Abstract
BACKGROUND:
Herbal mouthwash is considered as an alternative regimen in maintaining oral hygiene. Tea contains compounds such as catechin and tannin which possess bactericidal and bacteriostatic effect which helps to prevent dental caries.
AIM:
This study was conducted to determine the effectiveness between rinsing with steeping black tea and green tea solution in decreasing the amount of Streptococcus mutans.
METHODS:
This is an experimental study with pre and post-test controlled group design. The sample were 60 college students from North Sumatera University which were then divided into three groups: oral rinsing with steeping black tea (treatment group), oral rinsing with steeping green tea (treatment group) and oral rinsing with listerine (control group). Saliva collection was carried out before treatment (pre-test/baseline) and after treatment (post-test). Treatment group was instructed to rinse 15 ml of steeping black and green tea solution whereas control group were instructed to rinse 15 ml listerine for 30 seconds and get rid of it. The saliva samples before and after treatment were brought to the microbiology laboratorium for Streptococcus mutans amount calculation using Total Plate Count (TPC) method. A T-test were used to determine the difference between rinsing with black tea and green tea and Kruskalwalis used to determine the difference between rinsing with steeping black tea, steeping green tea and aquadest towards the mean amount of bacteria before and after treatment.
RESULT:
The results showed significant reduction in amount of Streptococcus mutans in both treatment group where black tea group before treatment 28.90 x 103 ± 7.152 x 103 CFU/ml and after treatment 21.60 x 103 ± 6.295 x 103 CFU/ml (p < 0.05) and green tea group before treatment 70.15 x 103 ± 34.814 x 103 CFU/ml and after treatment 54.85 x 103 ± 31.451 x 103 CFUml (p < 0.05). The results in control group also showed reduction in amount of Streptococcus mutans where before treatment 25.80 x 103 ± 12.190 x 103 CFU/ml and after treatment 11.30 x 103 ± 8.228 x 103 CFU/ml (p > 0.000). Statistical analysis revealed that significant difference was found in the mean reduction of total Streptococcus mutans before and after in black tea group 7.30 x 103 ± 3.062 x 103 CFU/ml and green tea group 15.30 x 103 ± 11.045 x 103 CFU/ml (p < 0.05).
CONCLUSION:
It can be concluded that rinsing with steeping green tea solution has more effectiveness in decreasing the total Streptococcus mutans as compared to black tea solution.
Keywords: Black tea, Green tea, Caries
Introduction
Oral hygiene is one of the indicators in assessing one’s oral health. The frequently occurring phenomenon in the community is that lack of attention towards oral hygiene which will cause problems to both the teeth and also oral cavity. The oral cavity is the most complex and favourable breeding places for the microbes to colonize in the human body. Bacteria are the most common microbes found in the human oral cavity [1].
Caries is the consequences of negligence towards importance of oral health. Caries is characterized as the dissolution of the enamel and the root surface (demineralization) by the acid produced from the metabolism of fermented carbohydrates in the diet by the colonizing bacteria on the tooth surface [2], [3]. Caries is caused by the teeth (hosts), substrates, time, and microorganisms [4]. Streptococcus mutans are the cariogenic microorganisms that predominate in the oral cavity. In addition, there are also lactobasillus organisms that plays a role in the formation of dental caries [5]. Streptococcus plays a role in the early stages of caries by destroying the outer part of the enamel, meanwhile lactobasillus will be taking over the role of deep caries [4]. According to RISKESDAS in 2013, DMF-T scores in Indonesia is 4.6. There are many ways in preventing cariogenic microorganisms, and the usage of herbal mouthwash is one of them [6].
Medicinal herbs are medicines derived from plants where the plant parts might be from the roots, stems, leaves, tubers, or possibly the entire plant. Plants derived from nature is widely used by the community, especially the people in Indonesia due to the affordable price, user friendly, and the abundance of plants or other materials that can be used as a healthy choice for treatment in Indonesia [1]. The advantages of herbal medicine over modern medicine was producing relatively lesser side effects. Till date, many types of herbs were used and developed as an analgesic, anti-inflammatory, anti-bacterial, anti-fungal, and anti-plaque [2].
According to WHO, 80% of the world’s population still rely on traditional medicine which includes the use of medicines from the plants. Among them is tea due to the perception of people in Indonesia as a daily beverage and it was also the most consumed beverage in the world after water. Tea produced and consumed in the world consists of 78% black tea, 20% green tea, less than 2% oolong tea and the rest are other less popular tea variation [3].
