Title	Tea Tree Oil Is an Effective Alternative to the Allopathic Treatment of Oral Candidiasis
Clinical Question	For patients with oral candidiasis, are the antifungal properties of tea tree oil equivalent to those of clotrimazole?
Clinical Bottom Line	Due to its low toxicity, cost, and ease of application tea tree oil is a viable alternative to toxic antifungals. This is based on a randomized controlled study to determine if tea tree oil could be an effective antifungal in the treatment of symptomatic lesions based on specific outcome parameters such as erythema.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26870682 Maghu/2015 36 Medically fit adults from 20-60 yrs. of age Randomized Controlled Trial Key results The tea tree oil (TTO - Group I) treated group showed a reduction in erythema (89%), inflammation (85.7%), burning sensation of a visual analog scale (VAS) (100%), and a reduction in hyphae (85.7%). The clotrimazole group (Group II) showed a reduction in erythema, inflammation, VAS, and hyphae of 71%, 80%, 100%, and 100% respectively. The conservative treatment group, which consisted of a cleaning and washing of the prosthesis on a daily basis followed by removal at night, showed a 40% reduction in erythema, 66.67% reduction in inflammation, 50% reduction in the VAS, and 100% reduction in hyphae. Groups I and II had comparative results in relieving symptoms of oral antifungal infections.
Evidence Search	("tea tree oil"[Mesh Terms] OR ("tea"[All Fields] AND "tree"[All Fields] AND "oil"[All Fields]) OR "tea tree oil"[All Fields]) AND ("mouth"[Mesh Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND ("mycoses"[Mesh Terms] OR "mycoses"[All Fields] OR ("fungal"[All Fields] AND "infection"[All Fields]) OR "fungal infection"[All Fields])
Comments on The Evidence	Validity: Groups were similar at the start with all patients (36 participating) being medically fit, between the ages of 20-60 years, and all having fungal infections; they were then randomly divided into the three blinded treatment groups by the clinicians. It was unclear whether or not the clinicians themselves were blinded. Each group was given specific instructions for their particular treatment. The TTO group was on 24 hr. recall to observe for toxic effects, but otherwise recall was performed after 1 week for 3 consecutive weeks for recording of the four parameter indices (erythema, inflammation, hyphae, and the visual analog scale). Sample size was small; there is a need for more extensive testing with a larger group. Perspective: Even with the currently limited number of studies looking at its oral antifungal properties and the small sample size from this study, tea tree oil seems to be a viable alternative to clotrimazole for any patient based on cost, ease of application, effectiveness, and low (if any) toxicity.
Applicability	In a clinical setting the use of tea tree oil may be an effective alternative to traditional medication. Tea tree oil is available to both patient and clinician at a cheaper cost than an antifungal. Toxicity is minimal and the application of tea tree oil is simple, so minimal clinician or patient training is needed.
Specialty	(Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Interprofessional CATs)
Keywords	Candidiasis, clotrimazole, conservative management, fungal infection, tea tree oil
ID#	3176
Date of submission	04/26/2017
E-mail	walkerx@livemail.uthscsa.edu
Author	Xavier Walker
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Georgiana S. Gross, MPH, RD, LD
Faculty mentor e-mail	GrossG@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available