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Original Research

Effects of Green Tea on Periodontal Health: A Prospective

Clinical Study
Swati Sharma, Lipsa Bhuyan1, Sujatha Ramachandra1, Smriti Sharma2, Kailash Chandra Dash3, Kanika Singh Dhull3
Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, 1Departments of Oral Pathology and Microbiology
and 3Preventive and Pediatric Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India, 2Insurance Department, Medcare Women and
Children Hospital, Dubai, UAE

Abstract
Background: An increasing number of people all around the world are turning to the nature by using the natural herbal products in both
prophylaxis and treatment of different diseases. Green tea with active chemical ingredients possesses diverse pharmacological properties
that include anti‑inflammatory, anticariogenic, antioxidant, and antibacterial effects. The aim of this study is to assess the protective
properties of green tea on periodontal health and also to know whether any side effect of green tea prevails in terms of staining of teeth.
Materials and Methods: This is a prospective randomized clinical intervention study. Three dependent variables: probing depth (PD), clinical
attachment loss (CAL), and bleeding on probing (BOP) were measured to reflect periodontal diseases. Results: The three dependent variables,
namely, PD, CAL, and BOP showed statistically significant reductions following introduction of green tea as a conjunct oral hygiene measure
in study group as compared to control group. Conclusion: Green tea has shown the antioxidant, antimicrobial, and anticollagenase activities
on periodontal health.

Keywords: Clinical attachment loss, green tea, probing depth, randomized clinical intervention study

Introduction
In the present decade, few of the foodstuffs can be called
functional if they have beneficial effect on one or more target
functions in the body, which is beyond adequate nutritional
effect to maintain health or reduction of risk of diseases.[1,2]
Tea, one of the most commonly consumed beverages, is
gaining increased importance in promoting overall health
and well‑being.
The word “tea” has been used to describe the shrub Camellia
sinensis. Tea has originated in China (2700 BC). It became very
popular globally due to its enormous therapeutic benefits in
many diseases.[3] Among all the types of tea, 76%–78% of black
tea is produced and consumed followed by 20%–22% of green
tea and <2% oolong tea. Among all of these, however, the most
significant effects on human health have been observed with
the consumption of green tea.[4] Globally, it is estimated that
approximately 2.5 million tons of tea leaves are produced each year,
out of which approximately 20% production were green tea.[5] For
manufacturing various types of tea, first of all, the fresh leaves of
the tea plant are picked which are called as flush. Macerating and
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heat drying this flush produces green tea, whereas fermentation
of flush before heat drying produces black tea. In specific, green
tea has been proved to have many functional properties, and at
present, its consumption is widely recommended.
The health‑promoting effects of green tea are mainly attributed
to its polyphenol (catechins). Epigaleocatechin‑3‑gallate and
epicatechin‑3‑gallate are the most important catechins. The
antioxidant, antimicrobial, anticollagenase, antimutagenic,
and chemopreventive properties of these catechins are proved
to be therapeutic and beneficial in the treatment of various
chronic diseases.[6]
Classification of tea
Tea can be broadly classified into three main types based on
the manufacturing process:[7‑12]
Address for correspondence: Dr. Sujatha Ramachandra,
Department of Oral Pathology and Microbiology, Kalinga Institute of
Dental Sciences, Campus 5, KIIT University, Bhubaneswar, Odisha, India.
E‑mail: sujathagoutham8@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the
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For reprints contact: reprints@medknow.com

DOI: How to cite this article: Sharma S, Bhuyan L, Ramachandra S, Sharma S,

10.4103/jioh.jioh_37_17 Dash KC, Dhull KS. Effects of green tea on periodontal health: A prospective
clinical study. J Int Oral Health 2017;9:39-44.

