study evaluated the antiplaque effects of a
new white tea mouthwash and also aimed to evaluate
whether the mouthwash had any adverse effects. White tea
mouthwash was compared with distilled water and 0.2%
chlorhexidine solution. The study design (4-day plaque
regrowth study) has been used in many studies and is a
standard method for testing the plaque-reducing effect.[16,17]
The advantage of a 4-day plaque regrowth study design is
that it eliminates the effect of the adjunctive mechanical oral
hygiene techniques because they are not permitted during
the trial period.[18]
In all the groups, PI showed statistically signicant (P < 0.01)
increase from baseline to day 5. The present study showed
signicant and comparable reduction in PI in the white tea
and chlorhexidine group as compared to the distilled water
(P = 0.001). White tea mouthrinse was found to be a potent
antiplaque agent, though less efcacious than chlorhexidine
mouthrinse. Postoperative mouthrinse of white tea and
chlorhexidine are shown in Figures 1 and 2, respectively.
Probably, it can serve as a long-term herbal antiplaque agent
in maintenance phase or as an alternative for the patients
looking for herbal products mouthrinse, or for the patients
who complaint of side-effects due to chlorhexidine mouthrinse.
One of the shortcomings of this study is the smaller sample
size. At the end of the study, no adverse effects of the white
tea mouthwash were seen in any of the subjects. The duration
of the study was short (4 days) as the plaque regrowth model
was used. Therefore, the antigingivitis efcacy of the white
tea extract mouthwash was not tested. More studies using a
longer duration, larger sample size and a cross-over model can
be performed for further research.
CONCLUSION
White tea mouthrinse was found to be a potent antiplaque agent
although less efcacious than chlorhexidine mouthrinse. It can
serve as a good alternative for the patients who prefer herbal
products, which have practically no side effects.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
Table 1: Results of plaque index and comparison
between groups using one-way analysis of variance
Sample Mean SD P
White tea 2.2133 0.12459 0.001*
Distilled water 2.5520 0.23902
Chlorhexidine 1.9400 0.16818
*Statistically signicant at P<0.05. SD – Standard deviation
Table 2: Comparison between groups using Bonferroni
multiple comparison test
Sample compared P
Chlorhexidine versus white tea 0.001*
Distilled water versus chlorhexidine 0.001*
White tea versus distilled water 0.001*
*Statistically signicant at P<0.05
Figure 2: Postoperative chlorhexidine mouthrinse patientFigure 1: Postoperative white tea mouthrinse patient
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Mitra, et al.: White tea mouthrinse
Journal of Indian Society of Periodontology ‑ Vol 20, Issue 5, September‑October 2016 517
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