Comparison of Antimicrobial Efficacy of Green Tea, Garlic with Lime, and Sodium Fluoride Mouth Rinses against Streptococcus mutans, Lactobacilli species, and Candida albicans in Children: A Randomized Double-blind Controlled Clinical Trial
Sneha Thakur, Rishika Habib
Citation Information :
Thakur S, Habib R. Comparison of Antimicrobial Efficacy of Green Tea, Garlic with Lime, and Sodium Fluoride Mouth Rinses against Streptococcus mutans, Lactobacilli species, and Candida albicans in Children: A Randomized Double-blind Controlled Clinical Trial. Int J Clin Pediatr Dent 2017; 10 (3):234-239.
Introduction: With greater awareness worldwide, the use of herbs and herbal products has increased to a large extent.
Objective: To evaluate and compare the antimicrobial efficacy of green tea, garlic with lime, and 0.05% sodium fluoride (NaF) mouth rinses against Streptococcus mutans, Lactobacilli species, and Candida albicans.
Materials and methods: A total of 45 children aged 4 to 6 years with severe early childhood caries (S-ECC; based on decayed extracted filled [defs] score) were selected. Children were divided randomly into three equal groups and were asked to rinse with the prescribed mouth rinse once daily for 2 weeks after breakfast under supervision. A base-line and postrinsing nonstimulated whole salivary sample (2 mL) was collected and tested for the number of colony-forming units (CFUs). The data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0 software with one-way analysis of variance (ANOVA) and Tukey's post hoc test.
Results: A statistically significant fall in colony count was found with the three mouth rinses in S. mutans (p < 0.001, p < 0.001) and Lactobacilli spp. (p < 0.001, p < 0.001), but not against C. albicans (p = 0.264, p = 0.264). On comparison, no statistically significant difference was found against S. mutans (p = 1, p = 0.554, p = 0.572), lactobacilli spp. (p = 0.884, p = 0.999, p = 0.819), and C. albicans (p = 0.999, p = 0.958, p = 0.983).
Conclusion: The findings of this study indicate that green tea and garlic with lime mouth rinse can be an economical alternative to NaF mouth rinse both for prevention and therapeutics.
Kukreja BJ, Dodwad V. Herbal mouthwashes: a gift of nature. Int J Pharm Biol Sci 2012 Apr-Jun;3(2):46.
Zafar S, Harnekar SY, Siddiqi A. Early childhood caries: etiology, clinical considerations, consequences and management. Int Dent Saudi Arabia 2009;11(4):24-36.
Gussy MG, Waters EG, Walsh O, Kilpatrick NM. Early childhood caries: current evidence for aetiology and prevention. J Paediatr Child Health 2006 Jan-Feb;42(1-2):37-43.
Peretz B, Mazor Y, Dagon N, Greenstein RB. Candida, mutans streptococci, oral hygiene and caries in children. J Clin Pediatr Dent 2011 Winter;36(2):185-188.
Lai G, Li M. The possible role of Candida albicans in the progression of dental caries. Int J Microbiol 2011 Dec;2(12): 504-506.
Zimmer S, Jahn KR, Barthel CR. Recommendations for the use of fluoride in caries prevention. Oral Health Prev Dent 2003;1(1):45-51.
Rugg-Gunn A, Bánóczy J. Fluoride toothpastes and fluoride mouthrinses for home use. Act Med Acad 2013 Nov;42(2): 168-178.
Whitford GM. Intake and metabolism of fluoride. Adv Dent Res 1994 Jun;8(1):5-14.
Leske GS, Ripa LW. Guidelines for establishing a fluoride mouthrinsing caries prevention program for school children. Public Health Rep 1977 May-Jun;92(3):240-244.
Ripa LW. Review of the anti-caries effectiveness of professionally applied and self-applied topical fluoride gels. J Public Health Dent 1989 Dec;49(5 Spec No):297-309.
Hamilton-Miller JM. Anti-cariogenic properties of tea (Camellia sinensis). J Med Microbiol 2001 Oct;50(4):299-302.
Yoshihara A, Sakuma S, Kobayashi S, Miyazaki H. Antimicrobial effect of fluoride mouthrinse on mutans streptococci and lactobacilli in saliva. Pediatr Dent 2001 Mar-Apr;23(2):113-117.
Si W, Gong J, Tsao R, Kalab M, Yang R, Yin Y. Bioassayguided purification and identification of antimicrobial components in Chinese green tea extract. J Chromatogr A 2006 Sep;1125(2):204-210.
