Thursday, June 11, 2015

Green Tea as an Anti-Bacterial Mouthwash? Regular Green Tea's Similarly Effective as "Gold-Std." 0.2% Chlorhexidine

You can turn this coffee mug into a dental health booster by using it for tea.
You will probably have heard of the controversy around chlorhexidine based mouthwash, right? Well, among all the attributes like "chemical" or "toxic" the most convincing argument is probably that chlorhexidine kills all bacteria, good or bad alike.

A study by Govoni et al. for example shows that the normal NO boosting NO increase in response to a standardized oral nitrate load is markedly attenuated by an antibacterial mouthwash containing chlorhexidine, because "the acute increase in plasma nitrite seen after a nitrate load is critically dependent on nitrate reduction in the oral cavity by commensal bacteria" (Govani. 2008).
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This, as well as better-known side effects as antimicrobial resistance, staining, taste alterations, and the mere fact that not everyone likes the burning sensation you get when you swish the mouthwash from one cheek to the other may be reason enough for you to consider using green tea instead.

What a stupid idea? Well, green tea (Camellia sinensis) is not only one of the most popular natural products in the world, its catechins have also been shown to kill Porphyromonas gingivalis (Pg) Prevotella spp  and Tannerella forsythus (Tf), as well as to have beneficial effects with respect to the prevention of periodontal disease. The aim of a recent study from the Sri Hasanamba Dental College and Hospital was now to "evaluate the antibacterial efficacy of green tea extract against two primary colonizers in vitro and to evaluate and compare the antiplaque efficacy in vivo" (Das. 2015).
Figure 1: Tea & chlorh. mouthrinse in identical bottles (left), comparison of Plaque Index after 4 days (right | Das. 2015).
And the results are promising. The plaque index the scientists measured after four days on the identically looking green tea and chlorhexidine mouthwash were not significantly different (Figure 1). Before you jubilee, it does yet have to be said that green tea killed only 12% of the Streptococcus sanguinis and only 48% of the Streptococcus oralis in the petri dish.
Table 1: The anti-cariogenic effects of green tea are no "news" - there are several studies that show that they will occur even if subjects only consume regular green (or black) tea | DMFT = Decayed, Missing, Filled (Hamilton-Miller. 2001).
Despite the lower efficacy of green tea compared to chlorhexidine, even the moderate intake of normal green tea has been found to be inversely correlated with the incidence of periodontal disease, clinical attachment loss, and bleeding on probing in previously conducted scientific studies (Kushiyama. 2009). To which extend these benefits are mediated by the anti-microbial effects of green tea (Hamilton-Miller. 1995 & 2001) and how much its anti-inflammatory properties contribute to its beneficial effect on dental health, is yet hard to say.
This is why tooth hygiene matters: In view of the fact that rotten teeth are chronically inflamed it's no wonder that dental health has been found to be associated with heart disease, stroke and dementia (including Alzheimer's | Mattila. 1998; Meurman. 2004; Ghezzi. 2000; Yamamoto. 2012).
At least theoretically, you could probably produce your own green tea mouthwash if you brew it three times (which is roughly what the scientists did to maximize the extraction of the antibiotic activity), cool it and use it just as any other mouthwash on a daily basis.

What is important, though, is that it is not "better" just because it is natural. What may be better, though, is a reduced risk on antibacterial resistance and maybe even a lack of negative effect on the conversion and uptake of nitrate that was observed by Govoni et al. in response to four days on chlorhexidine, but that's not something to take for granted | Comment on Facebook!
  • Das, Nikhil, et al. "The Effect of Green Tea Mouthrinse in a 4 Day Plaque Regrowth Model in Vivo and Antibacterial Efficacy in Vitro: A Randomized Controlled Trial." (2015).
  • Ghezzi, Elisa M., and Jonathan A. Ship. "Dementia and oral health." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 89.1 (2000): 2-5.
  • Govoni, Mirco, et al. "The increase in plasma nitrite after a dietary nitrate load is markedly attenuated by an antibacterial mouthwash." Nitric Oxide 19.4 (2008): 333-337.
  • Hamilton-Miller, J. M. T. "Anti-cariogenic properties of tea (Camellia sinensis)." Journal of medical microbiology 50.4 (2001): 299-302.
  • Kushiyama, Mitoshi, et al. "Relationship between intake of green tea and periodontal disease." Journal of periodontology 80.3 (2009): 372-377.
  • Mattila, Kimmo J., et al. "Association between dental health and acute myocardial infarction." Bmj 298.6676 (1989): 779-781.
  • Meurman, Jukka H., Mariano Sanz, and Sok-Ja Janket. "Oral health, atherosclerosis, and cardiovascular disease." Critical Reviews in Oral Biology & Medicine 15.6 (2004): 403-413.
  • Yamamoto, Tatsuo, et al. "Association between self-reported dental health status and onset of dementia: a 4-year prospective cohort study of older Japanese adults from the Aichi Gerontological Evaluation Study (AGES) Project." Psychosomatic medicine 74.3 (2012): 241-248.