Honey: A sweet therapy

Honey is a yellow-brown colored, sweet in taste and viscous in consistency substance made by bees. Honey starts as flower nectars collected by bees which gets broken down into simple sugars stored inside the honeycomb. The flavor depend on which flower was it from. Honey is used widely in food industries. Due to its health benefits, several studies have been conducted to explore its potential in health sector.

In the medical field, abundant uses of honey have been found. Honey was efficient in preventing infection and used for wound dressing. Honey also stimulates immune response, suppress inflammation and bring about rapid autolytic debridement, hence promoting wound repair. For oral health, honey was effective against Streptococcus mutans infections, has antiplaque and anticaries properties, and was useful for the prevention of gingivitis and halitosis. Honey was also useful in preventing side effects associated with treatment of cancers of the head and neck, such as oral mucositis and xerostomia.

In an in vitro study, 2% of Manuka honey was tested against twenty Porphyromonas gingivalis strains. The tested honey was effective in inhibiting the growth of 50% of the planktonic P. gingivalis, and the minimum inhibitory concentration (MIC) was 5%. In addition, 10% of Manuka honey inhibited the formation of P. gingivalis biofilms and reduced the numbers of viable bacteria within 42 hour-old biofilms. Nevertheless, there was no total prevention of biofilm formation nor a complete eradication of a 42 hour-old biofilm. This study proves that honey acts antibacterial against P. gingivalis in planktonic form but not within biofilm.

Furthermore, a systematic review covering five randomised clinical trials and eleven in vitro studies showed that honey has a significant antimicrobial activity against periodontal pathogens. However, this review suggested additional experiments to explore the entire antimicrobial spectrum of honey towards all pathogens involved in periodontal disease. 

Mouthrinses are often prescribed for periodontitis patients. However, there were some side effects such as tooth staining, altered taste and even general health implication such as increased blood pressure. Thus, natural product such as honey was being explored as a substitute to currently used mouthrinses. Honey-based mouthrinse effectively inhibited six tested microorganisms; Eubacterium nodatum, S. mutans, Campylobacter rectus, Streptococcus sanguinis, Aggregatibacter actinomycetemcomitans and P. gingival is in an in vitro study. However, chlorhexidine has a lower MIC compared to honey mouthrinse. Honey mouthrinse also has antiplaque effect tested within four days. A recent systematic review suggested combination use of honey in the form of topical and systemic application for better benefit in the management of oral mucositis among patients receiving radiotherapy with or without chemotherapy. 

In summary, further studies on the use of honey in oral health especially periodontitis patients should be further explored. Honey could be of great benefit for patients with life-long need for therapy due to the minimal side effects. The potential to be used widely in oral health sector could be increased by sufficient long-term evidence.

References

Aparna, S., Srirangarajan, S., Malgi, V., Setlur, K. P., Shashidhar, R., Setty, S., & Thakur, S. (2012). A comparative evaluation of the antibacterial efficacy of honey in vitro and antiplaque efficacy in a 4-day plaque regrowth model in vivo: preliminary results. Journal of periodontology, 83(9), 1116–1121. https://doi.org/10.1902/jop.2012.110461

Eick, S., Schäfer, G., Kwieciński, J., Atrott, J., Henle, T., & Pfister, W. (2014). Honey – a potential agent against Porphyromonas gingivalis: an in vitro study. BMC oral health, 14, 24. https://doi.org/10.1186/1472-6831-14-24

Gupta, I., Das, N., Ranjan, P., Sujatha, R., Gupta, R., & Gupta, N. (2021). A Preliminary Study on the Evaluation of In-vitro Inhibition Potential of Antimicrobial Efficacy of Raw and Commercial Honey on Escherichia coli: An Emerging Periodontal Pathogen. Mymensingh medical journal : MMJ, 30(2), 547–554.

Hbibi, A., Sikkou, K., Khedid, K., El Hamzaoui, S., Bouziane, A., & Benazza, D. (2020). Antimicrobial activity of honey in periodontal disease: a systematic review. The Journal of antimicrobial chemotherapy, 75(4), 807–826. https://doi.org/10.1093/jac/dkz527

Molan, P., & Rhodes, T. (2015). Honey: A Biologic Wound Dressing. Wounds : a compendium of clinical research and practice, 27(6), 141–151.

Ramsay, E. I., Rao, S., Madathil, L., Hegde, S. K., Baliga-Rao, M. P., George, T., & Baliga, M. S. (2019). Honey in oral health and care: A mini review. Journal of oral biosciences, 61(1), 32–36. https://doi.org/10.1016/j.job.2018.12.003

Yarom, N., Hovan, A., Bossi, P., Ariyawardana, A., Jensen, S. B., Gobbo, M., Saca-Hazboun, H., Kandwal, A., Majorana, A., Ottaviani, G., Pentenero, M., Nasr, N. M., Rouleau, T., Lucas, A. S., Treister, N. S., Zur, E., Ranna, V., Vaddi, A., Barasch, A., Lalla, R. V., … Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO) (2020). Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines – part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 28(5), 2457–2472. https://doi.org/10.1007/s00520-019-05256-4

DR NUR AYMAN ABDUL HAYEI
Faculty of Dentistry,
Universiti Sains Islam Malaysia.