The clinical and immunological efficacy of a mouth rinse containing green tea and Salvadora Persica L. in patients with dental biofilm-induced gingivitis (randomized clinical trial)
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Abstract
Background: Dental biofilm-induced gingivitis is an inflammatory condition resulting from the interaction between dental plaque and the host's immune-inflammatory response at the site level. Objective: examine the anti-plaque and anti-inflammatory properties of GT/SP (Green Tea/Salvadora Persica Linn) mouthwash in individuals with dental biofilm-induced gingivitis. Moreover, a study was conducted to compare the effects of GT/SP with those of CHX (Chlorhexidine) and placebo mouthwashes, and to anticipate outcomes of plaque control together with proposing cut-off points for the predictors on the profile of the salivary biomarker IL-6. Material and Methods: The clinical trial was conducted using a randomized, double-blinded, and parallel design. A total of sixty patients diagnosed with generalized biofilm-induced gingivitis were randomly divided into three groups for the administration of mouthwashes: GT/SP, CHX, and placebo. The study lasted for one month, during which participants used 15 milliliters of GT/SP mouthwash formulation, CHX (0.12%), or a placebo, twice daily. Each individual had two assessments, one at the beginning and another after one month. Before and after each participant’s mouthwash usage, the Patient's plaque level and bleeding on probing were assessed. The quantification of the Salivary IL-6 in saliva was assayed using enzyme-linked immunoassay (ELISA). Results: A significant decrease in salivary interleukin-6 was observed in all three groups. However, there was no significant difference between the GT/SP and CHX groups in intergroup comparisons at second visits (P>0.05). In addition, all treatments significantly decreased the build-up of Plaque, with the mouthwash containing Green Tea (GT) and Salvadora Persica Linn (SP) having a more pronounced effect compared to the other two treatments. Conclusion: Mouthwash with GT/SP exhibited both anti-plaque and anti-inflammatory properties. The above findings suggest that GT/SP may have positive effects in treating dental biofilm-induced gingivitis, making GT/SP a suitable alternative to chlorhexidine.
Received date: 07-04-2025
Accepted date: 16-06-2025
Published date: 15-03-2026
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References
Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque–induced gingival conditions. J Clin Periodontal. 2018;45:S17-S27.
Talib HJ, Ahmed MA. Assessment of Salivary Lactoferrin and pH Levels and Their Correlation with Gingivitis and Severity of Chronic Periodontitis (Part: 2). J Bagh Coll Dent. 2018;30(1):46-52.
Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontal. 2018;45 Suppl 20:S44-s67.
Li Y, Lee S, Hujoel P, Su M, Zhang W, Kim J, et al. Prevalence and severity of gingivitis in American adults. Am J Dent. 2010;23(1):9.
Harvanová G, Duranková S, Bernasovská J. The role of cytokines and chemokines in the inflammatory response. Alergol Pol. 2023;10(3):210-9.
Mohammed MA, Abbas RF, Akram HM. Salivary IL-17 and IL-10 as Potential Diagnostic Biomarkers of Different Stages of Periodontitis in Smoker and Nonsmoker Patients. Eur J Dent. 2024;18(1):253-64.
Nanakaly HT. Interleukine-6 level in saliva of patients with chronic periodontitis: A case-control study. J Bagh Coll Dent. 2016;325(3154):1-6.
Naruishi K, Nagata T. Biological effects of interleukin‐6 on gingival fibroblasts: cytokine regulation in periodontitis. J Cell Physiol. 2018;233(9):6393-400.
Salminen A, Gursoy UK, Paju S, Hyvärinen K, Mäntylä P, Buhlin K, et al. Salivary biomarkers of bacterial burden, inflammatory response, and tissue destruction in periodontitis. J Clin Periodontol. 2014;41(5):442-50.
Shrimathi S, Kemparaj U, Umesh S, Karuppaiah M, Pandian P, Krishnaveni A. Comparative evaluation of cocoa bean husk, ginger and chlorhexidine mouth washes in the reduction of Steptococcus mutans and Lactobacillus count in saliva: a randomized controlled trial. Cureus. 2019;11(6).
Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent. 2020;103:103497.
Cho Y-S, Oh JJ, Oh K-H. Antimicrobial activity and biofilm formation inhibition of green tea polyphenols on human teeth. Biotechnol Bioproc E. 2010;15:359-64.
Almas K, Skaug N, Ahmad I. An in vitro antimicrobial comparison of miswak extract with commercially available non‐alcohol mouthrinses. Int J Dent Hyg. 2005;3(1):18-24.
Darout IA, Albandar JM, Skaug N, Ali RW. Salivary microbiota levels in relation to periodontal status, experience of caries and miswak use in Sudanese adults. J Clin Periodontal. 2002;29(5):411-20.
Abdulbaqi HR, Himratul-Aznita WH, Baharuddin NA. Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial. BMC Complement Altern Med. 2016;16:1-7.
