Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2018  |  Volume : 36  |  Issue : 3  |  Page : 279--282

Efficacy of probiotic and green tea mouthrinse on salivary pH


Shashibhushan Kukkalli Kamalaksharappa, Ramya Rai, Prashant Babaji, MC Pradeep 
 Department of Pedodontics and Preventive Dentistry, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India

Correspondence Address:
Dr. Shashibhushan Kukkalli Kamalaksharappa
Department of Pedodontics and Preventive Dentistry, Sharavathi Dental College and Hospital, Shimoga, Karnataka - 577205
India

Abstract

Objectives: The aim of the study was to assess the efficacy of probiotic and green tea mouthrinse on salivary pH. Method: Study was conducted over a period of one month among 40 healthy school children aged between 6-8 years. The subjects who fulfilled inclusion criteria were selected and randomly divided into 2 groups namely probiotic and green tea groups. Salivary pH was recorded at baseline (0 day) and at the end of the specified time period using GC pH strips. Statistical analysis was done using paired ‘t’ test P < 0.05 was considered statistically significant. Result: The comparison of mean pH scores for green tea showed that the pH of saliva was increased in the children after rinsing with green tea (6.15 to 7.65) and was statistically significant (p<0.001). Similarly when pre and post mean pH was compared in the probiotic group pH increased from (6.45 to 6.65) however, the results were not statistically significant. Conclusion: The study conducted shows the beneficial effects of green tea in providing a alkaline environment which is conducive to the oral health of children.



How to cite this article:
Kamalaksharappa SK, Rai R, Babaji P, Pradeep M C. Efficacy of probiotic and green tea mouthrinse on salivary pH.J Indian Soc Pedod Prev Dent 2018;36:279-282


How to cite this URL:
Kamalaksharappa SK, Rai R, Babaji P, Pradeep M C. Efficacy of probiotic and green tea mouthrinse on salivary pH. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2021 Nov 29 ];36:279-282
Available from: https://www.jisppd.com/text.asp?2018/36/3/279/241973


Full Text



 Introduction



Dental caries is multifactorial in nature. Interaction of bacteria, diet and host response play a major role in initiation and progression of dental caries. Saliva plays a critical role in the maintenance of optimal oral health and thus creates an appropriate ecological balance.[1] Various components of saliva play individual roles in the properties of saliva. Salivary flow, pH, and buffering capacity play an important role in the initiation and progression of dental caries.[2] However, among these components, pH of saliva is an important component to maintain the integrity of oral cavity.[3] When the pH increases, the remineralization of tooth surface occurs because of the degree of supersaturation. The acidic pH can cause the maximum incidence of dental caries. It has been well documented that the dissolution of enamel occurs when the pH falls below critical pH of 5.5.[4] Recently, various economical and efficacious agents have been tried out in combating dental caries. Among these, green tea and probiotics are also being used.

The biological properties of polyphenolic compounds found in plant foods include antioxidants and anti-inflammatory effects.[5] Green tea contains a significant amount of catechins, which are subgroup of flavonoids and play a vital role in maintaining health. Major catechins are (−) epicatechin gallate, (−) epicatechin, (+) gallocatechin (GC), (−) epigallocatechin (EGC), and (−) EGC gallate (EGCG). GC, EGC, and EGCG possess strong bactericidal as well as antibacterial activity.[6]

Probiotics, on the other hand, are useful microorganisms which when administered in adequate amounts confer beneficial effects on the health of host. Commonly used probiotic strains are Lactobacillus rhamnosus GG, Lactobacillus casei, Lactobacillus reuteri, Lactobacillus plantarum, Lactobacillus brevis CD2, and Bifidobacterium species.[7] Probiotics in dentistry have proved to inhibit pathogenic biofilm formation, induction of cytoprotective proteins, reduction of inflammation, stimulation of the host immune response, and killing of pathogens through production of bacteriocins along with altering the local environment pH.[8] Hence, the present study was undertaken to clinically evaluate the effect of oral use of commercially available probiotic preparation and green tea mouthrinse on salivary pH and to ascertain the efficacy of oral probiotic and green tea as a preventive tool against the development of caries.

 Methods



A purposive sample of 40 schoolchildren aged 6–8 years was included in the study. The study was conducted over a period of 1 month and the study was carried out at a school in Shivamogga city, Karnataka, India. Informed oral and written consent was obtained from the parents of the children. Permission was sought from the principal of the respective schools. Ethical consent was obtained from the Institutional Ethical Committee.

Inclusive criteria

Healthy children aged between 6 and 8 years without any known systemic conditionChildren with written consent from their parentsChildren with no active carious lesionsNo history of use of antimicrobial agents or any other drugs (up to within 4 weeks).