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Sharma, et al.: Effects of green tea on periodontal health
1. Nonfermented green tea obtained by drying and steaming
the fresh leaves to inactivate the polyphenol oxidase by
nonoxidation
2. Semi‑fer mented oolong tea obtained by par tial
fermentation of fresh leaves before drying
3. Fermented black and red tea obtained by postharvest
fermentation before drying and steaming.
Beneficial effects of various tea components (catechins)
Antioxidative effect
The antioxidative effects of green tea are due to scavenging of
reactive oxygen, nitrogen species, and chelating redox‑active
transition of metal ions such as iron and copper or by inhibition
of pro‑oxidant enzymes’ redox‑sensitive transcription factors,
and induction of antioxidant enzymes.[13,14]
Effect of green tea by modulating the physical structure
of cell membranes
This process is due to the influence of catechins with the
cellular phospholipid palisade.[15‑18]
Antimicrobial effect
Epigallocatechin, epicatechin gallate, and epigallocatechin
gallate are the three most important antibacterial agents
which exert their antimicrobial effect on methicillin‑resistant
Staphylococcus aureus, Helicobacter pylori, and α‑hemolytic
Streptococcus.[19‑28]
Anticariogenic effect
Catechins exert anticariogenic effect by inhibitory action
against Streptococcus mutans and Streptococcus sobrin at
very minimum concentration between 50 and 1000 µg/ml.[29]
Periodontal diseases are infectious diseases involving
gingival inflammation and destruction of periodontal
tissue. Its incidence and progression are dependent on the
type of periodontal pathogens and various host as well as
environmental factors. Very few studies have been carried
out in the past to know the beneficial effects of green tea on
periodontal health.
Therefore, this study is specially aimed to focus the
antimicrobial, antioxidant, and anticollagenase effects of
green tea on periodontal health in patients attending outpatient
department at School of Dental Sciences with the chief
complaint of chronic periodontitis or suffering from chronic
periodontitis.
Aim of the study
An increasing number of people all around the world are
turning to the nature by using the natural herbal products
in both prophylaxis and treatment of different diseases.
Green tea with active chemical ingredients possesses diverse
pharmacological properties that include anti‑inflammatory,
anticariogenic, antioxidant, and antibacterial effects. The
aim of this study is to assess the protective properties of
green tea on periodontal health and also to know whether
any side effect of green tea prevails in terms of staining
of teeth.
40
Materials and Methods
A total of 840  patients who were suffering from chronic
periodontitis and who reported to the outpatient department at
School of Dental Sciences for seeking treatment were included
in the study.
The study was carried out at the Department of Public Health
Dentistry, School of Dental Sciences from January 2012
to June 2012. The Ethical Committee of School of Dental
Sciences has given approval. All the patients signed written
informed consent.
Inclusion criteria
• Patients suffering from chronic periodontitis who
reported to outpatient department at School of Dental
Sciences for seeking dental treatment
• Nonsmokers and not suffering from any systemic disease
• Willing to participate.
Exclusion criteria
• Patients who received antibiotic therapy from the last
3 weeks
• Had topical fluoride application.
This is a prospective randomized clinical intervention study.
The study comprised 840 patients who were nonsmokers with
chronic periodontitis ≥20 teeth and without systemic diseases
such as uncontrolled diabetes, cardiovascular diseases, and
medically compromised patients. Patients who were pregnant,
nursing, or using antibiotics or anti‑inflammatory drugs were
also excluded from the study.
All the patients who participated in the study were subjected
to a self‑administered questionnaire consisting of personal
history, medical history, and toothbrushing history. The
frequency of toothbrushing was divided and coded into five
categories as follows: 1 = never; 2 = sometimes; 3 = once a
day; 4 = twice a day; and 5 = three or more times a day. All
the patients received clinical monitoring and periodontal status
examination at baseline, 1 month, and 3 months’ time intervals.
All the patients who participated in the study were subjected
to a full supra‑gingival prophylaxis. All the patients were then
randomly allocated into two groups as study group and control
group. In the study group, the patients were asked to be on
normal oral hygiene instructions and then they were instructed to
rinse with 10–20 ml of 2% green tea 3 times/day (packets from
Himalaya group, using warm water, prepared directly before
use), whereas in control group, the patients were asked to be on
normal oral hygiene without rinsing with green tea. After random
allocation of patients, complete dental examination was carried
out using sterilized mirrors, explorers, and periodontal probes.
Periodontal parameters were assessed and measured clinically
by evaluating plaque index  (PI)  (Silness and Loe 1964)
and gingival index (GI) (Loe and Silness 1963) at baseline,
1  month, and 3  months in both study and control groups.
Three dependent variables such as probing depth (PD), clinical
attachment loss (CAL), and bleeding on probing (BOP) were
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Sharma, et al.: Effects of green tea on periodontal health