Abdulbaqi HR, Himratul-Aznita WH, Baharuddin NA. Anti-plaque effect of a synergistic combination of green tea and Salvadora persica L. against primary colonizers of dental plaque. Arch oral Biol. 2016;70:117-24.
Song M, Bai H, Zhang P, Zhou X, Ying B. Promising applications of human-derived saliva biomarker testing in clinical diagnostics. Int J Oral Sci. 2023;15(1):2.
Salman SA. Measurement of salivary Immunoglobulin A of participants with a healthy, gingivitis and chronic periodontitis conditions. J Bagh Coll Dent. 2015;27(3):120-3.
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol. 1970;41(1):41-3.
Van der Weijden GA, Timmerman MF, Nijboer A, Reijerse E, Van der Velden U. Comparison of different approaches to assess bleeding on probing as indicators of gingivitis. J Clin Periodontol. 1994;21(9):589-94.
Haynes RB, Sackett DL, Richardson WS, Rosenberg W, Langley GR. Evidence-based medicine: How to practice & teach EBM. Can Med Assoc J. 1997;157(6):788.
Montenegro R, Needleman I, Moles D, Tonetti M. Quality of RCTs in periodontology—a systematic review. J Dent Res. 2002;81(12):866-70.
Nair B. Clinical trial designs. Indian Dermatol online J. 2019;10(2):193-201.
Nobbs A, Jenkinson H, Jakubovics N. Stick to your gums: mechanisms of oral microbial adherence. J Dent Res. 2011;90(11):1271-8.
Soares S, Vitorino R, Osorio H, Fernandes A, Venancio A, Mateus N, et al. Reactivity of human salivary proteins families toward food polyphenols. J Agric Food Chem. 2011;59(10):5535-47.
Xiao Y, Liu T, Zhan L, Zhou X. The effects of tea polyphenols on the adherence of cariogenic bacterium to the collagen in vitro. Hua xi kou qiang yi xue za zhi= Huaxi kouqiang yixue zazhi= West China J Stomatol. 2000;18(5):340-2.
Joiner A, Muller D, Elofsson UM, Arnebrant T. Ellipsometry analysis of the in vitro adsorption of tea polyphenols onto salivary pellicles. Eur J Oral Sci. 2004;112(6):510-5.
Baban DA. Effect of sulcular green tea extract irrigation on experimental rabbit’ s gingivitis (A histopathological study). J Bagh Coll Dent. 2020;32(1):19-27.
Bansal S, Choudhary S, Sharma M, Kumar SS, Lohan S, Bhardwaj V, et al. Tea: A native source of antimicrobial agents. Food Res Int. 2013;53(2):568-84.
Xu X, Zhou XD, Wu CD. Tea catechin epigallocatechin gallate inhibits Streptococcus mutans biofilm formation by suppressing gtf genes. Arch Oral Biol. 2012;57(6):678-83.
Tenovuo J, Mansson-Rahemtulla B, Pruitt K, Arnold R. Inhibition of dental plaque acid production by the salivary lactoperoxidase antimicrobial system. Infect Immun. 1981;34(1):208-14.
Goyal M, Sasmal D, Nagori B. Salvadora persica (Meswak): chewing stick for complete oral care. Int J Pharmacol. 2011;7(4):440-5.
Al-Bayaty FH, AI-Koubaisi AH, Ali NAW, Abdulla MA. Effect of mouth wash extracted from Salvadora persica (Miswak) on dental plaque formation: a clinical trial. J Med Plant Res. 2010;4(14):1446-54.
Kaur H, Jain S, Kaur A. Comparative evaluation of the antiplaque effectiveness of green tea catechin mouthwash with chlorhexidine gluconate. Indian J Soc Periodontol. 2014;18(2):178-82.
Hambire CU, Jawade R, Patil A, Wani VR, Kulkarni AA, Nehete PB. Comparing the antiplaque efficacy of 0.5% Camellia sinensis extract, 0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children. J Int Soc Prev Community Dent. 2015;5(3):218-26.
Salah R, Abdulbaqi HR, Mohammed A, Abdulkareem AA. Four-day randomized controlled crossover trial evaluating the antiplaque effect of a combination of green tea and Salvadora persica L. mouthwash. J Herb Med. 2020;23:100357.
Al-Maweri SA, Nassani MZ, Alaizari N, Kalakonda B, Al-Shamiri HM, Alhajj MN, et al. Efficacy of aloe vera mouthwash versus chlorhexidine on plaque and gingivitis: A systematic review. Int J Dent Hyg. 2020;18(1):44-51.
Karamani I, Kalimeri E, Seremidi K, Gkourtsogianni S, Kloukos D. Chlorhexidine Mouthwash for Gingivitis Control in Orthodontic Patients: A Systematic Review and Meta-Analysis. Oral health Prev Dent. 2022;20:279-94.
Lee DW, Jung JE, Yang YM, Kim JG, Yi HK, Jeon JG. The antibacterial activity of chlorhexidine digluconate against Streptococcus mutans biofilms follows sigmoidal patterns. Eur J Oral Sci. 2016;124(5):440-6.
