Study: Green tea and miswak mouthwash effective in inhibiting dental plaque


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Using a 24-hour plaque re-growth protocol, researchers from Malaysia have examined the effects of an all-natural mouthwash consisting of green tea and miswak extract. (Photograph: Piotr Marcinski/Shutterstock)
Dental Tribune International

By Dental Tribune International

Tue. 20. December 2016


KUALA LUMPUR, Malaysia: Investigating the plaque-inhibiting effect of a green tea and miswak mouthwash, researchers from the University of Malaya have found that the all-natural formula significantly reduced dental plaque accumulation for 24 hours. Moreover, the mixture showed anti-bacterial and anti-adherence effects, proving to be a potent, yet milder alternative to conventional mouthwash that contains chemicals, such as chlorhexidine.

Dental plaque is the main cause of caries and periodontal disease. Therefore, controlling its accumulation is crucial for oral health. Due to its antibacterial properties, miswak twigs from the Salvadora persica tree, also known as the toothbrush tree, have been used as chewing sticks for oral hygiene since ancient times. Consumed as a tea, similar cleansing properties are attributed to the leaves of Camellia sinensis var. assamica and have shown to exhibit biological activities that enhance oral health. Combining both natural remedies, the researchers investigated, in a small study group, the plaque-inhibiting properties of a mouthwash mixture consisting of 0.25 mg green tea and 7.82 mg Salvadora persica L. aqueous extract.

One week before the trial, the 14 participants received scaling, polishing and oral hygiene education. On the trial day, they rinsed twice with either 15 ml of the randomly allocated test formula, a placebo mouthwash (distilled water) or 0.12% chlorhexidine. In addition, the participants were instructed to forgo additional oral hygiene measures for 24 hours. After the initial rinse, participants followed a 6-day washout period with regular oral hygiene measures. This overall protocol was repeated three times during the study.

Analysing the plaque index after 24 hours on each trial day, the results showed that the test mouthwash significantly reduced plaque accumulation when compared to the placebo and chlorhexidine mouthwashes. With an effect size of 1.158 and an achieved power of 0.897, the mean plaque index of the test group was significantly lower than that of the chlorhexidine group, with an effect size of 1.077 and power of 0.856. Moreover, the researchers found no significant difference between the chlorhexidine and the placebo mouthwash. This finding is particularly surprising, especially when taking into account that chlorhexidine is generally considered the gold standard in mouthwashes used for chemical plaque control, the researchers wrote.

In addition, participants who rinsed with the miswak and green tea mixture exhibited fewer biofilm promoting organisms, known as primary colonisers, on their teeth’s surfaces. According to the researchers, initial adherence of primary colonisers to oral surfaces is important as they provide new receptors for subsequent adhesion of secondary bacterial colonisers, thereby promoting plaque development.

In light of the findings, the researchers concluded that the green tea and miswak mixture could be an effective and safe means of plaque control. However, long-term clinical studies should investigate the mouthwash’s anti-plaque effect over longer periods in order to draw general conclusions of its effects on oral health.

The study, titled “Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial”, was published online on 1 December in the BMC Complementary and Alternative Medicine journal.

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