Tea and Oral Health Fact Sheet

Introduction

Dental disease remains a significant problem in the UK with a large number of the
population suffering with the consequences of this disease at some stage in their
lives. It can result in acute pain, aesthetic problems and can increase the risk of tooth
loss, which may have long-term effects on food intake resulting in impaired nutritional
status and subsequent overall well being.

Damage to or loss of teeth may result from:-

o Dental caries
o Acid erosion
o Periodontal disease

Dental Caries

Caries is caused by bacterial acid production in tooth plaque, which can cause deep
localized lesions if it remains too near the tooth for any length of time. If left the
bacteria then may penetrate the tooth further and progress into the soft pulp tissue.
Untreated dental caries can lead to incapacitating pain, potential tooth loss and loss of
dental function. The development and progression of dental caries is due to a number
of factors, specifically bacteria in the dental plaque (particularly Streptococcus
mutans) on susceptible tooth surfaces and the availability of fermentable
carbohydrates.

The prevalence of dental decay in children in the UK has fallen significantly since the
1970’s mainly as a result of the introduction of fluoridated toothpaste and fluoridation
of water supplies.1 Nevertheless dental caries still remains a significant problem in
some parts of the UK.

Acid Erosion

The damage to teeth from acid erosion is now thought to be a significant contributor to
dental disease.2 Erosion arises from acid derived from foods and drinks, or
regurgitations from the stomach, which repeatedly wash over the teeth and result in
shallower but more widespread lesions.

Periodontal Disease

Periodontal disease results from inflammation of the gum (gingivitis) that gradually
causes destruction of the bone supporting the teeth. Gingivitis usually results from
infection from debris that has accumulated at crevices at the base of the teeth.

Although the main reason for tooth extraction is as a result of dental caries, there
appears to be an increasing trend for tooth loss in adulthood resulting from periodontal
disease.3

Prevention of Dental Disease

 o Good oral hygiene practices – including proper cleaning of the teeth and gums
to remove plaque build up and accumulation of debris at the base of the teeth
o Fluoride Protection – fluoride is incorporated into tooth enamel making it harder
and more resistant to acid attack. As well as fluoride containing toothpastes,
the fluoride content of drinking water is also an important factor, and caries
prevalence is lower where water is naturally or artificially high.4 However, there
are wide variations in the levels of fluoride naturally occurring in fresh water
ranging from 0.01 to 100 ppm.5 Currently only about 10% of the water in the UK
is fluoridated at the optimal level for the prevention of tooth decay at 1ppm.
o Dietary measures including:
o Reducing the frequency of consumption of sugar containing foods and
drinks
o Consuming acidic drinks only at meal times. Between meal drinks
should be non-acidic.

Tea and Dental Health

Drinking tea (without added sugar) has been associated with a number of beneficial
effects in preventing tooth decay.6 Epidemiological surveys have reported that some
populations who drink tea on a regular basis have a reduced number of carious
teeth.7,8,9 Proposed mechanisms for tea’s oral health benefits include:

Fluoride
The tea plant (Camellia Sinensis) extracts fluoride from the soil, which then
accumulates in its leaves. For this reason tea is a very rich natural source of
fluoride; dry tea leaves may contain 4-400ppm fluoride, the brewed tea 0.34-
6ppm10,11,12,13,14,15 resulting in one cup of tea containing between 0.3mg and 0.5mg
of fluoride.

The Food Standards Agency Total Diet Study16 conducted in 1997 showed that our
fluoride intake is heavily influenced by tea consumption; beverages (mainly tea)
account for 1mg/day or 85% of our total fluoride intake, excluding the contribution
of fluoride in the water used to make the tea. When the water is from a fluoridated
supply this approximately doubles the fluoride intake for consumers drinking 4 to 5
cups of tea per day. Consequently tea provides a good source of dietary fluoride.

Findings from a study that investigated the bio-availability of fluoride from tea in
relation to its interaction with the tooth surface and oral tissues,17 demonstrated
that after rinsing with tea, 34% of the fluoride was retained in the oral cavity and
that some of this showed a strong binding ability to enamel particles on the tooth
surface. For this reason the authors concluded that tea was an effective vehicle for
delivering fluoride to the oral cavity where it may then become associated with the
oral tissues potentially helping to prevent dental decay.