Awadalla HI, Ragab MH, Bassuoni MW, Fayed MT, Abbas MO. A pilot study of the role of green tea use on oral health. Int J Dent Hyg 2011 May;9(2):110-116.
Owhe-Ureghe UB, Ehwarieme DA, Eboh DO. Antibacterial activity of garlic and lime on isolates of extracted carious teeth. Afr J Biotechnol 2010 May;9(21):3163-3166.
Fani MM, Kohanteb J, Dayaghi M. Inhibitory activity of garlic (Allium sativum) extract on multidrug-resistant Streptococcus mutans. J Indian Soc Pedod Prev Dent 2007 Oct-Dec;25(4): 164-168.
Houshmand B, Mahjour F, Dianat O. Antibacterial effect of different concentrations of garlic (Allium sativum) extract on dental plaque bacteria. Indian J Dent Res 2013 Jan- Feb;24(1):71-75.
Ankri S, Mirelman D. Antimicrobial properties of allicin from garlic. Microbes Infect 1999 Feb;1(2):125-129.
Eja ME, Asikong BE, Abriba C, Arikpo GE, Anwan EE, Enyi- Idoh KH. A comparative assessment of the antimicrobial effects of garlic (Allium sativum) and antibiotics on diarrhea genic organisms. Southeast Asian J Trop Med Public Health 2007 Mar;38(2):343-348.
Palaksha MN, Ahmed M, Das S. Antibacterial activity of garlic extract on streptomycin-resistant Staphylococcus aureus and Escherichia coli solely and in synergism with streptomycin. J Nat Sci Biol Med 2010 Jul;1(1):12-15.
Kudva S, Prabhakar S, Pai V, Tegginamani A. Effects of garlic extract on salivary pH: a clinical study. Arch Orofac Sci 2012 Jan;7(1):1-8.
American Academy of Pediatric Dentistry, American Academy of Pediatrics, American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy on early childhood caries (ECC): classifications, consequences and preventive strategies. Pediatr Dent 2005-2006;27(7 Suppl):31-33.
Tehrani MH, Asghari G, Hajiahmadi M. Comparing Streptococcus and Lactobacilli colony count changes following green tea mouth rinse or sodium fluoride mouth rinse use in children (Randomized double blind Control Trial). Den Res J 2011 Dec;8(Suppl 1):S58-S63.
Pratten J, Wills K, Barnett P, Wilson M. In vitro studies of the effect of antiseptic-containing mouthwashes on the formation and viability of Streptococcus sanguis biofilms. J Appl Microbiol 1998 Jun;84(6):1149-1155.
Kaur H, Jain S, Kaur A. Comparative evaluation of the antiplaque effectiveness of green tea catechin mouthwash with chlorhexidinegluconate. J Indian Soc Periodontol 2014 Mar- Apr;18(2):178-182.
Ferrazzano GF, Roberto L, Amato I, Cantile T, Sangianantoni G, Ingenito A. Antimicrobial properties of green tea extract against cariogenic microflora: an in vivo study. J Med Food 2011 Sep;14(9):907-911.
Taylor PW, Hamilton-Miller JM, Stapleton PD. Antimicrobial properties of green tea catechins. Food Sci Technol Bull 2005;2:71-81.
Evensen NA, Braun PC. The effects of tea polyphenols on Candida albicans: inhibition of biofilm formation and proteasome inactivation. Can J Microbiol 2009 Sep;55(9):1033-1039.
Ross ZM, O'Gara EA, Hill DJ, Sleightholme HV, Maslin DJ. Antimicrobial properties of garlic oil against human enteric bacteria: evaluation of methodologies and comparisons with garlic oil sulfides and garlic powder. Appl Environ Microbiol 2001 Jan;67(1):475-480.
Prabhakar AR, Vipin A, Basappa N. Effect of curry leaves, garlic and tea tree oil on Streptococcus mutans and Lactobacilli in children: a clinical and microbiological study. Pesq Bras Odontopediatria Clin Integr 2009 Sep-Dec;9(3):259-263.
Whittaker JM, James RA, Lozada J, Cordova C, GaRey DJ. Histological response and clinical evaluation of heterograft and allograft materials in the elevation of the maxillary sinus for the preparation of endosteal dental implants sites. Simultaneous sinus elevation and root form implantation: An eight-month autopsy report. J Oral Implantol 1989;15(2):141-44.
Linkow LI, Wagner JR. Management of implant-related problems and infections. J Oral Implantol 1993;19(4): 321-35.
