The Saudi Dental Journal (2014) 26, 108–114

King Saud University

The Saudi Dental Journal

www.ksu.edu.sa
www.sciencedirect.com

ORIGINAL ARTICLE

Effect of honey in preventing gingivitis and

dental caries in patients undergoing orthodontic
treatment
AL-Dany A. Atwa a, Ramadan Y. AbuShahba a, Marwa Mostafa b,
Mohamed I. Hashem c,d,*

a
Orthodontic Department, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
b
The Regional Center for Myology and Biotechnology, Culture and Sensitivity Unit, Al-Azhar University, Cairo, Egypt
c
Dental Health Department, College of Applied Medical Science, King Saud University, Saudi Arabia
d
Dental Biomaterial Department, Al-Azhar University, Cairo, Egypt

Received 24 April 2013; revised 29 December 2013; accepted 31 March 2014

Available online 19 April 2014

KEYWORDS Abstract Objectives: This study was conducted to investigate the following: (1) the effects of
Honey; chewing honey on plaque formation in orthodontic patients, (2) the effect of chewing honey on den-
Plaque control; tal plaque bacterial counts, (3) determine if honey possesses antibacterial effects on bacteria recov-
Bacterial counting; ered from plaques.
pH measurement; Methods: Female orthodontic patients (n = 20, 12–18 years of age) participated in this random-
Orthodontic treatment ized controlled study. The effects of honey were compared to treatment with either 10% sucrose or
10% sorbitol that served as positive and negative controls, respectively. The pH of plaque was mea-
sured using a digital pH meter prior to baseline and at 2, 5, 10, 20, and 30 min after chewing honey
or rinsing with control solutions and the numbers of Streptococcus mutans, Lactobacilli, and
Prophymonas gingivalis in respective plaques were determined. The antibacterial activity of honey
was tested against commonly used antibiotics using the disk diffusion method.
Results: Significant differences in pH were observed in the honey and sucrose groups compared
to the pH observed in the sorbitol group (p 6 0.001). The maximum pH drop occurred at 5 min in
both the honey and sucrose groups; however the pH in the honey group rapidly recovered
10–20 min after exposure and did not drop below the critical decalcification pH of 5.5. On the other
hand, the pH following sucrose exposure fell <5.5 and was associated with a 30 min recovery time.

* Corresponding author at: Dental Health Department, College of

Applied Medical Science, King Saud University, Riyadh, Saudi
Arabia. Tel.: +966 554777685.
E-mail address: Omer_hh@yahoo.com (M.I. Hashem).
Peer review under responsibility of King Saud University.

Production and hosting by Elsevier

1013-9052 ª 2014 Production and hosting by Elsevier B.V. on behalf of King Saud University.
http://dx.doi.org/10.1016/j.sdentj.2014.03.001
Effect of honey in preventing gingivitis and dental caries 109

The pH observed for the sorbitol group did not change over time. Bacterial counts were signifi-
cantly reduced in the honey group compared to the other treatment groups (p 6 0.001) and honey
significantly inhibited the growth of all studied strains compared to inhibition observed with
antibiotics (p 6 0.001).
Conclusions: Honey can be used as an alternative to traditional remedies for the prevention of
dental caries and gingivitis following orthodontic treatment.
ª 2014 Production and hosting by Elsevier B.V. on behalf of King Saud University.

