Periodontal Application of Manuka Honey: Antimicrobial and Demineralising Effects In Vitro

Medical-Grade Honey as a Potential New Therapy for Bacterial Vaginosis

The prevalence of bacterial vaginosis (BV) among women of reproductive age is 29%. BV arises from a vaginal imbalance marked by reduced levels of lactic acid-producing lactobacilli and an overgrowth of pathogenic anaerobes. The multifactorial nature of BV's pathogenesis complicates its treatment. Current antibiotic therapy exhibits a recurrence rate of about 60% within a year. Recurrence can be caused by antibiotic treatment failure (e.g., due to antimicrobial resistance), the persistence of residual infections (e.g., due to biofilm formation), and re-infection. Because of the high recurrence rates, alternative therapies are required. Medical-grade honey (MGH), known for its antimicrobial and wound healing properties in wound care, emerges as a potential novel therapy for BV. MGH exerts broad-spectrum antimicrobial activity, employing multiple mechanisms to eliminate the risk of resistance. For example, the low pH of MGH and the production of hydrogen peroxide benefit the microbiota and helps restore the natural vaginal balance. This is supported by in vitro studies demonstrating that MGH has an antibacterial effect on several pathogenic bacteria involved in the pathophysiology of BV, while lactobacilli and the vaginal microenvironment can be positively affected. In contrast to antibiotics, MGH exerts anti-biofilm activity, affects the microbiome as pre- and probiotic, and modulates the vaginal microenvironment through its anti-inflammatory, anti-oxidative, physicochemical, and immunomodulatory properties. More clinical research is required to confirm the positive effect of MGH on BV and to investigate the long-term cure rate.

Green Alternatives as Antimicrobial Agents in Mitigating Periodontal Diseases: A Narrative Review

Periodontal diseases and dental caries are the most common infectious oral diseases impacting oral health globally. Oral cavity health is crucial for enhancing life quality since it serves as the entranceway to general health. The oral microbiome and oral infectious diseases are strongly correlated. Gram-negative anaerobic bacteria have been associated with periodontal diseases. Due to the shortcomings of several antimicrobial medications frequently applied in dentistry, the lack of resources in developing countries, the prevalence of oral inflammatory conditions, and the rise in bacterial antibiotic resistance, there is a need for reliable, efficient, and affordable alternative solutions for the prevention and treatment of periodontal diseases. Several accessible chemical agents can alter the oral microbiota, although these substances also have unfavorable symptoms such as vomiting, diarrhea, and tooth discoloration. Natural phytochemicals generated from plants that have historically been used as medicines are categorized as prospective alternatives due to the ongoing quest for substitute products. This review concentrated on phytochemicals or herbal extracts that impact periodontal diseases by decreasing the formation of dental biofilms and plaques, preventing the proliferation of oral pathogens, and inhibiting bacterial adhesion to surfaces. Investigations examining the effectiveness and safety of plant-based medicines have also been presented, including those conducted over the past decade.

Therapeutic Manuka Honey as an Adjunct to Non-Surgical Periodontal Therapy: A 12-Month Follow-Up, Split-Mouth Pilot Study

Periodontitis is recognized as one of the most common diseases worldwide. Non-surgical periodontal treatment (NSPT) is the initial approach in periodontal treatment. Recently, interest has shifted to various adjunctive treatments to which the bacteria cannot develop resistance, including Manuka honey. This study was designed as a split-mouth clinical trial and included 15 participants with stage III periodontitis. The participants were subjected to non-surgical full-mouth therapy, followed by applying Manuka honey to two quadrants. The benefit of adjunctive use of Manuka honey was assessed at the recall appointment after 3, 6, and 12 months, when periodontal probing depth (PPD), split-mouth plaque score (FMPS), split-mouth bleeding score (FMBS), and clinical attachment level (CAL) were reassessed. Statistically significant differences between NSPT + Manuka and NSPT alone were found in PPD improvement for all follow-up time points and CAL improvement after 3 and 6 months. These statistically significant improvements due to the adjunctive use of Manuka amounted to (mm): 0.21, 0.30, and 0.19 for delta CAL and 0.18, 0.28, and 0.16 for delta PPD values measured after 3, 6, and 12 months, respectively. No significant improvements in FMPS and FMBS were observed. This pilot study demonstrated the promising potential of Manuka honey for use as an adjunct therapy to nonsurgical treatment.