Bagheri R, Rashidlamir A, Ashtary-Larky D, Wong A, Grubbs B, Motevalli MS, et al. Effects of green tea extract supplementation and endurance training on irisin, pro-inflammatory cytokines, and adiponectin concentrations in overweight middle-aged men. Eur J Appl Physiol. 2020;120(4):915-23.
Mekhemar M, Geib M, Kumar M, Radha, Hassan Y, Doerfer C. Salvadora persica: Nature’s gift for periodontal health. Antioxidants. 2021;10(5):712.
Lebda MA, Ali H, Noreldin AE, Elewa YH, Al Jaouni SK, Mousa SA. Protective effects of miswak (Salvadora persica) against experimentally induced gastric ulcers in rats. Oxid Med Cell Longev. 2018;2018.
Mohamed SA, Almulaiky YQ, Ahmed YM, Al-Bar OA, Ibrahim IH. Purification and characterization of α-Amylase from Miswak Salvadora persica. BMC Complement Altern Med. 2014;14:1-10.
Haghighatdoost F, Hariri M. The effect of green tea on inflammatory mediators: a systematic review and meta‐analysis of randomized clinical trials. Phytother Res. 2019;33(9):2274-87.
Lin C-C, Lin H-H, Chang H, Chuang L-T, Hsieh C-Y, Lu S-H, et al. Prophylactic effects of purple shoot green tea on cytokine immunomodulation through scavenging free radicals and NO in LPS-stimulated macrophages. Curr Issues Mol Biol. 2022;44(9):3980-4000.
Ibrahim AY, El-Gengaihi SE, Motawea HM, Sleem AA. Anti-inflammatory activity of Salvadora persica L. against carrageenan induced paw oedema in rat relevant to inflammatory cytokines. Not. Sci. Biol. 2011;3(4):22-8.
Oz HS. Chronic inflammatory diseases and green tea polyphenols. Nutrients. 2017;9(6):561.
Noronha NY, Pinhel MA, Nicoletti CF, Quinhoneiro DCG, Pinhanelli VC, de Oliveira BA, et al. Green tea supplementation improves oxidative stress biomarkers and modulates IL-6 circulating levels in obese women. Nutr. Hosp. 2019;36(3):583-8.
Bagheri R, Rashidlamir A, Ashtary-Larky D, Wong A, Grubbs B, Motevalli MS, et al. Effects of green tea extract supplementation and endurance training on irisin, pro-inflammatory cytokines, and adiponectin concentrations in overweight middle-aged men. Eur. J Appl. Physiol. 2020;120:915-23.
Bokhary T, Refaat B, Bakr ES, Baz S, Rajab B, Gadalla H, et al. Salvadora persica extract attenuates cyclophosphamide-induced hepatorenal damage by modulating oxidative stress, inflammation and apoptosis in rats. J Integr Med. 2022;20(4):348-54.
Al-Quraishy S, Thagfan FA, Al-Shaebi EM, Qasem M, Abdel-Gaber R, Dkhil MAM. Salvadora persica protects mouse intestine from eimeriosis. Rev Bras Parasitol Vet. 2019;28(4):605-12.
Hosseini M, Vazirian M, Nomani A, Monsef-Esfahani H. Evaluation of anti-inflammatory effect of Salvadora persica in IBD-induced rat. Res. J Pharmacogn. 2017;4(Supplement):27.
Saddiq AA, Alkinani MH. Fungicidal Impact of Salvadora Persica L. (Miswak) Extract on Growth of Foodborne Pathogens, Aspergillus Species. Dose Response. 2019 26;17(3).
Finoti LS, Nepomuceno R, Pigossi SC, Corbi SC, Secolin R, Scarel-Caminaga RM. Association between interleukin-8 levels and chronic periodontal disease: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2017;96(22):e6932.
Yoshida RA, Gorjão R, Mayer MPA, Corazza PFL, Guare RO, Ferreira A, et al. Inflammatory markers in the saliva of cerebral palsy individuals with gingivitis after periodontal treatment. Braz Oral Res. 2019;33:e033.
Kobayashi T, Ito S, Kobayashi D, Kojima A, Shimada A, Narita I, et al. Interleukin-6 receptor inhibitor tocilizumab ameliorates periodontal inflammation in patients with rheumatoid arthritis and periodontitis as well as tumor necrosis factor inhibitors. Clin Exp Dent Res. 2015;1(2):63-73.
Mohammad C. Efficacy of Curcumin Mouth Wash on Gingival Inflammation in Patients with Chronic Gingivitis. Sulaimani Dent J. 2022;9(1):12-12.
Machado V, Botelho J, Lopes J, Patrão M, Alves R, Chambrone L, et al. Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis. Diagnostics (Basel). 2020;10(4).
McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne Effect: a randomised, controlled trial. BMC Med Res Methodol. 2007;7:30.
Zou Y, Grender J, Adam R, Levin L. A Meta-analysis Comparing Toothbrush Technologies on Gingivitis and Plaque. Int Dent J. 2024;74(1):146-56.