Exclusive criteria

Children with a known history of allergy to any mouthrinse or drugChildren suffering from any systemic illnessChildren using any other commercially available probiotic productsChildren using any other oral hygiene aids other than routine teeth brushing.

The participants who fulfilled the inclusion criteria were selected and randomly divided into two groups, with 20 children in each group.

Group A: Probiotic groupGroup B: Green tea group.

Preparation of probiotic mouthrinse

Probiotic mouthrinse was prepared using commercially available probiotic product Darolac (Aristo Pharmaceuticals, India). 1 g Darolac powder contains 1.25 billion freeze-dried bacterial combination comprised of Lactobacillus acidophilus, Lactobacillus rhamnous, Bifidobacterium longum, and Saccharomyces boulardii. The sachet contents were dissolved in 10 ml of distilled water which was used as a mouthrinse.[9]

Preparation of green tea mouthrinse

Fresh green tea (Lipton green tea bags, packing date <1 month) was procured from the local market which is available in the form of green tea dip bags. Two percent green tea was prepared with 2 g of green tea dip bag dipped in 100 ml warm water for 5 min (10 ml for each participant).[10]

Salivary pH measurements

A volume of 2 ml saliva samples was collected before the commencement of mouth rinsing, baseline and after 1 month rinsing. Unstimulated whole saliva samples were collected using Navazesh spitting method by pooling saliva for 60 s and then spitting in a disposable container sitting in an upright position in a well-lit room with good ventilation.[11] Saliva was collected in the morning between 10.00 am and 10.30 am to prevent any bias in the concentration of saliva due to circadian rhythm.[12] Children were also informed not to eat or drink anything (except water) 1 h before saliva collection to minimize possible food debris and stimulation of saliva.

Salivary pH was measured using GC pH strips. A single sheet was dipped into the saliva till it is fully wet and removed immediately. After 30 s, the acid produced reacts to these pH indicators, thus leading to colorimetric change which was compared with color code chart, and the pH value was noted.[13]

After the baseline recording of salivary pH, the designated mouthrinse was dispensed to the respective groups. Group A received probiotic mouthrinse and Group B received green tea mouthrinse, and they were instructed to swish the 10 ml of mouthrinse for 1 min for 1 month between 10 am and 11am, and salivary pH was measured using GC pH strips. Statistical analysis was done using paired t- test. P < 0.05 was considered statistically significant.

 Results



[Table 1] and [Graph 1] show the comparison of mean pH scores for green tea, which revealed that the pH of saliva was increased in the children after rinsing with green tea (6.15–7.65) and was statistically significant (P < 0.001). Similarly, when pre- and post-mean pH was compared in the probiotic group pH was higher in the probiotic rinse group (6.45–6.65) as seen in [Table 2] and [Graph 2]. However, the results were not statistically significant.{Table 1}[INLINE:1]{Table 2}[INLINE:2]

 Discussion



The purpose of this study was to evaluate the effect of green tea and probiotic as mouthrinse on salivary pH in children. Salivary pH is one of the key indicators of carious process.[4] The average pH of saliva at rest is 6.8 and it varies between 6.5 and 7.0. Research suggests that it is pH, rather than sugar, which is the selective factor for caries initiation and progression. When the salivary pH is low, it promotes the growth of aciduric bacteria which allows the acidogenic bacteria to proliferate, thereby creating an inhospitable environment for the protective oral bacteria. This allows for a shift in the environmental balance in favor of cariogenic bacteria, which further lowers the salivary pH. By controlling pH, it is possible to alter the plaque biofilms, remineralize the existing lesions, and perhaps prevent the disease altogether.[1]

Baseline mean pH for green tea was 6.15, and after rinsing with green tea mouthrinse for 1 month, the salivary pH increased to 7.65. The increase in salivary pH after rinsing with green tea and black tea was also observed in the study done by Srinidhi et al. and the pH rise was more in green tea intake compared to black tea.[14] In the present, it was observed that green tea mouthrinse showed statistically significant results in maintaining the alkalinity of saliva compared with the baseline (P < 0.001). Studies have shown that consumption of tea reduced caries development, and the effect is attributed to its fluoride content polyphenols and catechin. The catechins present in green tea represent a marked effect on pH of saliva and dental plaque. Xu et al. in their detailed study determined the effect of EGCG on acid production by S. mutans by monitoring the glycolytic pH drop of Streptococcus mutans culture. The acid production by S. mutans cells was significantly inhibited by EGCG at subminimum inhibitory concentrations levels.[15] A study conducted by Hamilton-Miller concluded that rinsing with green tea catechins for a suitable time prevents acid production and preserves pH within the normal range (7.2–7.4), which is not favorable conditions for Streptococcus mutans growth, and he stated that green tea possesses anticariogenic and antibacterial properties.[16] Hirasawa et al. evaluated plaque pH value at different time intervals before and after rinsing with 2% green tea for 5 min and found that the pH values were significantly higher after treatment with catechins.[17]

From the present study, it was observed that in the probiotic mouthrinse group, salivary pH was increased compared to baseline, but the result was not statistically significant.