Vassos DM, Petrik PK. The sinus lift procedure: An alternative to the maxillary subperiosteal implant. Pract Periodont Aesth Dent 1992;4:14-19.
Judy KWM. Oral implantology case reports. NYS Dent J 1986;52:24-26.
Wagner JR. A 3½-year clinical evaluation of resorbable hydroxylapatite OsteoGen (HA Resorb) used for sinus lift augmentations in conjunction with the insertion of endosseous implants. J Oral Implantol. 1991;17:152-64.
Wagner JR. A clinical and histological case study using resorbable hydroxylapatite for the repair of osseous defects prior to endosseous implant surgery. J Oral Implantol 1989;15: 186-92.
LeGeros RZ. Calcium phosphates in oral biology and medicine. In: Myers HM (Ed). New York: Karger Press 1991;15.
Fang Y, Agrawal DK, Roy DM. Thermal stability of synthetic hydroxylapatite. In: Brown PW, Constantz B (Eds). Hydroxylapatite and Related Materials. CRC Press: Boca Raton, Fla: 1994:269-82.
Brown WE, Eidelman N, Tomazic B. Octacalcium phosphate as a precursor in biomineral formation. Adv Dent Res 1987;1:306-13.
Urist MR, Dowell TA. The newly deposited mineral in cartilage and bone matrix. Clin Orthopaed Rel Res 1967;50:291-308.
Bonar LC, Roufosse AH, Sabine WK, Grynpas MD, Glimcher MJ. X-ray diffraction studies of the crystallinity of bone mineral in newly synthesized and density fractionated bone. Calcif Tissue Int. 1983;35:202-09.
Roberts JE, Bonar LC, Griffin RG, Glimcher MJ. Characterization of very young mineral phases of bone by solid state phosphorus magic angle sample spinning nuclear magnetic resonance and X-ray diffraction. Calcif Tissue Int 1992;50: 42-48.
Lee DD, Landis WJ, Glimcher MJ. The solid, calcium-phosphate mineral phases in embryonic chick bone characterized by highvoltage electron diffraction. J Bone Min Res 1986;1:425-32.
Roberts WE, Turley PK, Brezniak N, Fielder PJ. Bone physiology and metabolism. Calif Dent Assoc J 1987;15:54-61.
Roberts WE. Bone tissue interface. J Dent Educ 1988;52: 804-09.
Brunski JB. Biomechanical factors affecting the bone-dental implant interface. Clin Mat 1992;10:153-201.
Spivak JM, Ricci JL, Blumenthal NC, Alexander H. A new canine model to evaluate the biological response of intramedullary bone to implant materials and surfaces. J Biomed Mat Res 1990;24:1121-49.
Karande V, Levrant S, Hoxsey R, Rinehart J, Gleicher N. Lysis of intrauterine adhesions using gynecoradiologic techniques. Fertil Steril 1997;68:658-62.
Chen FP, Soong YK, Hui YL. Successful treatment of severe uterine synechiae with transcervical resectoscopy combined with laminaria tent. Hum Reprod 1997;12:943-47.
Protopapas A, Shushan A, Magos A. Myometrial scoring: A new technique for the management of severe Asherman's syndrome. Fertil Steril 1998;69:860-64.
Coccia ME, Becattini C, Bracco GL, Pampaloni F, Bargelli G, Scarselli G. Pressure lavage under ultrasound guidance: A new approach for outpatient treatment of intrauterine adhesions. Fertil Steril 2001;75:601-06.
Coccia ME, Becattini C, Bracco GL, Bargelli G, Scarselli G. Intraoperative ultrasound guidance for operative hysteroscopy: A prospective study. J Reprod Med 2000;45:413-18.
Polishuk WZ, Weinstein D. The Soichet intrauterine device in the treatment of intrauterine adhesions. Acta Eur Fertil 1976;7:215-18.
March CM. Intrauterine adhesions. Obstet Gynecol Clin North Am 1995;22:491-505.
Amer MI, El Nadim A, Hassanein K. The role of intrauterine balloon after operative hysteroscopy in the prevention of intrauterine adhesion: A prospective controlled study. MEFS J 2005;10:125-29.
Amer MI, Abd-El-Maeboud KH. Amnion graft following hysteroscopic lysis of intrauterine adhesions. J Obstet Gynaecol Res 2006;32:559-66.
Burns JW, Skinner K, Colt J, Sheidlin A, Bronson R, Yaacobi Y, Goldberg EP. Prevention of tissue injury and postsurgical adhesions by precoating tissues with hyaluronic acid solutions. J Surg Res 1995;59:644-52.