Antibacterial and Antibiofilm Effect of Honey in the Prevention of Dental Caries: A Recent Perspective

The successful application of honey in wound care management has been achieved due to honey’s potent antibacterial effects, characterised by its multifactorial action. Impressive clinical efficacy has ignited its further use in diverse clinical disciplines, including stomatology. Indeed, there is increasing usage of honey in dental medicine as a preventive or therapeutic remedy for some periodontal diseases mainly associated with bacteria, such as dental caries, gingivitis and mucositides. Dental caries is undoubtedly a major oral health problem worldwide, with an increasing tendency of incidence. The purpose of this perspective review is to describe the recent progress in the laboratory and clinical use of honey in the prevention of dental caries, with emphasis on the antibacterial and antibiofilm effects of honey. The role of honey in the cariogenic process is also discussed. In addition, the quality of honey and the urgent in vitro evaluation of its antibacterial/antibiofilm properties before clinical use are highlighted. Findings based on data extracted from laboratory studies demonstrate the pronounced antibacterial effect of different honeys against a number of periodontal pathogens, including Streptococcus mutans. Although the promising antibiofilm effects of honey have been reported mainly against S. mutans, these results are limited to very few studies. From a clinical point of view, honey significantly reduces dental plaque; however, it is not superior to the conventional agent. Despite the positive in vitro results, the clinical effectiveness of honey in the prevention of dental caries remains inconclusive since further robust clinical studies are needed.

Bee Venom, Honey, and Royal Jelly in the Treatment of Bacterial Infections of the Oral Cavity: A Review

Oral diseases affect a very large number of people, and the applied pharmacological methods of treatment and/or prevention have serious side effects. Therefore, it is necessary to search for new, safer methods of treatment. Natural bee products, such as honey, royal jelly, and bee venom, can be a promising alternative in the treatment of oral cavity bacterial infections. Thus, we performed an extensive literature search to find and summarize all articles about the antibacterial activity of honey, royal jelly, and bee venom. Our analysis showed that these bee products have strong activity against the bacterial strains causing caries, periodontitis, gingivitis, pharyngitis, recurrent aphthous ulcers, supragingival, and subgingival plaque. An analysis of average MIC values showed that honey and royal jelly have the highest antimicrobial activity against Porphyromonas gingivalis and Fusobacterium nucleatum. In turn, bee venom has an antibacterial effect against Streptococcus mutans. Streptococcus sobrinus and Streptoccus pyogenes were the most resistant species to different types of honey, and royal jelly, respectively. Moreover, these products are safer in comparison to the chemical compounds used in the treatment of oral cavity bacterial infections. Since the antimicrobial activity of bee products depends on their chemical composition, more research is needed to standardize the composition of these compounds before they could be used in the treatment of oral cavity bacterial infections.

Usefulness of Honey as an Adjunct in the Radiation Treatment for Head and Neck Cancer: Emphasis on Pharmacological and Mechanism/s of Actions

BACKGROUND

In the treatment of head and neck cancer (HNC), ionizing radiation is an important modality in achieving curative objectives. However, the effective use of radiation is compromised by the side effects resulting from the damage to the adjacent normal tissue. Preclinical studies carried out in the recent past have shown that the age old dietary agent honey, which also possess myriad medicinal use is beneficial in mitigating diverse radiation-induced side effects like mucositis, xerostomia, fatigue, weight loss and to promote healing of refractory wounds.

OBJECTIVE

The objective of this memoir is to review the beneficial effects of honey in mitigating radiation-induced side effects in HNC and to emphasize on the underlying mechanism of action for the beneficial effects Methods: Two authors searched Google Scholar, PubMed, Embase, and the Cochrane Library for publications up to December 2019 to assess the ability of honey in reducing the severity of radiation-induced ill effects in the treatment of HNC. Subsequently, the adjunct pharmacological effects and mechanism/s responsible were also searched for and appropriately used to substantiate the underlying mechanism/s of action for the beneficial effects.

RESULTS

The existing data is suggestive that honey is beneficial in mitigating the radiation-induced mucositis, xerostomia, healing of recalcitrant wounds in radiation exposed regions and multiple pathways mediate the beneficial effects especially, free radical scavenging, antioxidant, wound healing, anticancer, analgesic, anti-inflammatory, anabolic, anti-fatigue and anti-anaemic effects that add additional value to the use of honey as an adjunct in cancer therapy.

CONCLUSION

For the first time this review addresses the underlying pharmacological effects related to the beneficial effects of honey in radiation-induced damage, and attempts at emphasizes the lacunae that need further studies for optimizing the use of honey as an adjunct in radiotherapy of HNC. The authors suggest that future studies should be directed at understanding the detail molecular mechanisms responsible for the beneficial effects using validated cell culture and animal models of study. Large multi centric clinical trials with standardised honey is also needed to understand the clinical use of honey.

Antimicrobial activity of honey in periodontal disease: a systematic review

BACKGROUND

Honey has shown positive antimicrobial and anti-inflammatory actions in several dermatological studies; however, it is unclear if it could be effective in the treatment of periodontal disease.

OBJECTIVES

To answer the question: Does honey have antimicrobial activity against periodontopathogens?

