|Year : 2017 | Volume
| Issue : 6 | Page : 251-254
Knowledge of oral health benefits of tea in an urban dental patient population
Michelle A Wheater, Ana Barajas
Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI, USA
|Date of Web Publication||20-Dec-2017|
Dr. Michelle A Wheater
Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, 2700 Martin Luther King Jr. Blvd., Clinic Building Room 430, Detroit, MI 48208
Source of Support: None, Conflict of Interest: None
Aims: Much has been written about the health benefits of green tea in both the scientific and lay literature. The purpose of this cross-sectional survey study was to determine dental patient knowledge of the composition of green tea and attitudes regarding the potential oral health benefits of green tea consumption. Materials and Methods: A nine-item questionnaire, with several items in a multipart format, was distributed in paper and pencil form to a convenience sample of dental patients in the waiting area of an urban dental school. Data were entered into Qualtrics Research Suite software and analyzed using descriptive statistics and Chi-square with significance at P < 0.05. Results: Three hundred and thirty adult volunteers completed the questionnaire. The majority of the respondents were aware that tea is a popular drink worldwide, and nearly half of the respondents drink tea often. Those who drink tea prefer hot green tea and consume it mainly for the taste. Respondents knew that tea contains antioxidants but were less aware that tea contains polyphenols and epigallocatechin-3-gallate (EGCG). Although the majority of respondents agreed that green tea is beneficial to oral health, responses were generally split on agreement that it prevents caries or halitosis or protects tooth enamel. For the majority of the questions, there was no difference in responses relative to age or consumption of tea. Conclusion: While respondents generally agreed that green tea is beneficial to oral health, they do not take green tea, or EGCG supplements or use commercially available oral health products that contain green tea.
Keywords: Antioxidants, catechin, epigallocatechin gallate, green tea
|How to cite this article:|
Wheater MA, Barajas A. Knowledge of oral health benefits of tea in an urban dental patient population. J Int Oral Health 2017;9:251-4
|How to cite this URL:|
Wheater MA, Barajas A. Knowledge of oral health benefits of tea in an urban dental patient population. J Int Oral Health [serial online] 2017 [cited 2018 Aug 14];9:251-4. Available from: http://www.jioh.org/text.asp?2017/9/6/251/221253
| Introduction|| |
Worldwide, tea is the second most popular drink after water. All teas originate from Camellia sinensis, but processing of tea leaves varies. Green tea leaves are immediately steamed or pan-fired so that no oxidation occurs. Black tea is more oxidized that green, white, or oolong tea.
Much has been written about the oral health benefits of green tea., Polyphenols in tea include catechins, theaflavins, tannins, and flavonoids. Epigallocatechin-3-gallate (EGCG) is the most abundant polyphenol catechin and accounts for many biological and potential therapeutic effects of polyphenols. Green tea has the highest amounts of EGCG although concentrations vary among commercial sources.
Green tea may function to prevent tooth loss, periodontal disease, dental caries, halitosis, and reduce cariogenic potential. Dental websites promote green tea as an adjunct to oral health, citing studies for instance that males who drink green tea have superior periodontal health. Popular magazines provide information regarding oral health benefits of green tea in lay terms, namely cavity prevention, gum health, less tooth loss, and better breath. Oral health-care products that contain green tea include toothpaste and mouthwashes and are promoted online.
Knowledge of the lay public in understanding the components of green tea that may provide the reported health benefits is not fully known. The objective of this survey-based research study is to determine the knowledge of dental patients in an urban dental school regarding green tea composition and oral health-care benefits.
| Materials and Methods|| |
In this cross-sectional study design, a nine-item questionnaire, with several items in a multipart format, was distributed in paper and pencil format to dental patients in the waiting area of an urban dental school. Before distribution, the questionnaire was piloted to a group of adults who were not a part of the research team to determine readability. The survey research study was approved by the Institutional Review Board (Protocol #1314-81).
There were no specific inclusion or exclusion criteria in recruiting volunteers for this survey other than participants must be at least 18 years of age. This study employed a convenience sample consisting of any adult patients in the waiting area of an urban dental school who consented to participate in the survey. As a cross-sectional study, the final sample size consisted of all volunteers recruited in a 1-month study timeframe. Risks and benefits to participation were provided to potential volunteers through a research information sheet. Volunteers completed the questionnaire in their own time and returned completed surveys to a marked box in the waiting area. No personal identifiers were included in the questionnaire, but demographic data questions of gender and age were included [Questionnaire 1] [Additional file 1]. Data were entered into Qualtrics survey software for analysis (Qualtrics Research Suite, Provo, UT, USA). Analyses included descriptive statistics (frequency and percentages) and cross-tabulation with Chi-square analysis for categorical variables. Statistical analyses were completed within the Qualtrics program with significance P < 0.05.
| Results|| |
A total of 330 surveys were returned. Of all respondents, 35% (n = 116/330) were adult males and 65% (n = 214/330) were adult females. The age of respondents was defined in five categories, with 16% (n = 53/330) between 18 and 25 years of age, 15% (n = 49/330) between 26 and 35, 18% (n = 58/330) between 36 and 45, 18% (n = 60/330) between 46 and 55, and 33% (n = 110/330) 56 and over.
