Tea Tree Oil versus Chlorhexidine Mouthwash in Treatment of Gingivitis: A Pilot Randomized, Double Blinded Clinical Trial

Discussion

Gingivitis is the disease that affects, through an inflammatory process caused by bacteria, gum tissues. It is really common and can show up in different phases of the life of an individual. In fact, gingivitis can be determined by stressful situations, drugs, or hormonal changes. 29 Its etiological factor has proved to be the bacterial component. That is why the treatment of choice is a professional oral hygiene procedure that allows removal of the etiologic factor. At the same time, domestic oral hygiene is fundamental, so that bacteria will not colonize gingival tissues again and inflammation will not show up again. 30

Among the medical products recommended for the cure of gingivitis, chlorhexidine-based mouthwash is included. In fact, chlorhexidine is a synthetic biguanide cationic molecule with a strong bactericidal and bacteriostatic action. However, if its use is prolonged, it can cause dental dyschromia, taste alteration, and plaque deposit. 31

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That is why, over the last decades, researchers looked for an alternative to this molecule, so that gingivitis could be cured without any limitation or complication, due to the use of the medication over time. 32 Tea tree oil is an essential oil that was recently discovered and introduced into the oral hygiene world. It has always been used as excellent substance in healing herpetic lesions or mouth ulcers by virtue of its antibacterial and antiviral properties. 1333 The study aims at demonstrating the efficacy of a new natural Melaleuca essential oil-based substance, both for the control of dental plaque and inflammatory response in comparison to chlorhexidine. Based on the results achieved, it can be stated that both substances are effective in treating gingivitis through a treatment realized in 14 days. Furthermore, tea tree oil proved to be a suitable substitute of chlorhexidine not much for its antibacterial action, but more in reducing PD and clinical signs of inflammation.

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Furthermore, the subjects of the trial better appreciated tea tree oil’s typical taste compared with that of chlorhexidine, improving also the breath, especially when used first thing in the morning. All participants accomplished this without any taste alteration, dental dyschromia, or plaque deposit.

Just few experimental trials regarding the use of this essential oil in treating gingivitis were performed. 173435 In spite of this, clear results were obtained, and they reflected and confirmed the investigation performed in this article.

In accordance with the studies of Salvatori et al, 17 Soukoulis et al 34 and Saxer et al, 35 tea tree oil proved to be a concrete agent with anti-inflammatory and antibacterial actions.

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In Salvatori’s research, 17 despite the small number of subjects analyzed, the same improvements of this study in question were obtained, but in different percentages. In fact, the powerful and greater efficacy of the anti-inflammatory function of tea tree oil compared with other mouthwashes was confirmed. In both cases, essential oil reduced bleeding in the sites detected during the first session, improving GI when characterized by moderate or severe inflammation (grade 2-3), mild inflammation (grade 1), or even absence of inflammation (grade 0). The same beneficial effect was demonstrated in a study by Soukoulis et al, 34 investigating 49 nonsmoking patients affected by severe chronic gingivitis. Concerning the antibacterial effect, in all the studies, tea tree oil showed to be a potential reducer of the bacterial load, but not the most powerful and effective. In fact, chlorhexidine remains the most incisive substance for the reduction of periodontopathogens bacteria that represent the etiologic factor of the disease. 36 In the above-mentioned studies, dental or gum dyschromia was not detected. But, as many studies demonstrated, one of the complications of this powerful antiseptic is exactly the coloration of dental surfaces, generally detected after a long period of treatment. 31 That is why it has to be reiterated how tea tree oil, despite a minor efficacy, can still reduce or control the bacterial load without causing nor dyschromia or taste alteration; in fact, all the patients undergoing the treatment with the essential oil complained about nothing in any study. Everything should be considered without leaving out the eventual conditioning of a poor or wrong domestic oral hygiene realized by the patient. At the end of the revaluation session, no toxicity manifestation due to the consumption was shown; the two pregnant patients are an example of this affirmation, given that they did not report any disturb. As reported by the study realized by Hammer et al, 37 it was discovered that the topical use of the product is safe and that complications are random. The data published in this study refer to the presence of toxicity if the product is ingested in massive doses (1.9 per kg of weight).

Furthermore, in this study, the product was not ingested, but administered through rinses of drops diluted in water, so it was assimilated in a very small daily amount without being toxic. Unfortunately, in this trial, just two pregnant women were analyzed. They underwent the treatment with tea tree oil under the supervision of a professional figure; they did not show any complication in the revaluation session. This, as well, is due to the minimal quantity of the product assimilated during the phase of treatment. It is always important to recommend the patient to store the product in a dry and cool place and far from sun rays, not altering its composition.

To better understand its dynamics, it would be appropriate to further explore the study, thereby increasing the number of samples of pregnant or breastfeeding subjects.

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