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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.
Introduction to Manuka Honey for Dental Health
Therapeutic Manuka honey has not yet been investigated as a possible adjunct to NSPT. Therefore, this pilot study aims to evaluate the effects of a product containing Manuka honey on periodontal parameters when applied to periodontal pockets after nonsurgical periodontal treatment in patients with stage 3 periodontitis.
The concentration of hydrogen peroxide in Manuka honey is lower than in other types of honey. The specific antibacterial activity in Manuka honey is based on methylglyoxal (MGO), a compound proven to be a very efficient bactericide, virucide, and fungicide. Furthermore, Manuka honey is highly effective against antibiotic-resistant bacteria. The antibacterial potency of Manuka honey was found to be related to its Non-Peroxide Activity (NPA), trademarked as Unique Manuka Factor (UMF) rating, a classification system which reflects the equivalent concentration of phenol (%, w/v) required to produce the same antibacterial activity as honey, and it is correlated with the methylglyoxal and total phenols content. In addition to its antimicrobial properties, published literature suggests that MGO also has immunomodulatory effects which may positively impact wound healing and tissue regeneration.
The fact that bacteria are becoming increasingly resistant to antibiotics and antiseptics has shifted the interest of medicine to alternative treatment methods against which bacterial resistance cannot be developed. This approach includes using honey, which is increasingly used in medicine. Since the 1990s, when the first studies appeared on the therapeutic effects of honey, particular interest has been focused on its antibacterial properties against infections and antibiotic-resistant bacteria. This effect is consequential mainly of the high sugar concentration of honey, its low pH value, and the formation of hydrogen peroxide that occurs in the enzymatic breakdown of glucose by the glucose oxidase enzyme. Contemporary research on the effects of honey focuses predominantly on one specific honey type, leading to the medicinal use of Manuka honey due to its antibacterial properties. This is an endemic type of honey produced by bees in Australia and New Zealand from the flowers of the plant Leptospermum scoparium.
Current Treatment Methods for Periodontitis
Various systemically administered and locally delivered adjuncts to NSPT have been suggested, including systemic and local antibiotics, antiseptics, probiotics, lasers, and photodynamic treatment. However, the latest guidelines on the treatment of periodontitis stage I–III do not support the use of adjuncts. The exception in terms of open recommendations is given for locally administered sustained-release chlorhexidine and antibiotics and the use of systemic antibiotics in specific patient groups.
The main goal of periodontal treatment is to reduce the number of periodontal pathogens and arrest the inflammatory process. The contemporary gold treatment standard is non-surgical periodontal therapy (NSPT), which involves scaling and root planning using manual and machine-driven (sonic or ultrasonic) instruments. The literature suggests that this therapy is highly effective in eliminating the infection. The latest systematic review article by Suvan et al. on subgingival instrumentation for periodontitis treatment estimates a weighted range of pocket depth reduction of 1.0–1.7 mm and a ratio of pocket closure of 57–74% after 3/4 and 6/8 months, respectively, that was achieved through non-surgical periodontal treatment only. Although NSPT can effectively reduce the number of periodontal pathogens, microbial recolonization commonly occurs, and residual pockets are expected to remain after NSPT.
The Study on Manuka Honey as an Adjunctive Treatment
This pilot study aimed to investigate the effects of Manuka honey as an adjunct to NSPT in patients with stage III periodontitis. The study included 15 participants who underwent non-surgical full-mouth therapy followed by the application of Manuka honey to two quadrants. The benefits of this adjunctive treatment were assessed at recall appointments after 3, 6, and 12 months.
The results of the study showed statistically significant improvements in periodontal probing depth (PPD) and clinical attachment level (CAL) in the quadrants treated with NSPT + Manuka compared to NSPT alone. The improvements in PPD and CAL were observed at all follow-up time points (3, 6, and 12 months). The delta CAL values measured after 3, 6, and 12 months were 0.21, 0.30, and 0.19 mm, respectively. The delta PPD values measured after 3, 6, and 12 months were 0.18, 0.28, and 0.16 mm, respectively. These improvements suggest that the adjunctive use of Manuka honey can lead to better periodontal outcomes.
No significant improvements were observed in split-mouth plaque score (FMPS) and split-mouth bleeding score (FMBS) between the NSPT + Manuka and NSPT-only quadrants. However, it is important to note that the baseline values for plaque and bleeding scores were significantly higher in the NSPT + Manuka quadrants compared to the NSPT-only quadrants.
Antibacterial Properties of Manuka Honey
The antibacterial activity of Manuka honey is attributed to its high concentration of methylglyoxal (MGO), which has been proven to be a very efficient bactericide, virucide, and fungicide. Manuka honey is also highly effective against antibiotic-resistant bacteria. The antibacterial potency of Manuka honey is measured by its Non-Peroxide Activity (NPA) rating, which reflects the equivalent concentration of phenol required to produce the same antibacterial activity as honey.
In addition to its antibacterial properties, Manuka honey has been found to have immunomodulatory effects that can positively impact wound healing and tissue regeneration. These effects may contribute to the improved periodontal outcomes observed in the study.
This pilot study provides promising evidence for the potential use of Manuka honey as an adjunct therapy to nonsurgical periodontal treatment. The study demonstrated statistically significant improvements in periodontal probing depth and clinical attachment level in the quadrants treated with NSPT + Manuka compared to NSPT alone. These improvements suggest that the adjunctive use of Manuka honey can lead to better periodontal outcomes. Further research is needed to confirm these findings and explore the antibacterial properties of Manuka honey in the oral cavity.