Document Type : Original Article


1 1- Department of Operation Room, School of Paramedical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

2 Department of Nursing Education, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Physiology and Pharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

4 Social Determinants on Oral Health Research Center AND Department of Oral and Maxillofacial Pathology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

5 Department of Biostatistic, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran

6 School of Dentistry, Hormozgan University of Medical Sciences, Bandar Abbas, Iran


BACKGROUND AND AIM: In a normal non-diseased person, the throat condition is favorable for the growth of different germs. This investigation intended to assess the impression of mouthwash obtained from green tea and chlorhexidine on the oral sanitation in intubated subjects in the intensive care unit (ICU).
METHODS: In this clinical trial study, 46 subjects, who were being carried out mechanical ventilation in the ICU, were recruited. For the first group, mouthwashing was implemented with chlorhexidine solution for four days and then with green tea solution for another four days. In the second group, we first mouthwashed the cases with green tea solution, followed by another four days of mouthwashing with chlorhexidine solution. Ultimately, checklist of oral health evaluation was filled and compared between the studied groups.
RESULTS: On the first day, no statistically significant difference was detected between the two groups. Nonetheless, the amount of food leftover in teeth showed significant difference (P = 0.020). Furthermore, we found no difference in the mucosal and plaque score criteria at the beginning of the study between the two groups. On the other side, no significant difference was observed in the oral health settings between the groups after conducting mouthwashing. However, the two groups had statistically significant difference with respect to the plaque scoring criteria (P = 0.029).
CONCLUSION: It can be postulated that both green tea and chlorhexidine mouthwash possess similar impressions on the oral sanitation. Nonetheless, since green tea is obtained from natural compounds and is easily available, it is suggested to be utilized instead of a chemical compound, namely chlorhexidine.


1. Blot S, Vandijck D, Labeau S. Oral care of intubated patients. Clin Pulm Med 2008; 15: 153-60.
2. Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: Frequency and documentation. Am J Crit Care 2003; 12(2): 113-8.
3. Browne JA, Evans D, Christmas LA, Rodriguez M. Pursuing excellence: Development of an oral hygiene protocol for mechanically ventilated patients. Crit Care Nurs Q 2011; 34(1): 25-30.
4. Cason CL, Tyner T, Saunders S, Broome L. Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. Am J Crit Care 2007; 16(1): 28-36.
5. Ames NJ. Evidence to support tooth brushing in critically ill patients. Am J Crit Care 2011; 20(3): 242-50.
6. Adib-Hajbaghery M, Ansari A, Azizi-Fini E. Oral care in ICU patients: A review of research evidence. Feyz 2011; 15(3): 280-93. [In Persian].
7. Berry AM, Davidson PM. Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs 2006; 22(6): 318-28.
8. Ames NJ, Sulima P, Yates JM, McCullagh L, Gollins SL, Soeken K, et al. Effects of systematic oral care in critically ill patients: A multicenter study. Am J Crit Care 2011; 20(5): e103-e114.
9. Munro CL, Grap MJ. Oral health and care in the intensive care unit: State of the science. Am J Crit Care 2004; 13(1): 25-33.
10. Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care 2009; 18(5): 428-37.
11. Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002; 11(6): 567-70.
12. Feider LL, Mitchell P, Bridges E. Oral care practices for orally intubated critically ill adults. Am J Crit Care 2010; 19(2): 175-83.
13. Chandrasekaran M, Venkatesalu V. Antibacterial and antifungal activity of Syzygium jambolanum seeds. J Ethnopharmacol 2004; 91(1): 105-8.
14. Panchabhai TS, Dangayach NS, Krishnan A, Kothari VM, Karnad DR. Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: An open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009; 135(5): 1150-6.
15. Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea-a review. J Am Coll Nutr 2006; 25(2): 79-99.
16. Feng Q, Kumagai T, Torii Y, Nakamura Y, Osawa T, Uchida K. Anticarcinogenic antioxidants as inhibitors against intracellular oxidative stress. Free Radic Res 2001; 35(6): 779-88.
17. Paye M, Barel AO, Maibach HI. Handbook of cosmetic science and technology. Abingdon, UK: Taylor & Francis Publications; 2019.
18. SafarAbadi M, Rezaei K, Ghaznavirad E. Comparing the effect of Echinacea and chlorhexidine mouthwash on oral health in patients hospitalized in intensive care units. Complement Med J Fac Nurs Midwifery 2012; 2(3): 222-34. [In Persian].
19. Lee MJ, Maliakal P, Chen L, Meng X, Bondoc FY, Prabhu S, et al. Pharmacokinetics of tea catechins after ingestion of green tea and (-)-epigallocatechin-3-gallate by humans: formation of different metabolites and individual variability. Cancer Epidemiol Biomarkers Prev 2002; 11(10 Pt 1): 1025-32.
20. Rafiee H, Iranmanesh S, Sabzevari S. Comparison of the endotracheal tube suctioning with and without normal saline solution on heart rate and oxygen saturation. Iran J Crit Care Nurs 2011; 4(3): 117-20. [In Persian].
21. Jenabian N, Moghadamnia AA, Karami E, Mir AP. The effect of Camellia Sinensis (green tea) mouthwash on plaque-induced gingivitis: A single-blinded randomized controlled clinical trial. Daru 2012; 20(1): 39.
22. Balappanavar AY, Sardana V, Singh M. Comparison of the effectiveness of 0.5% tea, 2% neem and 0.2% chlorhexidine mouthwashes on oral health: A randomized control trial. Indian J Dent Res 2013; 24(1): 26-34. [In Persian].
23. Estaji Z, Alinejad M, Hassan RM, Rad M. The comparison of chlorhexidine solution and swab with toothbrush and toothpaste effect on preventing oral lesions in hospitalized patients in intensive care unit. Glob J Health Sci 2015; 8(5): 211-6.
24. Sargolzaie N, Rajabi O, Arab H, Esmaele H, Ehteshamfar A. Comparative evaluation of Green Tea- Aloe Vera mouthwash and chlorhexidine 0.2% on gingival indices (A randomized clinical trial). Journal of Dental Materials and Techniques 2016; 5(1): 31-5. [In Persian].
25. Hamilton-Miller JM. Anti-cariogenic properties of tea (Camellia sinensis). J Med Microbiol 2001; 50(4): 299-302.