also assessed at baseline, 1 month, and 3 months in both study
and control groups to reflect periodontal disease status.
PD and CAL were measured using periodontal probe at the
mesio‑buccal and buccal sites, whereas BOP was evaluated by
calculating the percentage of teeth exhibiting gingival bleeding
within few seconds of probing the periodontal ligament. The
examiner reliability of periodontal examination was verified
by an intra‑examiner calibration of volunteers.
All the patients were then re‑called after a period of 1 month
and 3 months. All the clinical parameters were measured again
to determine the status of periodontal health in both the groups.
Statistical analysis
The data so obtained were then put for SPSS Software for
Windows Version 18 (IBM SPSS, Chicago, IL:SPSS Inc.),
and the mean values of observed dependent and independent
variables were put to the following statistical tests: paired t‑test,
Wilcoxon’s test, Chi‑square test, and Spearman’s correlation
coefficient, where P < 0.05 was considered statistically
significant. Spearman’s correlation coefficient was mainly
calculated among each periodontal parameter, intake of green
tea, and other study variables.
Results
The present study was conducted to know the protective
properties of green tea on periodontal health as an adjunct to
oral prophylaxis followed by routine oral hygiene instructions
by assessing the periodontal parameters.
Table 1 shows the details of periodontal parameters of all
patients (study and control groups) taking part in the study.
Table 1: Details of periodontal parameters of all patients
taking part in the study
Variables Clinical parameters
measurements
Mean probing depth (mm) 4.2
Mean clinical attachment loss (mm) 3.2
Mean bleeding on probing (%) 60
Table 2 shows the comparison of clinical parameters in both
study and control groups. In both study and control groups,
there is a reduction in PI as well as GI at baseline, 3 and
6 months. Percentage of teeth which are bleeding also shows
reduction in both study and control groups at baseline, 1 and
3 months. Tables 3‑5 show the mean reduction of clinical
parameters at baseline, 1 and 3 months in both study and
control groups. The mean reduction in PI, GI, and PD from
baseline to 1 month and baseline to 3 months was statistically
significant (P < 0.001) in both study and control groups. Table 6
shows Spearman’s correlation coefficient of the study variable
and clinical parameters. Tables  7 and 8 depict statistical
significant differences among indices PI and GI between both
the groups (study and control) at baseline, 1 and 3 months.
Discussion
Green tea is a popular health drink which has demonstrated
beneficial and protective effects on periodontium. Various
studies on green tea have shown its therapeutic effects, but
very few studies have correlated the daily dietary oral intake
of green tea on periodontal health. Green tea extracts possess
anti‑inflammatory, antioxidant, and antimicrobial properties.
In the present study, we have focused on the beneficial effects
of green tea on periodontium as an adjunct to mechanical
periodontal therapy. Green tea extracts are not widely available
and are difficult to administer on a daily basis, especially in
the Indian rural and peri‑urban population.
Periodontal pathogens such as Porphyromonas gingivalis
and Actinobacillus actinomycetemcomitans produce matrix
metalloproteinases, exhibit collagenase activity, and ultimately
breakdown collagen and gelatin that make up the extracellular
matrix of periodontal tissue. Nonsurgical periodontal therapy
has long been documented to preserve the natural dentition by
achieving and maintaining a healthy periodontium.[29,30] The
gold standard of periodontal treatment has been scaling and root
planing procedure, but various adjunctive such as local drug
delivery have also been used in conjunction to this to improve
the therapeutic results. Scaling and root planing procedures
alone are difficult in eliminating complete subgingival bacteria

Table 2: Comparison of clinical parameters in the study and control groups

Variables Study group Control group
Mean±SD P Post hoc test Mean±SD P Post hoc test
Age (in years) 39.06±2.56 36.80±5.21
Plaque index at baseline 1.91±0.36 <0.001 B >3 months 1.71±0.32 <0.001 B >3 months
Plaque index at 1 month 1.07±0.28 1.01±0.24
Plaque index at 3 months 0.73±0.34 0.85±0.33
Gingival index at baseline 1.81±0.23 <0.0001 B >3 months 1.78±0.32 <0.0001 B >3 months
Gingival index at 1 month 0.78±0.32 1.01±0.28
Gingival index at 3 months 0.46±0.23 0.75±0.33
Percentage of teeth bleeding at baseline 92.2±6.77 <0.01 B >3 months 88.5±7.54 <0.1 B >3 months
Percentage of teeth bleeding at 1 month 48.2±10.3 58.5±13.4
Percentage of teeth bleeding at 3 months 28.2±6.88 44.6±12.2
SD: Standard deviation

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Sharma, et al.: Effects of green tea on periodontal health