1. Introduction honey on plaque pH in orthodontic patients, (2) the effect of

chewing honey on bacterial counts present in dental plaques
Clinicians have been attempting to reduce gingivitis and enamel and, (3) the in vitro effects of honey on the growth of plaque
demineralization during orthodontic treatments (Agerbaek bacteria.
et al., 1975; Mizrahi, 1988; O’Reilly and Featherstone, 1987;
2. Materials and methods
Patel et al., 2010; Shannon, 1980; Underwood et al., 1989)
by using of fluoride dentifrices and fluoride solutions (Mizrahi,
1988; O’Reilly and Featherstone, 1987; Shannon, 1980; Female patients (n = 20, 12–18 years of age) undergoing
Underwood et al., 1989), antibacterial mouth rinses (Agerbaek orthodontic treatment were enrolled in the present study.
et al., 1975), and antibiotics (Park et al., 1998). The study was reviewed and approved by the Ethical Commit-
Recently, much attention has been given to natural prod- tee of the Faculty of Dental Medicine, Al-Azhar University,
ucts with health-promoting benefits. Historically, honey has Cairo, Egypt and informed consent was obtained from each
been used as an eco-friendly medicine for many years in the subject after the study was explained. Treatment constituted
treatment of burns, infected wounds (Cutting, 2007; Moore of fixed orthodontic therapy with extraction of the first bicus-
et al., 2001), peptic ulcers, bacterial gastroenteritis (Ali, 2003; pids followed by individual canine retraction (maintaining
Salem, 1981), and ophthalmic infections (Emarah, 1982). In maximum anchorage conservation) and space closure. Subjects
addition, honey possesses potent broad-spectrum antibacterial having received antibiotic therapy 2-weeks prior to the start of
activity and studies have demonstrated that manuka honey the study or subjects with xerostomia were excluded.
have anti-cancer properties (English et al., 2004).
In vitro studies have shown that exposure to a honey solu- 2.1. Assessment of plaque pH
tion affected monocyte activity (Fischer et al., 2007). It was
found that mouth washes containing propolis (present in bee The pH of the honey (Imtenan Co. Ltd., Elnozha Elgededa,
products) possessed antimicrobial activity against Streptococ- Cairo, Egypt), sucrose (Al Monairy Corn Products. Cairo,
cus mutans and can be used as an alternative treatment in den- Egypt), and sorbitol (Sorbidex, Cargill Middle East, Dubai,
tal caries prevention (Duailibe et al., 2007) and in the United Arab Emirates) was measured using a digital pH meter
reduction of plaque accumulation and polysaccharide forma- (Orion model 230A, Thermo Scientific Inc., Tokyo, Japan).
tion (Koo et al., 2002). Recently it was reported that periodon- The electrode was calibrated before measurement using stan-
tal pockets irrigated with 10% propolis solution had a 95% dard buffers of pH 4.0 and 7.0 and the pH read after allowing
decrease in gingivitis (do Amaral et al., 2006) suggesting (based the reading to stabilize for 30 s. Measurements were taken 3
on both clinical and microbiological parameters) that subgin- times and the means were recorded.
gival irrigation with a propolis extract as an adjunct to peri-
odontal treatment and more effective than scaling and root 2.2. Plaque collection
planing (Ahuja and Ahuja, 2011; Coutinho, 2012). Topical
application of a propolis extract on oral Candida albicans Plaque samples were collected for pH measurement as
lesions resulted in remission within three weeks and treatment described with modifications described below (Rugg-Gunn
efficacy was comparable to treatment with nystatin, the stan- et al., 1975). All subjects were required to refrain from brush-
dard antifungal product used to treat these infections (Santos ing their teeth or using any oral hygiene products for 24 h and
et al., 2005). Another study conducted on premolars for direct to abstain from consuming any food or drink (except water)
pulp capping also showed that propolis was as effective as cal- for at least 2 h before each test session. These criteria con-
cium hydroxide. Based on these observations it has been con- formed to the guidelines of the Plaque Acidity Working Group
cluded that propolis can be used along with calcium hydroxide of the Food, Nutrition, and Dental Health Committee of the
as an intra-canal treatment (de Rezende et al., 2008). American Dental Association (Harper et al., 1986). Patients
A study conducted by Patel et al. (2010) on bacterial iso- were asked to return on a weekly basis and at each visit, base-
lates obtained from patients undergoing orthodontic treatment line plaque samples were collected with a spoon excavator
showed that the honey was a more effective antibacterial than from all accessible surfaces of the upper central incisors, buccal
some of the common antibiotics tested, further suggesting that surfaces of upper first molars and premolars, and the lingual
honey might inhibit dental plaque formation and aid in con- surfaces of lower molars and incisors. The subjects were asked
trolling gingivitis associated with orthodontic procedures to swallow immediately before plaque collection to minimize
(Coutinho, 2012; Nayak et al., 2010; Patel et al., 2010; salivary contamination, and during sample collection care
Steinberg et al., 1996). Therefore, the present study was con- was taken to avoid contamination with blood or saliva.
ducted to determine the following: (1) the effect of chewing Patients were then asked to chew and ingest 10 g of pure
110 AL-Dany A. Atwa et al.

undiluted honey in 2 min or rinse with 15 ml of 10% sucrose or

sorbitol solutions (positive and negative controls, respectively)
for 1 min (Nayak et al., 2010; Parsons, 2011). Post consump-
tion plaque samples were collected at 2, 5, 10, 20, and
30 min and the pH determined in the same manner (Table 1).
Only one substance (honey, sucrose, or sorbitol) was tested at
each visit in a randomized order with at least 7 days between
each test to avoid any carryover effects.
Collected plaque samples were mixed with 20 ll of distilled
water and the pH was measured with a micro-combination
electrode (Orion model 9802BN, Thermo Scientific Inc.,
Tokyo, Japan) in conjunction with a portable pH meter (Orion
model 230A, Thermo Scientific Inc., Tokyo, Japan). Calibra-
tion of the system was carried out before each test and the
electrode was cleaned with distilled water and placed in a stan-
dard solution of pH 7.0.
Figure 1 Mean plaque pH differences between groups over time.
2.3. Bacterial counts

