Green tea, derived from the leaves of Camellia sinensis, is one of the most widely consumed beverages globally, appreciated not only for its refreshing taste but also for its multiple health-promoting properties.¹ Rich in polyphenolic compounds, particularly catechins such as epigallocatechin-3-gallate (EGCG), green tea exhibits potent antioxidant, anti-inflammatory, and antimicrobial effects. These bioactive properties have been associated with a range of systemic benefits, including cardiovascular protection, improved metabolic profiles, and cancer prevention. Despite its popularity as a dietary component, the therapeutic potential of green tea beyond systemic health, particularly in oral health,² has only recently begun to be explored. Emerging evidence suggests that green tea may play a significant role in preventing and mitigating oral diseases, including periodontitis, dental caries, and oral mucosal inflammation.Oral health is a critical component of overall well-being³, yet it is often compromised in patients undergoing cancer treatment. Oral mucositis, characterized by painful inflammation, swelling, and ulceration of the oral mucosa, is a common and debilitating side effect of high-dose chemotherapy and radiotherapy.⁴ The incidence of oral mucositis in patients with head and neck cancers can be as high as 80%, leading to significant discomfort, nutritional deficiencies, and increased risk of local and systemic infections. In addition, surgical interventions for oral cancer can result in trismus—restricted mouth opening due to muscle fibrosis or scarring—which further hampers patients’ ability to perform routine oral hygiene. Consequently, patients frequently experience deterioration in oral health, which may force reductions in cancer treatment intensity or even discontinuation of therapy, adversely impacting prognosis and survival outcomes.Maintaining oral hygiene during cancer treatment is therefore paramount.⁵ Standard approaches include mechanical cleaning of the teeth and tongue, along with the use of chemical mouth rinses. Conventional mouthwashes such as chlorhexidine have demonstrated efficacy in reducing oral bacterial load and alleviating symptoms of mucositis. However, prolonged use of these mouthwashes is associated with undesirable effects, including mucosal irritation, altered taste sensation, and a burning sensation, which can limit adherence. These limitations underscore the need for safe, effective, and patient-friendly adjuncts for oral care in cancer populations.Green tea mouthwash has recently emerged as a promising nonpharmacological intervention for oral health,⁶ offering potential therapeutic benefits without the side effects associated with conventional antiseptics.Catechins such as EGCG have demonstrated antimicrobial activity against oral pathogens, inhibition of inflammatory mediators, and promotion of tissue healing in preclinical studies. These mechanisms are particularly relevant in the context of oral cancer treatment, where the oral mucosa is highly susceptible to damage and infection^7,8,9. By integrating green tea mouthwash into oral care regimens, clinicians may offer patients a natural, safe, and effective means of preserving oral health, potentially improving adherence to cancer therapies and enhancing quality of life.^10,11

AIM

To evaluate the effectiveness of green tea mouthwash in improving oral health status among oral cancer patients.

This study was designed as a single-blind, randomized controlled trial to evaluate the effectiveness of green tea mouthwash in improving oral health among oral cancer patients. Conducted at Department of dentistry, Govt. Medical college, Dungarpur for 1 yr. The study received ethical approval, and informed consent was obtained from all participants. A total of 32 patients, aged 20 years or older, who were newly diagnosed with oral cancer and had undergone oral surgery within three months prior to enrollment, were recruited. Patients currently using other medicated mouthwashes, with severe systemic illnesses, or allergies to green tea were excluded. Participants were randomly assigned to either the intervention group, which received a 5% green tea mouthwash, or the control group, which used tap water for rinsing after brushing. Both groups were instructed to rinse twice daily, and participants were blinded to the purpose of the mouthwash to reduce bias.

Table 1: Age-wise Distribution of Patients

The age distribution of patients showed that the majority were between 41–50 years (34%), followed by 51–60 years (25%). Fewer patients were in the <30 years (8%) and 31–40 years (14%) groups, while those above 60 years constituted 19% of the study population.

Table 2: Distribution of Tumor Sites

The distribution of tumor sites showed that the buccal mucosa was the most commonly affected area, accounting for 36% of cases, followed by the tongue at 31%. Tumors of the floor of the mouth and gingiva were less frequent, representing 19% and 14% of patients, respectively.