De Iaco PA, Stefanetti M, Pressato D, Piana S, Dona M, Pavesio A, Bovicelli L. A novel hyaluronan-based gel in laparoscopic adhesion prevention: Preclinical evaluation in an animal model. Fertil Steril 1998;69:318-23.
Tsapanos VS, Stathopoulou LP, Papathanassopoulou VS, Tzingounis VA. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res 2002;63:10-14.
Pace S, Stentella P, Catania R, Palazzetti PL, Frega A. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol 2003;30:26-28.
Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V. Reproductive outcome following hysteroscopic adhesiolysis in Asherman's syndrome. Int J Fertil Menopausal Stud 1996;41:462-65.
Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: Prospective study fromgeneral practice. BMJ 1997;315:32-34.
Kumari AS, Haq A, Jayasundaram R, Abdel-Wareth LO, Al Haija SA, Alvarez M. Metformin monotherapy in lean women with polycystic ovary syndrome. R & Pro D. Biomed Online 2005;10:100-04.
Crave JC, Fimbel S, Lejeune H, Cugnardey N, Dechaud H, Pugeat M. Effects of diet and metformin administration on sex hormone binding globulin, androgens, and insulin in hirsute and obese women. J Clin Endocrinol Metab 1995;80:2057-62.
Pasquali R, Gambineri A, Biscotti D, Vicennati V, Gagliardi L, Colitta D, Fiorini S, Cognigni GE, Filicori M, Morselli-Labate AM. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J Clin Endocrinol Metab 2000;85:2767-74.
Ehrmann DA, Cavaghan MK, Imperial J, Sturis J, Rosenfield RL, Polonsky KS. Effects of metformin on insulin secretion, insulin action, and ovarian steroidogenesis in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997;82:524-30.
De Leo V, la Marca A, Ditto A, Morgante G, Cianci A. Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome. Fertil Steril 1999;72:282-85.
Yarali H, Yildiz B, Demirol A, Zeyneloglu HB, Yigit N, Bukulmez O, Koray Z. Co-administration of metformin during rFSH treatment in patients with clomiphene citrate-resistant polycystic ovarian syndrome: A prospective randomized trial. Hum Reprod 2002;17:289-94.
Palomba S, Falbo A, Orio F (Jr), Manguso F, Russo T, Tolino A, Colao A, Dale B, Zullo F. A randomized controlled trial evaluating metformin pretreatment and coadministration in nonobese insulin-resistant women with polycystic ovary syndrome treated with controlled ovarian hyperstimulation plus timed intercourse or intrauterine insemination. Hum Reprod 2005 Jun 15 (Epub ahead of print).
Stadtmauer LA, Toma SK, Riehl RM, Talbert LM. Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors. Fertil Steril 2001;75:505-09.
Stadtmauer LA, Toma SK, Riehl RM, Talbert LM. Impact of metformin therapy on ovarian stimulation and outcome in ‘coasted’ patients with polycystic ovary syndrome undergoing in vitro fertilization. Reprod Biomed Online 2002;5:112-16.
Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce firsttrimester spontaneous abortion: A pilot study. Fertil Steril 2001;75:46-52.
Kocak M, Caliskan E, Simsir C, Haberal A. Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome. Fertil Steril 2002;77:101-06.
Cole PA, Robinson CH. Mechanism and inhibition of cytochrome P-450 aromatase. J Med Chem 1990;33:2933-42.
Akhtar M, Njar VC, Wright JN. Mechanistic studies on aromatase and related C-C bond cleaving P-450 enzymes. J Steroid Biochem Mol Biol 1993;44:375-87.
Palter SF, Tavares AB, Hourvitz A, Veldhuis JD, Adashi EY. Are estrogens of import to primate/human ovarian folliculogenesis? Endocr Rev 2001;22:389-424.
Weil S, Vendola K, Zhou J, Bondy CA. Androgen and follicle stimulating hormone interactions in primate ovarian follicle development. J Clin Endocrinol Metab 1999;84:2951-56.
Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 1998;101:2622-29.
Mitwally MF, Casper RF. Aromatase inhibitors for the treatment of infertility. Expert Opin Investig Drugs 2003;12:353-71.
Mitwally MF, Biljan MM, Casper RF. Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation. Am J Obstet Gynecol 2005;192:381-86.
Mitwally MFM, Casper RF. The use of aromatase inhibitor for induction of ovulation in cases of clomiphene citrate failure. Curr Opin Obstet Gynecol 2002;14:255-63.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.