Base-line and 30 min plaque samples were collected in 2 ml of

sterile thioglycollate broth transport media in screw capped
vials and immediately transferred to the laboratory (the regio-
nal Center for Myology and Biotechnology, Culture and Sen-
sitivity Unit, Al-Azhar University, Cairo, Egypt). S. mutans,
Lactobacillus acidophilus, and Prophyromonas gingivalis were
isolated from respective samples (Cowan et al., 2004) and bac-
terial counts determined using the standard pour plate method
(Norden and Kass, 1968).

2.4. Bacterial sensitivity testing

The antimicrobial activity of honey was studied using the disk

diffusion method (Cruickshank, 1968). Antibiotic discs (5 mm
diameter) were placed in the center of the agar plates. Disks
(5 mm diameter) containing honey were prepared from What-
man’s filter paper and were autoclaved. Respective disks were
placed equidistant from each other on the streaked nutrient
agar plates and incubated for 24 h at 37 C. The zone of inhi-
bition to the nearest millimeter (including the diameter of the Figure 2 Mean bacterial counts (CFU/10 ll) before and one
disk) was measured using a ruler. hour after honey consumption.

2.5. Statistical analysis

3. Results
Data were analyzed by ANOVA and Tukey’s post hoc tests
using SPSS Version V.17 (SPSS Inc, Chicago, Illinois). Data There were significant differences in the plaque pH between the honey
are expressed as the mean ± standard deviation (SD) or stan- and sucrose groups compared to the pH observed in the sorbitol group
(Fig. 1 and Table 1; p 6 0.001). The maximum decrease in pH occurred
dard error (SE) of triplicate readings and p-values < 0.05 were
at 5 min in both the honey and sucrose groups with the pH in the
considered statistically significant.
honey group recovering in 20 min. The critical value for decalcification

Table 1 Changes in pH over time.

Groups pH ANOVA
Baseline 2 min 5 min 10 min 20 min 30 min F Sig.
Honey 6.85 ± (.45)a 6.42 ± (.40)a 5.86 ± (.20)c 6.23 ± (.20)b 6.54 ± (.20)a 6.84 ± (.20)a
Sucrose 6.82 ± (.45)a 6.22 ± (.34)b 5.28 ± (.29)c 5.71 ± (.18)c 6.33 ± (.16)b 6.79 ± (.24)a 17.756 .000***
Sorbitol 6.88 ± (.45)a 6.74 ± (.45)a 6.72 ± (.48)a 6.67 ± (.47)a 6.82 ± (.48)a 6.86 ± (.48)a
Data are expressed as the mean ± SD of 3 observations.
Means with similar letters are not significantly different.
(a, b) and (b, c) are significant at p 6 0.05, (a, c) are significant at p 6 0.01, ***p 6 0.001.
Effect of honey in preventing gingivitis and dental caries 111

(pH 5.5) was not reached for in either the honey or sorbitol groups, reduction in pH compared to changes observed following
however, the pH in the sucrose group fell below the critical value sucrose consumption. Exposure to sorbitol was not associated
but recovered by 30 min. The pH curve for sorbitol was almost linear with a significant drop in pH suggesting that the inherent pH
with no significant drop over time during the test period (Fig. 1). of liquids was not indicative of pH changes to the plaque or
Although the pH was affected by exposure to either honey, sucrose,
of their erosive potential (Edwards et al., 1999; Grenby
or sorbitol only exposure to honey significantly reduced (p < 0.001)
the number of bacteria that were recovered from plaques 30 min after
et al., 1989). The plaque pH measurement method used in this
exposure (Fig. 2 and Table 2). study has been used successfully in previous studies and shown
The antibacterial properties of honey were assessed by comparing to be a reliable method of determining the cariogenicity of
the zones of inhibition resulting from the culture of S. mutans, P. gin- food (Lehl et al., 1993). These methods have been shown to
givalis, and L. acidophilus in the presence of either honey or various satisfactorily identify non acidogenic foods compared to
antibiotics (Table 3 and Fig. 3). Honey significantly inhibited the appropriate positive (sucrose) and negative (sorbitol) controls
growth of all the strains studied compared to zones of inhibition result- (Curzon and Hefferren, 2001). Although acidic plaques have
ing from growth in the presence of antibiotics (p 6 0.001). been correlated with increase in the numbers of caries,
(Tahmassebi and Duggal, 1997) few studies have examined
4. Discussion the effect of honey on plaque pH. Since honey is an important
sweetening agent it represents a source of fermentable sugar
Although honey is acidic (endogenous pH 4.2) both sucrose for oral bacteria and studies have suggested that honey was
and sorbitol were used at pH 7. Data presented in this study as cariogenic as sucrose (Bowen and Lawrence, 2005; Rells
demonstrated that eating honey was associated with a greater and Nizell, 1973; Shannon et al., 1979) or as in other studies