Table 3: Distribution of Tumor Stages

The tumor stage distribution showed that the majority of patients presented with advanced disease, with Stage IV accounting for 33.4% of cases, followed by Stage III at 25%. Early-stage tumors were less common, with Stage I and II representing 19.4% and 22.2% of patients, respectively.

Table 4: Distribution of Treatment Modalities

The treatment modalities among patients showed that surgery was the most commonly used approach, accounting for 53% of cases. Radiotherapy and chemotherapy were less frequent, representing 31% and 16% of patients, respectively.

Table 5: Frequency of Oral Side Effects in Patients after chemo and radiotherapy

The most common oral side effects observed in patients were oral mucositis (83.3%) and oral ulcers/lesions (77.7%), followed by gingival inflammation (72.2%) and halitosis (67%). Less frequent complications included plaque accumulation (56%), xerostomia (50%), and tooth sensitivity or pain (44.4%).

Table 6:Comparison of Oral Side Effects Before and After Intervention

The Green Tea Mouthwash group showed a marked reduction in oral side effects after the trial compared to baseline, with fewer patients experiencing oral mucositis, ulcers, gingival inflammation, plaque, halitosis, xerostomia, and tooth pain. In contrast, the Placebo group showed only minimal improvements, highlighting the effectiveness of Green Tea Mouthwash in reducing oral complications.

The age-wise distribution of patients in this study indicates that middle-aged adults were the most affected. The largest group comprised patients aged 41–50 years, accounting for 34% of the total. Those in the 51–60 years age range formed the second-largest group at 25%. Younger patients below 40 years were less commonly affected, with 8% in the <30 years group and 14% in the 31–40 years group. Elderly patients above 60 years constituted 19% of the study population. These findings suggest that oral cancer and related complications are more prevalent among middle-aged and older adults.

The distribution of tumor sites among patients in this study indicates that the buccal mucosa was the most commonly affected site, seen in 36% of cases. The tongue was the second most frequent site, accounting for 31% of patients. Tumors involving the floor of the mouth were observed in 19% of cases, while the gingiva was the least affected site at 14%. This pattern suggests that oral cancers predominantly involve the buccal mucosa and tongue. The data highlight the importance of careful examination of these sites during diagnosis. Overall, the findings reflect site-specific prevalence trends in oral cancer patients.

The distribution of tumor stages among patients in this study indicates that a significant proportion presented with advanced disease. Stage IV tumors were the most common, seen in 33.4% of cases, followed by Stage III at 25%. Early-stage tumors were less frequently observed, with Stage II accounting for 22.2% and Stage I for 19.4% of patients. This suggests that many patients were diagnosed at a later stage, highlighting the need for early detection and screening. The data also reflect the progressive nature of oral cancer in this population. Overall, the findings emphasize the predominance of advanced-stage tumors in oral cancer patients.

The distribution of treatment modalities among patients in this study indicates that surgery was the primary approach, used in 53% of cases. Radiotherapy was the second most common treatment, administered to 31% of patients, while chemotherapy was used in 16% of cases. This suggests that surgical intervention remains the cornerstone of oral cancer management. The choice of treatment likely depended on tumor stage, location, and overall patient condition. Radiotherapy and chemotherapy were mainly used as adjuncts or for patients unsuitable for surgery. Overall, the data reflect the varied treatment strategies employed in managing oral cancer patients.

The oral side effects observed in this study were highly prevalent among patients. Oral mucositis was the most common complication, affecting 83.3% of patients, followed closely by oral ulcers and lesions at 77.7%. Gingival inflammation was seen in 72.2% of cases, while halitosis affected 67% of patients. Plaque accumulation was noted in 56% of patients, and xerostomia was reported by 50%. Tooth sensitivity or pain was the least frequent, occurring in 44.4% of patients. These findings highlight the significant impact of oral complications in patients, emphasizing the need for effective preventive and therapeutic interventions.

The study demonstrated a significant reduction in oral side effects among patients using Green Tea Mouthwash. Before the trial, the majority of patients in both groups experienced complications such as oral mucositis, ulcers, and gingival inflammation. After the intervention, the Green Tea group showed marked improvement, with fewer patients reporting these side effects. In contrast, the Placebo group showed only slight reductions in the frequency of oral complications. This indicates that Green Tea Mouthwash was effective in alleviating oral mucositis, ulcers, gingival inflammation, plaque accumulation, halitosis, xerostomia, and tooth sensitivity. Overall, the findings support the use of Green Tea Mouthwash as a beneficial adjunct for improving oral health in patients.Similarly,In a study byLiao YC, Hsu LF, et al.¹² there were 31 subjects in the intervention group and 30 subjects in the control group in the final analysis. The results of t-test showed that compared with baseline, the improvement in the oral health status in the intervention group was significantly better than that in the control group at 4 months after the intervention began. At 4 to 6 months after the intervention began, the oral health status score in the intervention group significantly decreased, by 1.71, 2.97 and 2.93 points, respectively, compared with that in the control group.