Some concern has been raised over excessive intakes of fluoride causing fluorosis
in the enamel of the teeth while it is still forming in children. Early signs of fluorosis
are mottling and discoloration of the teeth. Although appearance of the teeth might
be affected, there are no adverse effects to dental health. Reviews by expert
panels have found no evidence that water fluoridation (at the optimal level for
dental health) causes any adverse health effects.4,18 Furthermore, the Dental
profession is almost totally in favour of water fluoridation as a means of preventing
tooth decay and any concerns have been carefully considered and discounted by
 the UK Public Health Alliance, The British Dental Association, The Faculty of
Public Health and the British Fluoridation Society.19

Tannins
Other components of tea may also contribute to the inhibition of caries. It has been
reported that the tannins in tea can inhibit salivary amylase thereby reducing the
cariogenic potential of starch-containing foods.20 A number of studies have also
demonstrated that tannic acid inhibits the growth of S.mutans bacteria,21,22,23,24,25 a
major factor in the build-up of dental plaque.

Acid erosion
In addition to its beneficial effect on plaque, tannin, along with other components of
tea such as catechin, caffeine and tocopherol have been shown to be effective in
increasing the acid resistance of tooth enamel.26 Their effects increased
dramatically when they were used in combination with fluoride.

The acid content of black tea and its influence on oral acidity during consumption
has also been investigated.27 The pH of the tooth surface in ten healthy volunteers
was examined after consuming black tea. The very small, short-lived, pH decrease
that was observed led to the conclusion that tea can be recommended as an
alternative drink to the more acidic versions, such as fizzy drinks, as part of
preventive measures for dental erosion.

1. Flavonoids
Both green and black tea and their specific flavonoids, mainly catechins, have
exhibited inhibitory effects on the growth of cariogenic bacteria by preventing the
adherence and growth of plaque bacteria at the tooth surface.28,29,30 Extracts of
green tea inhibit oral bacteria such as Esherichia coli, Streptococcus salivarius and
Streptococcus mutans.31

Tea and Oral Cancer

It has been suggested that tea may play a role in the prevention of oral cancer.32 One
double-blind, randomised intervention trial suggested that treating patients with a
mixture of black and green tea components could improve the clinical manifestations
of precancerous oral lesions.33

Another study investigating the effect of tea as a chemopreventive agent in

precancerous lesions (oral leukoplakia) has also found positive results. Eighty two
subjects with oral leukoplakia received black tea in a fixed regimen for a year.
Preliminary results on the first 15 patients who first entered the study have shown a
clinical improvement.34

A pilot study showed that heavy smokers who consumed 5 cups of green tea a day for
four weeks reduced the number of damaged cells in the mouth. The authors
concluded that these results warrant a large scale intervention trial to further verify the
role of green tea in the prevention of oral cancer in smokers.35

However, epidemiological evidence for oral cancer prevention has been sparse and
inconclusive. For example, a population-based, case–control study in Denmark has
found no association between tea consumption and the development of oral
squamous cell cancer.36
In Summary…

There is a growing amount of in-vitro research identifying tea’s potential oral health
benefits. However, further longer term, well controlled human trials are required before
any firm conclusions can be made. In the mean time it is reasonable to conclude that
drinking tea, without the addition of sugar, is compatible with dietary advice to prevent
dental decay, thereby helping to promote overall health and well being.
References:
1
Children’s dental health in the United Kingdom 2003. Office for National Statistics 2004
2
British Nutrition Foundation (1999) Oral Health: Diet and other factors. London: BNF 1999
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4
McDonagh MS, et al (2000) A systematic review of public water fluoridation. York: The University of York NHS
Centre for Reviews and Dissemination. Report 18
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Hamilton-Miller J. M. (2001) Anti-cariogenic properties of tea (Camellia sinensis). J. Med. Microbiol., 50: 299-
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Ramsey AC, et al (1975) Fluoride intakes and caries increments in relation to tea consumption by British
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Cremer HD, et al (1970) Absorption of fluorides, Fluoride and human health. Geneva: WHO, 75-91
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Wei SHY, et al (1989) Concentration of fluoride and selected other elements in tea. Nutrition 5; 237-40
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Chan JT, et al (1996) Fluoride content in caffeinated, decaffeinated and herbal teas. Caries Research 30; 88-
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Zhang J, et al (1998) Inhibition of salivary amylase by black and green teas and their effects on the intraoral
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Yu H, et al (1995) Effects of several tea components on acid resistance of human tooth enamel. J Dent 23;
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