When asked if they drink tea, 12% (n = 40/330) responded never, 42% (n = 137/330) responded rarely, and 46% (n = 153/330) responded often. For subsequent analyses, “never” and “rarely” responses were grouped (54%, n = 177/330) and compared against “often.” Of the 153 respondents who claimed that they drink tea often, the greatest percentage (37%, n = 56/153) were in the 56 and above age category, and the least percentage (12.5%, n = 19/153) were those between 18 and 25 years of age. When asked about tea drinking habits, 55% of those who responded (n = 115/208) prefer hot tea whereas 45% (n = 93/208) prefer cold or iced tea. With respect to the type of tea, 39% (n = 95/245) of those who responded drink green tea. The preference for other tea types is as follows: 20% (n = 48/245) prefer black tea, 6% (n = 15/245) drink white tea, 9% (n = 22/245) drink oolong tea, and 27% (n = 65/245) drink herbal tea. Respondent's reasons for drinking tea include taste (50%, n = 112/221), source of caffeine (14%, n = 30/221), perceived health benefits (29%, n = 63/221) and other reasons such as cultural habits (7%, n = 16/221).
Respondents were asked about their general knowledge of green tea. In assessing the entire survey population, 59% of all respondents agreed that tea is a popular drink (n = 193/330). When asked if tea types originate from the same plant, 23% of all respondents agreed (n = 75/330). Regarding the fact that green tea differs from black tea in the way that it is processed, 55% agreed (n = 181/330). There was no difference in knowledge of the facts that tea is a popular drink [drink, [Figure 1]], that all tea types derive from the same plant species [plant, [Figure 1]], or that green tea differs from black tea [different, [Figure 1]] relative to age group.
|Figure 1: Knowledge of tea and the tea plant based on respondents' age group|
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Volunteers were also queried on their knowledge of the components in tea. When asked if tea contains antioxidants, 80% of all respondents (n = 265/330) replied yes. When asked if tea contains polyphenols, 35% (n = 116/330) replied yes. When asked if EGCG is the major polyphenol in green tea, 23% (n = 76/330) replied yes. There was no difference in knowledge of the fact that tea contains antioxidants [antioxidant, [Figure 2]], that tea contains polyphenols [polyphenol, [Figure 2]], or that EGCG is the major polyphenol in green tea [EGCG, [Figure 2]] relative to age group.
General knowledge of tea and its components were then analyzed based on respondents' consumption of tea [Figure 3]. Respondents who drink tea had a higher “yes” response for all of the survey questions. Significant differences in responses were observed for respondents' knowledge that tea was a popular drink [drink, [Figure 3]], P = 0.01], that all types of tea derive from the same plant [plant, [Figure 3]], P = 0.09], and that tea contains antioxidants [antioxidant, [Figure 3]], P = 0.03].
|Figure 3: Knowledge of tea, the tea plant, and tea components based on respondents' tea consumption|
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Volunteers were questioned regarding their agreement with the beneficial effects of green tea on oral health. When asked if green tea can help prevent cavities (dental caries), 47% of all respondents (n = 156/330) agreed. When asked if green tea can help prevent bad breath (halitosis), 52% (n = 172/330) agreed. When asked if green tea can help protect tooth enamel, 46% (n = 151/330) agreed. When asked if green tea is good for your oral health, 61% (n = 201/330) agreed. There was no difference in agreement with the oral benefits of green tea relative to age group [Figure 4].
|Figure 4: Knowledge of green tea oral health benefits based on respondents' age group|
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Agreement that green tea has oral health benefits were then analyzed based on respondents' consumption of tea [Figure 5]. There were no differences in respondents' agreement that green tea prevented caries [cavity, [Figure 5]], that green tea prevented bad breath [breath, [Figure 5], that green tea protects tooth enamel [enamel, [Figure 5]], or that green tea is good for oral health [health, [Figure 5]].
|Figure 5: Knowledge of green tea oral health benefits based on respondents' tea consumption|
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When asked about the use of green tea containing supplements, 14% of all respondents (n = 45/330) have used green tea or EGCG dietary supplements. Only 1% (n = 4/330) have used a toothpaste or mouthwash containing green tea.
| Discussion|| |
The supposed benefits of tea, especially green tea, on oral health are plentiful on the internet as anecdotal information. A search on the internet using the phrase “green tea oral health” returns over 32 million results. The scientific literature also reports studies regarding the benefits of green tea. In a study of young boys, a 1-time mouth rinsing with honey and green tea solution for 2 min reduced salivary bacteria. Probing depth, clinical attachment loss, and bleeding on probing were all significantly reduced upon introduction of green tea as an adjunct oral hygiene regimen. Given the abundance of lay and scientific information supporting tea as a healthy drink, it would seem logical to expect that tea consumption is high among the public if they are cognizant of this information.
