Comparative evaluation of Green Tea- Aloe Vera mouthwash and chlorhexidine 0.2% on gingival indices (A randomized clinical trial)

Introduction

Dental plaque is the major etiological factor responsible for periodontal disease. Plaque control is a critical component of dental practice, permitting long term success of periodontal and dental care. There is a growing interest throughout the oral health care profession in therapeutic agents that compliments and enhances the mechanical removal of biofilms in the oral cavity.[1] Various chemical methods of reducing plaque, such as mouth rinses, are used, as they can provide significant benefits to patients who cannot maintain adequate mechanical plaque control[2]. Most of the mouth rinses, which contain modern chemicals like chlorhexidine, and triclosan [3-5], have undesirable side effects, such as staining of teeth and taste alteration. Hence, there has been increased interest in plants with antibacterial and anti-inflammatory activity [6]. The numerous side effects associated with these substances have limited their long term use. Of the numerous herbal extracts, Green tea (Camellia sinensis) and Aloe vera have numerous medicinal benefits, mainly due to their antibacterial and antioxidant properties [7]. Green tea contains phenolic phytochemicals, which possess promising properties beneficial to human health. They include a group of polyphenol compounds called catechins[8]. The remedial effects are associated with the catechins present in green tea, comprising eppigallocatechin gallate (EGCG), epicatechin gallate (ECG). The epicatechin have been suggested that inhibit growth and attachment of periopatogens on the teeth [9,10] There is scarcity of evidence demonstrating the efficacy of A. vera on the plaque and gingivitis. The anti-microbial effects of A. vera have been attributed to the plant’s natural anthraquinones: aloe emodin, aloetic acid, aloin, anthracine, anthranol, barbaloin, chrysophanic acid, ethereal oil, ester of cinnamonic acid, isobarbaloin, and resistannol.[11] In relatively small concentrations, together with the gel fraction, these anthraquinones provide analgesic, antibacterial, antifungal, and antiviral activity; although in high concentrations, they can be toxic.[12]

The purpose of this present study was to compare the effect of green tea- aloe vera mouthwash and chlorhexidine 0/2% on gingival indices.

Materials and Methods

A parallel designed randomized controlled clinical trial was conducted among patients with chronic generalized plaque-induced gingivitis visiting the Department of Periodontology, Mashhad Dental College, Iran. All the patients were briefed on the study protocol and informed consent was obtained from each subject. An approval was obtained from the Institutional Ethical Committee of Mashhad Dental College, before commencement of the study. Sixty volunteer subjects (34 males and 26 females, with a mean age of 32.7 and 34.9 years) were enrolled in this study. Factors as exclusion criteria were, medically compromised patients, any long term medications, smokers and patient who had used any type of antibacterial mouthwash four weeks prior the initiation of the study.

Final recruited patients were distributed into 4 groups. A total of 60 patients were included and evaluated. All the patients underwent scaling after which they were grouped as: Group 1-30 (patients received Placebo mouthwash), Group 2- 30 (patients received Chlorhexidine mouthwash), and Group 3- 30 (patients received Green tea –Aloe vera mouthwash). All patients were instructed to use 5 ml of the mouthwash followed by rinsing for 30 seconds, twice daily. The Plaque index (Loe & Sillness) [13], gingival index (Sillness and Loe) [14] and sulcus bleeding index (Muhlemann)[15] of each patient was recorded at baseline, 14th day postoperatively.

Statistical analysis

Statistical Package for Social Sciences (SPSS) statistical package version 17[16] was used for the entire analysis. In each group, the mean scores of plaque and gingival index were compared between baseline (0 day) and the end of the trial (14 days) by the Paired t-test. One way analysis of variance (ANOVA) was used to compare the mean difference between the groups. All analysis was made at 5% level of significance.

Results

Mean age in males and females was 32.7 ± 7.2 and 34.9 ± 9.8 years, respectively. Using T-test, there was no significant differences between females and males (p=0.32, t=0.98). Also the same was for Chi-square tests, with no corresponding significant difference between groups in terms of sex (p=0.27), implying tests homogeneity. The mean plaque score, gingival score and bleeding score was compared at baseline (0 day) and at the end of the trial (14 days) for all the three mouth rinses. The mouth rinses (aloe vera-green tea and chlorhexidine) exhibited significant reductions in plaque score [Table 1], gingival score [Table 2] and bleeding score [Table 3] from baseline (0 day) to 14 days. However, there was no significant difference observed for aloe vera-green tea and chlorhexidine mouth rinses when the plaque (p=0.008 gingival (p=0.001)and bleeding scores (p=0.001) were  compared.

Table 1. Comparison of mean plaque score at baseline (0day) and after 14 days.