Table 3: Mean reduction of plaque index in study and Table 6: Characteristics of variables and Spearman’s
control groups at various time intervals correlation coefficients
Mean difference (d) Paired t‑test P Variables Mean±SD Spearman’s correlation coefficient
Study group Mean PD Mean CAL BOP
Baseline to 1 month 0.75±0.65 6.2 0.00 PD 2.5±0.8 ‑ 0.05* 0.06*
Baseline to 3 months 0.8±0.45 7.28 0.000 CAL 3.2±1.3 0.05* ‑ 0.006*
Control group BOP (%) 17.7±23 0.03* 0.05* ‑
Baseline to 1 month 0.8±0.67 6.4 0.001 Toothbrushing 3.7±0.9 −0.15* −0.01 −0.004*
Baseline to 3 months 0.7±0.45 7.21 0.00 frequency
(times/day)
*P<0.05. ‑: Not applicable, CAL: Clinical attachment loss, BOP: Bleeding
Table 4: Mean reduction of gingival index in study and on probing, PD: Probing depth, SD: Standard deviation
control groups at various time intervals
Mean difference (d) Paired t‑test P Table 7: Comparison of reduction of gingival index between
Study group study and control groups at various time intervals
Baseline to 1 month 0.7±0.52 6.74 0.000
Baseline 1 month 3 months Reduction
Baseline to 3 months 1.15±0.58 8.79 0.000 from baseline
Control group to 3 months
Baseline to 1 month 0.42±0.52 4.94 0.01
Study group 1.65±0.54 1.14±0.2 1.08±0.13 0.57±0.41
Baseline to 3 months 1.1±0.64 7.67 0.00
Control group 1.65±0.54 1.32±0.12 1.14±0.22 0.51±0.32
t 7.28 7.14 7.04 6.08
df 4 3.08 2.80 3.07
Table 5: Mean reduction of probing depth in study and P 0.000 0.001 0.000 0.000
control groups at various time intervals CI 95% 95% 95% 95%
Mean difference (d) Paired t‑test P Significance S S S S
Study group df: Degree of freedom, S: Significance level, CI: Confidence interval
Baseline to 1 month 0.6±0.52 5.32 0.000
Baseline to 3 months 1.60±0.67 10.51 0.000
Table 8: Comparison of reduction of plaque index between
Control group
study and control groups at various time intervals
Baseline to 1 month 0.43±0.42 3.82 0.001
Baseline to 3 months 1.2±0.76 6.99 0.000 Baseline 1 month 3 months Reduction
from baseline
to 3 months
and calculus due to complex anatomy of teeth and mechanical
Study group 1.78±0.56 0.42±0.21 0.28±0.12 1.5±0.45
limitations due to the size of instrument to reach in deep pockets. Control group 1.78±0.56 0.56±0.12 0.35±0.10 1.43±0.46
Local drug delivery systems are specially designed to deliver t 5.67 4.56 3.58 2.03
therapeutic agents into the base of deep periodontal pockets for df 4.02 3.01 3.18 3.00
a pronged time period.[31] This kind of a nonsurgical therapy P 0.05 0.003 0.024 0.03
can halt the periodontal disease and also reduce the chances CI 95% 95% 95% 95%
Significance S S S S
of surgical intervention. This particular aspect of using green
df: Degree of freedom, S: Significance level, CI: Confidence interval
tea extracts such as catechins in local drug delivery systems
has not been discussed in the present study.
Statistical significant reductions in probing pocket depth (PPD)
Many studies have shown that green tea polyphenols, mainly from baseline to 3 months was observed in both study and
catechins, inactivate P. gingivalis‑induced collagenase.[32] In control groups. The decrease in PPD was due to decrease
the present study, the three dependent variables, namely, PD, in inflammation of adjacent gingival tissues. This reduced
CAL, BOP as well as PI and GI showed statistically significant inflammation can be due to the property of green tea catechins
reductions following introduction of green tea as a conjunct to inhibit collagenase activity.[36]
oral hygiene measure in study group as compared to control
Periodontitis is an infectious disease of bacterial etiology,
group.[33,34]
immunological response, and tissue destruction, thus stating
In the present study, a significant reduction in both PI and that green tea has a putative effect on periodontal pathogens. In
GI scores was seen. The mean reduction from baseline to the present study, along with monitoring of clinical parameters,
3 months in PI was 0.8 ± 0.45 and for GI it was 1.15 ± 0.58 in microbiological analysis was not carried out. Hence, no effect
study group. This mean reduction in PI and GI scores was in on bacterial species monitoring could be carried out in both
accordance with the study done by Ramfjord et al.[35] study and control groups. In addition, green tea has been

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Sharma, et al.: Effects of green tea on periodontal health
advised as an adjunct to routine oral hygiene instructions rather
as a local drug delivery system.
Further detailed researches with comparatively larger sample
size, long follow‑up, and use of new local drug delivery
systems are needed for further in‑depth study of efficacy
of green tea as an adjunct not only to routine oral hygiene
instructions but also with the standard treatment of periodontitis
(scaling and root planing procedures). The correlation
coefficients in this study were generally small, suggesting
that it is difficult to explain periodontal disease using only
few variables because periodontitis is a multifactorial disease.
The sample size in our study was sufficiently large to show the
significance between the intake of green tea and periodontal
disease, but the factors considered in this study were not
sufficient to account for periodontal disease. Our periodontal
examination at the mesio‑buccal and mid‑buccal sites of each
tooth may have led to bias because we did not examine the
periodontal condition at six sites per tooth.
Conclusion
The present study has shown the beneficial and protective
properties of green tea on periodontal health. The study is also
suggestive of the positive effect of daily oral intake of green
tea as an adjunct to mechanical periodontal therapy. There is
a need for long term follow up studies with comparatively
larger sample size before green can be advised for routine
use for the prophylactic and therapeutic effects in various
periodontal diseases.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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