The study in this report demonstrates that 46% of those surveyed drink tea often, with the majority drinking hot tea as well as green tea. A survey of Taiwanese university students showed that 36% consumed tea. These students drank less hot tea, preferring sugar-sweetened iced tea bought from tea houses, or bottled tea drinks purchased from convenience stores. In a study of a Japanese population, 72% drank green tea and 18% drank black tea. Among participants of the Polish arm of the Health, Alcohol and Psychosocial Factors in Eastern Europe study, 22% drank >2 cups of tea per day. Finally, in participants in a nationwide population-based study carried out in Luxembourg, 36% were tea drinkers. The prevalence of tea drinkers, the preference for the type of tea consumed, and how the tea is prepared clearly varies among populations. With the exception of the Japanese population study, in most of the published studies, the percentage of tea drinkers is <50%, with the current study in line.
It would be rational to think that consumers of tea have greater knowledge of tea components, and the survey shows that, in general, they did. Indeed, tea drinkers had greater knowledge that tea was a popular drink, that all tea types derive from the same plant species, and that tea contains antioxidants. It is interesting to note that while there was a high degree of knowledge of the antioxidant properties of green tea, there was less knowledge of the polyphenol content and relatively very low knowledge of the EGCG content. This may be explained by the more common use of the term antioxidant in print media, leading respondents to be more familiar with the term. This is supported by search results on the internet; searching for “green tea antioxidants” returns almost 20 million results whereas “green tea EGCG” returns 290,000 results.
About half of those surveyed agreed that green tea is beneficial to oral health, and there were no differences in responses compared to age or to tea consumption. However, few respondents take green tea or EGCG supplements or use oral health products that contain green tea. This may correlate to the relative lack of knowledge on the respondents' part that EGCG is a component of tea or to the availability of the commercial products.
A strength of this cross-sectional survey is that because age was fairly evenly distributed among five categories, analyses of the effect of age on knowledge of tea was obtainable. One might think that younger consumers are more internet savvy and might have greater knowledge of tea benefits, but analysis of data in this study did not show that to hold true. A second strength of the survey was to utilize a population of dental patients since knowledge of tea effects on oral health was the focus of the study. Many of the reported studies by other authors focused on a relatively homogeneous population from one distinct area. In contrast, in the urban population surveyed in this report, many cultures and races could be represented, thus a potential flaw of the current study is that demographic information on race and ethnicity was not collected. Repetition of the study with inclusion of such information could tease out contributing factors of ethnicity to knowledge of oral health benefits of tea.
| Conclusion|| |
The results of the present study conclude that about one-half of the population of dental patients at an urban dental school consumes tea. Tea drinkers had generally higher knowledge of certain facts about tea. Although respondents agreed that green tea contains oxidants, they had less knowledge of the polyphenol and EGCG content of the tea. While respondents generally agreed that green tea is beneficial to oral health, they do not take green tea or EGCG supplements or use commercially available oral health products that contain green tea.
Financial support and sponsorship
Internal grant funds from the University of Detroit Mercy School of Dentistry.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zlotogorski A, Dayan A, Dayan D, Chaushu G, Salo T, Vered M, et al.
Nutraceuticals as new treatment approaches for oral cancer: II. Green tea extracts and resveratrol. Oral Oncol 2013;49:502-6.
Zhao J, Deng JW, Chen YW, Li SP. Advanced phytochemical analysis of herbal tea in China. J Chromatogr A 2013;1313:2-3.
Wierzejska R. Tea and health – A review of the current state of knowledge. Przegl Epidemiol 2014;68:501-6, 595-9.
Khurshid Z, Zafar MS, Zohaib S, Najeeb S, Naseem M. Green tea (Camellia sinensis
): Chemistry and oral health. Open Dent J 2016;10:166-73.
Oz HS. Chronic inflammatory diseases and green tea polyphenols. Nutrients 2017;9. pii:E561.
Abdelmegid F, Al-Agamy M, Alwohaibi A, Ka'abi H, Salama F. Effect of honey and green tea solutions on Streptococcus mutans
. J Clin Pediatr Dent 2015;39:435-41.
Sharma S, Bhuyan L, Ramachandra S, Sharma S, Dash KC, Dhull KS. Effects of green tea on periodontal health: A prospective clinical study. J Int Oral Health 2017;9:39-44. [Full text]
Tseng HC, Wang CJ, Cheng SH, Sun ZJ, Chen PS, Lee CT, et al.
Tea-drinking habit among new university students: Associated factors. Kaohsiung J Med Sci 2014;30:98-103.
Noguchi-Shinohara M, Yuki S, Dohmoto C, Ikeda Y, Samuraki M, Iwasa K, et al.
Consumption of green tea, but not black tea or coffee, is associated with reduced risk of cognitive decline. PLoS One 2014;9:e96013.
Grosso G, Stepaniak U, Micek A, Topor-Mądry R, Pikhart H, Szafraniec K, et al.
Association of daily coffee and tea consumption and metabolic syndrome: Results from the Polish arm of the HAPIEE study. Eur J Nutr 2015;54:1129-37.
Alkerwi A, Sauvageot N, Crichton GE, Elias MF. Tea, but not coffee consumption, is associated with components of arterial pressure. The observation of cardiovascular risk factors study in Luxembourg. Nutr Res 2015;35:557-65.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]