Tea is one of the plants that contains quite a number polyphenols. The benefits of polyphenols, especially those found in the tea or tea leaves, are tannins and flavonoids such as catechin. The catechins contained in the tea leaves are composed of several compounds: C (catechin), EC (epicatechin), EGC (epigalocatechin), and ECG (epigalocatechin) [5]. Catechins contained in tea leaves are bactericidal and bacteriostatic. Catechin works by destroying the cytoplasmic membrane of the bacteria as well as causing protein denaturation [3], [5]. In addition, the tea also contains fluor [4], [6]. Fluor possesses antibacterial and antiplaque effects [4].
The results of Dellon et al’s research on the inhibition of black tea, green tea and oolong tea towards the growth of Streptococcus mutans. The results of the study showed that black tea with 3,7833 ± 0,82744, green tea with 4,3667 ± 0,6607, and oolong tea with 4,0889 ± 0,6061. From these results, it can be concluded that there is no significant difference in inhibiting Streptococcus mutans among the three groups [7].
Research conducted by Jalayer et al about the antibacterial activity of green tea and black tea against Streptococcus mutans. The study used five different concentrations ranging from 50 mg/ml, 100 mg/ml, 200 mg/ml, 300 mg/ml, and 400 mg/ml. From the results showed that green tea was effective at the concentrations of 150 mg/ml meanwhile black tea was effective at the concentrations of 100 mg/ml. This suggested that black tea was more effective at a lower concentration than the green tea. This study was also supported by the research conducted by Hamdi et al. Their results also showed that black tea reduces bacterial attachment to plaque at concentrations of 1 mg/ml meanwhile green tea at the concentrations of 1.5 mg/ml [8].
Nyoman et al., conducted a study to analyze the effects of rinsing with black tea towards plaque growth. This study was conducted on 20 respondents which were divided into 2 groups such as group rinsing with chlorhexidine gluconate 0.2% and the group rinsing with sugarless black tea. An average plaque score before treatment of 6.02 ± 0.79 was obtained in the group rinsing with 0.2% chlorhexidine gluconate meanwhile after treatment was 3.31 ± 0.58 whereas in the group rinsing with black sugarless tea before treatment was 6.22 ± 0.81 meanwhile after treatment was 1.90 ± 0.59. This suggested that black tea is more effective in inhibiting plaque growth (p < 0.05) [6].
The benefits of this research are where by rinsing tea can be a cheap alternative mouthwash, user friendly and free from any chemical compounds which can be used to prevent dental caries.
Material and Methods
This is a clinical experimental research with pre and post-test group control design. The subjects of this research were 60 college students of North Sumatera University aged 19-23 years with the inclusion criteria: willingness to be the subject of research and have a minimum decay score of 2 per person. Meanwhile, exclusion criteria are users of fixed orthodontic appliance and prosthesis, suffering from systemic disease and routine user of antiseptic mouth rinses.
Steeping tea solution was made by brewing 2 gr of tea powder (1 tea bag) with 25 ml of water and leave it for 5 minutes to facilitate the escape of catechin from the tea leaves.
Subjects were instructed to fast for 1 hour before the study. Early saliva sampling was performed by the spitting method and then stored in a sterile tube and sealed for the calculation of bacterial counts before treatment (pretest/baseline). Then the subjects were randomly divided into 3 groups such as the treatment group which rinses 15 ml steeping black tea for 30 seconds, treatment group which rinses 15 ml of steeping green tea for 30 seconds and the control group which rinses 15 ml listerine for 30 seconds. The subjects in all three groups were instructed to rinse and then discarded. Later on, the total saliva of the subjects was immediately stored in a sterile tube and sealed closely to calculate Streptococcus mutans count after the treatment (post-test). Sampling of saliva samples was conducted in the clinic of dental public health Faculty of Dentistry North Sumatera University. All saliva samples were immediately taken to Microbiology Laboratory of Industrial Chemical Technology Polytechnic (PTKI) Medan for Streptococcus mutans count using the Total Plate Count (TPC) method.
Data processing was done by using computer program for statistical analysis. The data was analyzed to calculate the difference in mean Streptococcus mutans count before and after rinsing of steeping black tea, green tea and listerine using T test. Kruskalwallis test was also used to calculate the difference in bacterial count between the group rinsing with steeping black tea, green tea and listerine.