A study conducted by Jindal et al. also reported a statistically significant reduction in mutans streptococcus count in saliva when probiotic powder containing combination of bacteria was used as mouthrinse for 14 days.[18] Similarly, in the present study, here probiotic powder containing combination of bacteria was used as mouthrinse and alkalinity of saliva was maintained compared to baseline. In the present study, a patient-specific approach using GC pH strips was used to assess the salivary pH which aids as an effective educational tool.[19]

In the present study, the lesser sample size was the drawback. Further, long-term clinical studies are required to evaluate the efficacy of probiotic and green tea mouthrinse on salivary pH along with microbiological evaluation.

 Conclusion



The study conducted shows beneficial effects of green tea in providing a alkaline environment which is conducive to oral health of children. However, further studies are needed to be conducted to arrive at definitive conclusions regarding the beneficial actions of green tea and probiotic rinses.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Hurlbutt M, Novy B, Young D. Dental caries: A pH-mediated disease. CA Dent Hyg J 2010;25:9-15.
2Sivapathasundaram B, Raghu AR. Dental Caries. In: Rajendran R, Sivapathasundaram B, editor. Shafer's Textbook of Oral Pathology, 6th ed. New Delhi: Elsevier Publishers; 2009. p. 409-73.
3Young WG. The oral medicine of tooth wear. Aust Dent J 2001;46:236-50.
4Shetty C, Hegde MN, Devadiga D. Correlation between dental caries with salivary flow, pH, and buffering capacity in adult South Indian population: An in-vivo study. Int J Res Ayurveda Pharm 2013;4:219-23.
5Groppo FC, Bergamaschi Cde C, Cogo K, Franz-Montan M, Motta RH, de Andrade ED, et al. Use of phytotherapy in dentistry. Phytother Res 2008;22:993-8.
6Goenka P, Sarawgi A, Karun V, Nigam AG, Dutta S, Marwah N, et al. Camellia sinensis (Tea): Implications and role in preventing dental decay. Pharmacogn Rev 2013;7:152-6.
7Cagetti MG, Mastroberardino S, Milia E, Cocco F, Lingström P, Campus G, et al. The use of probiotic strains in caries prevention: A systematic review. Nutrients 2013;5:2530-50.
8Agarwal V, Kapoor S, Shah N. Role of ‘live microorganisms’ (probiotics) in prevention of caries: Going on the natural way towards oral health. Ind J Multidiscip Dent 2012;2:491-6.
9Thakkar PK, Imranulla M, Naveen Kumar PG, Prashant GM, Sakeenabi B, Sushanth VH. Effect of probiotic mouthrinse on dental plaque accumulation: A randomized controlled trial. Dent Med Res 2013;1:7-12.
10Neturi RS, Srinivas R, Simha VB, Sree SY, Shekhar CT, Kumar SP. Effects of green tea on Streptococcus mutans counts – A randomised control trail. J Clin Diagn Res 2014;8:128-30.
11Navazesh M. Methods for collecting saliva. Ann N Y Acad Sci 1993;694:72-7.
12Jain I, Jain P. Comparative evaluation of antimicrobial efficacy of three different formulations of mouth rinses with multi-herbal mouth rinse. J Indian Soc Pedod Prev Dent 2016;34:315-23.
13Coulter C, Walsh LJ. Saliva testing: Good practice, good sense. Stepwise 2006;1:32-5.
14Srinidhi PB, Basha S, Naveen Kumar P, Prashant GM, Sushanth VH, Imranulla M. Effect of two different commercially available tea products on salivary pH: A randomized double blinded concurrent parallel study. Dent Med Res 2014;2:39-42.
15Xu X, Zhou XD, Wu CD. The tea catechin epigallocatechin gallate suppresses cariogenic virulence factors of Streptococcus mutans. Antimicrob Agents Chemother 2011;55:1229-36.
16Hamilton-Miller JM. Anti-cariogenic properties of tea (Camellia sinensis). J Med Microbiol 2001;50:299-302.
17Hirasawa M, Takada K, Otake S. Inhibition of acid production in dental plaque bacteria by green tea catechins. Caries Res 2006;40:265-70.
18Jindal G, Pandey RK, Agarwal J, Singh M. A comparative evaluation of probiotics on salivary Mutans streptococci counts in Indian children. Eur Arch Paediatr Dent 2011;12:211-5.
19Tayab T, Rai K, Kumari V, Thomas E. Effect of chewing paneer and cheese on salivary acidogenicity: A comparative study. Int J Clin Pediatr Dent 2012;5:20-4.