METHODS

Six electronic databases were screened from initiation to 31 January 2019 for randomized clinical trials (RCTs) and controlled in vitro studies exploring the antimicrobial effect of honey against periodontopathogens. Honey's botanical origin, periopathogens that showed microbial susceptibility to honey, MICs, microbial growth conditions, control product and clinical follow-up were the main investigated outcomes. The risk of bias (RoB) of included RCTs was assessed using the Cochrane Collaboration RoB tool. The RoB of in vitro studies was evaluated based on the Sarkis-Onofre judgement model adapted to the context of honey.

RESULTS

A total of 1448 publications were found as search results in the screened databases. Sixteen eligible papers were included based on predetermined inclusion criteria. Retained studies included 5 RCTs and 11 in vitro controlled trials. Manuka and multifloral honeys were the most studied varieties. The tested honeys showed a significant antimicrobial action, with different MICs, against eight periopathogens. Four of the five RCTs showed a high RoB, while 4 of the 11 retained in vitro studies showed a medium RoB.

CONCLUSIONS

Honey showed a significant antimicrobial activity against all targeted periopathogens. Additional experiments are required to explore the entire antimicrobial spectrum of honey towards all pathogens involved in periodontal disease.

Physical characteristics and antimicrobial properties of Apis mellifera, Frieseomelitta nigra and Melipona favosa bee honeys from apiaries in Trinidad and Tobago

Background

Honey is a versatile and complex substance consisting of bioactive chemicals which vary according to many bee and environmental factors. The aim of this study was to assess the physical and antimicrobial properties of five honey samples obtained from three species of bees; two stingless bees, Frieseomelitta nigra and Melipona favosa and one stinging bee, Apis mellifera (fresh and aged honey). Samples were acquired from apiaries across Trinidad and Tobago. An artificial honey, made from sugar, was also used for comparison.

Methods

Physical properties such as appearance, pH, moisture content, sugar content and specific gravity were determined. Antimicrobial activity was assessed utilizing the agar diffusion assay and comparison to a phenol equivalence. The broth microdilution test was performed to determine the minimum inhibitory concentrations (MICs) and the minimum bactericidal concentrations (MBCs) of the five honey samples against four common pathogens, including Staphylococcus aureus, Escherichia coli, Streptococcus pyogenes and Haemophilus influenzae.

Results

All honey samples were acidic, with pH values ranging from 2.88 (M. favosa of Tobago) to 3.91 (fresh A. mellifera). Sugar content ranged from 66.0 to 81.6% with the highest values detected in stinging bee honeys of the A. mellifera (81.6 and 80.5°Bx). Moisture content ranged from 16.9% for aged A. mellifera honey (from Trinidad) to 32.4% for F. nigra honey (from Tobago). The MICs (2 to 16%) and MBCs (2 to 32%) of stingless bee honeys were lower than that of stinging bee and artificial honeys (16 to > 32%). Stingless bee honeys also exhibited a broad spectrum of antimicrobial activity against both Gram-positive and Gram-negative organisms with higher phenol equivalence values (4.5 to 28.6%) than the A. mellifera honeys (0 to 3.4%) against the isolates tested. M. favosa honey of Tobago displayed the greatest antimicrobial activity as indicated by the high phenol equivalence and low MIC and MBC values.

Conclusions

Stingless bee honeys from Tobago showed the greatest antimicrobial activity when compared to the other honeys used in this study. M. favosa honey of Tobago showed the most potential for use as medicinal honey.

Impact of honey on dental erosion and adhesion of early bacterial colonizers

The aim was to investigate if honey causes erosion and if salivary pellicle modified with honey, or its components, or the by-product propolis has a protective effect against dental erosion and adhesion of early bacterial colonizers. The tested substances were: 3 types of honey, methylglyoxal (MGO), hydrogen peroxide, propolis. First in the erosion experiment, 120 human enamel specimens were covered with salivary pellicle and modified with the substances. Then they were eroded with 1% citric acid, pH 3.6 for 2 min, before surface hardness was measured. In the microbiological assay, the enamel specimens (n = 126) covered with modified salivary pellicle were contaminated with bacterial suspensions. The antimicrobial activity of each substance and their effect on early bacterial colonizer adhesion and biofilm formation were determined. Despite a low pH, honey did not cause erosion. On the other hand, pellicle modification with the tested solutions did not protect the enamel from erosion. Microbiologically, the 3 honeys inhibited species-specific growth of oral bacteria. Propolis decreased initial attachment of Streptococcus gordonii, while one honey inhibited demineralization of enamel by biofilm. In conclusion, pellicle modification with honey, or its components, or propolis did neither protect against erosion nor promote it. Propolis presented some bacterial adhesion inhibition.