Results
In the steeping black tea solution group, the average amount of Streptococcus mutans before treatment (pre-test) was 28,90 x 103 ± 7,152 x 103 CFU/ml whereas after treatment (post-test) was 21,60 x 103 ± 6,295 x 103 CFU/ml. In the steeping green tea group, the average amount of Streptococcus mutans was 70,15 x 103 ± 34,814 x 103 CFU/ml whereas after treatment (post-test) was 54,85 x 103 ± 31,451 x 103 CFU/ml. Meanwhile in the listerine group, the average amount of Streptococcus mutans before treatment (pre-test) was 25,80 x 103 ± 12,190 x 103 CFU/ml whereas after treatment (post-test) was 11,30 x 103 ± 8,228 x 103 CFU/ml. The result of t-test showed that there was a significant decrease in bacterial count in steeping black tea and green tea solution group (p < 0,05) (Table 1).
Table 1.
Average amount of Streptococcus mutans before treatment (pre-test) and after treatment (post-test) in steeping black tea, green tea and listerine rinsing group
| Group | n | Average amount of Streptococcus mutans (± SD) (CFU/ml) | Statistical Analysis | |
|---|---|---|---|---|
| Before | After | |||
| Rinsing steeping black tea solution | 20 | 28.90 x 103± 7.152 x 103 | 21.60 x 103± 6.295 x 103 | P = 0.000 |
| Rinsing steeping green tea solution | 20 | 70.15 x 103± 34.814 x 103 | 54.85 x 103± 31.451 x 103 | |
| Rinsing listerine | 20 | 25.80 x 103± 12.190 x 103 | 11.30 x 103± 8.228 x 103 | |
The difference in the bacterial count of pre-treatment and post-treatment in the steeping black tea rinsing group was 7.30 x 103 ± 3,062 x 103 CFU/ml whereas the difference in the bacterial count before treatment (pre-test) and after treatment (post-test) in steeping green tea rinsing group was 15.30 x 103 ± 11.045 x 103 CFU/ml. The difference in the average amount of bacterial count between the groups before treatment (pre-test) and after treatment (post-test) was 1450 x 103 ± 6.228 x 103 CFU/ml. The results showed that there was a significant difference between the rinsing group of steeping black tea and green tea solution (p = 0.000) (Table 2).
Table 2.
Difference in bacteria count before (pre-test) and after treatment (post-test) in steeping black tea, green tea and listerine rinsing group
| Group | n | Difference in bacteria count (± SD) (CFU/ml) | Statistical Analysis |
|---|---|---|---|
| Rinsing steeping black tea solution | 20 | 7.30 x 103± 3.062 x 103 | P = 0.000 |
| Rinsing steeping green tea solution | 20 | 15.30 x 103± 11.045 x 103 | |
| Rinsing listerine | 20 | 14.50 x 103± 6.228 x 103 |
Discussion
There was a significant decrease amount streptococcus mutans in the steeping black tea, green tea and listerine solution rinsing groups (p < 0.05). This happened because the steeping black tea and green tea contains catechin. Catechins contained in the tea leaves are bactericidal and bacteriostatic. Catechin works by inhibiting the activity of glucosyltransferase enzymes produced by Sterptococcus mutans bacteria. The glucosyltransferase enzyme will convert sucrose to glucan which inhibit the formation of carbohydrate that is easily fermented (maltose) by bacteria hence bacterial growth will be inhibited and also decrease in acid production by bacteria [9], [10]. Besides that, black tea also contains tannin which have the ability to inactivate the adhesion of microbial cells (molecules attached to host cells) present on the cell surface and the enzymes attached to cell membranes or the cell wall polypeptides [10]. This result is consistent with Dellon et al’s research on inhibition of black tea, green tea and oolong tea towards the growth of Streptococcus mutans. In this study found that black tea with 3.7833 ± 0.82744, green tea with 4.3667 ± 0.6607, and oolong tea with 4.0889 ± 0.6061. From these results, it can be concluded that there was no significant difference among the three groups in inhibiting Streptococcus mutans [7]. This result indicate that the steeping black tea is as effective as the steeping green tea. This may be due to both the leaves of black tea and green tea possess an antibacterial trait that can cause a decrease in the bacterial count. Black tea and green tea leaves both contain catechins, but the leaves of black tea undergo an enzymatic oxidation process which causes the catechin to turn into theaflavin and thearubigin. Theaflavin in the black tea plays a role in the inhibition of salivary amylases and bacteria by inhibiting the fermentation process of sugars that can produce acids. The amount of theaflavin in the black tea is 95 times more than the green tea, meanwhile thearubigin is 45 times more than that in green tea [11].
These results also showed that rinsing with steeping green tea solution has more effectiveness in decreasing the total Streptococcus mutans as compared to black tea solution.
Footnotes
Funding: This research received financial support from TALENTA Research USU, Indonesia
Competing Interests: The authors have declared that no competing interests exist
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