Study demonstrates that green tea mouthwash is effective in improving oral health status among oral cancer patients. In this study, the majority of patients presented with advanced-stage disease, with the buccal mucosa and tongue being the most commonly affected sites. Oral side effects such as mucositis, ulcers, gingival inflammation, and xerostomia were highly prevalent, significantly impairing quality of life. However, following the intervention, patients in the green tea group showed marked reductions in these complications compared to the placebo group, highlighting the therapeutic potential of this natural, non-pharmacological agent. These results suggest that green tea mouthwash can serve as a safe and effective adjunct to conventional oral care in cancer patients, particularly those undergoing radiotherapy and chemotherapy.

1. Mathur A., Gopalakrishnan D., Mehta V., Rizwan S.A., Shetiya S.H., Bagwe S., 2018. Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis. Indian J Dent Res. 29(2), 225-232
2. Katy Vaillancourt., Amel Ben Lagha., Daniel Grenier., 2021. A green tea extract and epigallocatechin-3-gallate attenuate the deleterious effects of irinotecan in an oral epithelial cell model. Arch Oral Biol. 126, 10513
3. Naidu M.U., Ramana G.V., Rani P.U., Mohan I.K., Suman A., Roy P., 2004. Chemotherapy-induced and/or radiation therapy-induced oral mucositis--complicating the treatment of cancer. Neoplasia. 6(5), 423-31.
4. Sonis S.T., Elting L.S., Keefe D., Peterson D.E., Schubert M., Hauer-Jensen M., Bekele B.N., Raber-Durlacher J., Donnelly J.P., Rubenstein E.B., 2004.
5. Mucositis Study Section of the Multinational Association for Supportive Care in Cancer. International Society for Oral Oncology. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 100(9 Suppl), 1995-2025.
6. Vagliano L., Feraut C., Gobetto G., Trunfio A., Errico A., Campani V., et al., 2011. Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT--results of a multicentre study. Bone Marrow Transplant. 46(5), 727-32.
7. Brown T.J., Gupta A., 2020. Management of Cancer Therapy-Associated Oral Mucositis. JCO Oncol Pract. 16(3), 103-109.
8. Valer J.B, Curra M., Gabriel A.F., Schmidt T.R., Ferreira M.B.C., Roesler R., Evangelista J.M.C., Martins M.A.T., Gregianin L., Martins M.D., 2021. Oral mucositis in childhood cancer patients receiving high-dose methotrexate: Prevalence, relationship with other toxicities and methotrexate elimination. Int J Paediatr Dent. 31(2), 238-246.
9. Barasch A., Peterson D.E., 2003. Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol. 39(2), 91-100.
10. Cinausero M., Aprile G., Ermacora P., Basile D., Vitale M.G., Fanotto V., Parisi G., Calvetti L., Sonis S.T, 2017. New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury. Front Pharmacol. 8, 354.
11. Chen S.C., Lai Y.H., Huang B.S., Lin C.Y., Fan K.H., Chang J.T., 2015. Changes and predictors of radiation-induced oral mucositis in patients with oral cavity cancer during active treatment. Eur J Oncol Nurs. 19, 214–219.
12. De Sanctis V., Bossi P., Sanguineti G., Trippa F., Ferrari D., Bacigalupo A., Ripamonti C.I., Buglione M., Pergolizzi S., Langendjik J.A., Murphy B., Raber-Durlacher J., Russi E.G., Lalla R.V, 2016. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements. Crit Rev Oncol Hematol. 100, 147–166.
13. Liao YC, Hsu LF, Hsieh LY, Luo YY. Effectiveness of green tea mouthwash for improving oral health status in oral cancer patients: A single-blind randomized controlled trial. Int J Nurs Stud. 2021 Sep;121:103985. doi: 10.1016/j.ijnurstu.2021.103985. Epub 2021 May 25. PMID: 34186380.