Table 2 Bacterial counts before and 1 h after chewing honey.

Mean SD t – Test
Mean difference SD SE t Value Sig.
Streptococci Before 255.6 90.8 151.20 47.51 15.03 10.063 .000***
After 104.4 51.7
Lactobacilli Before 100.2 63.5 58.00 33.83 10.69 5.422 .000***
After 42.2 33
P. gingivalis Before 56.4 24.4 14.40 7.44 2.35 6.119 .000***
After 42 17.8
CFU = Colony Forming Unit.
CFUs determined from 10 ll.
SD, standard deviation; SE, standard error.
***
p 6 0.001.

Table 3 The effect of honey on bacterial growth.

Mean SD Tukey’s HSD test
Mean difference Std. error Sig.
Streptococcus mutans
Honey 27.6 3.1
Penicillin 18.2 3.5 9.40 1.37073 .000***
Oxytetracycline 20.4 3.1 7.20 1.37073 .000***
Chloramphenicol 19.2 2.0 8.40 1.37073 .000***
Cefaclor 16.4 2.9 11.20 1.37073 .000***
Prophymonas gingivalis
Honey 24.5 2.7
Penicillin 16.8 3.4 7.70 1.26139 .000***
Oxytetracycline 19.3 2.4 5.20 1.26139 .002**
Chloramphenicol 18.3 2.1 6.20 1.26139 .000***
Cefaclor 15.6 2.6 8.90 1.26139 .000***
Lactobacillus acidophilus
Honey 31.9 2.9
Penicillin 21.4 3.1 10.50 1.25536 .000***
Oxytetracycline 21.5 2.8 10.40 1.25536 .000***
Chloramphenicol 15.2 2.0 16.70 1.25536 .000***
Cefaclor 19.2 2.6 12.70 1.25536 .000***
**
p 6 0.01.
***
p 6 0.001.
112 AL-Dany A. Atwa et al.

Figure 3 Bactericidal properties of honey compared to antibiotics.

which labeled it as more cariogenic than sucrose (Konig, 1967; to honey than antibiotics. At this time, however, the mechanism
Wakeman et al., 1948). In contrast, other reports have shown associated with the antibacterial effects of honey remain
that honey was less cariogenic than sucrose (Molan, 2001) and unknown, although the presence of hydrogen peroxide
that honey and other bee products (e.g., propolis) were non- (Havsteen, 1983), flavonoids (Mundo et al., 2004), and hyper-
cariogenic, in addition to suggesting that honey be used for tonic sugar concentrations (Cai and Wu, 1996) have been put
control of dental caries (Kujumgiev et al., 1999; Menezes forth as possibilities. More specifically, hydrogen peroxide has
et al., 1997; Park et al., 1998). been shown to form in honey by the action of the enzyme glucose
The present study demonstrated that the mean minimum oxidase that produces gluconic acid and hydrogen peroxide
plaque pH 5 min after exposure to honey was higher than from glucose. Flavonoids have been shown to have antibacterial
the pH observed following sucrose exposure (5.86 and 5.28, properties (Mundo et al., 2004), and high sugar concentrations
respectively) although this difference was not statistically sig- produce a hypertonic condition causing plasmolysis of micro-
nificant. In contrast, at 10 and 20 min the plaque pH after bial cells resulting in growth inhibition and death (Cai and
chewing honey was significantly higher than after rinsing with Wu, 1996).
sucrose (p 6 0.05). Unlike sucrose, chewing honey did not
result in a decrease in pH below the critical value of 5.5 asso- 5. Conclusions
ciated with enamel demineralization. Perhaps the antibacterial
activity of honey against cariogenic bacteria overcame its pH Within the limitations of the study it can be concluded that
reducing effects based on previous observations demonstrating topical application of honey can modify the pH, reduce bacte-
that honey possessed antibacterial properties against medically rial counts, and inhibit bacterial growth. These data suggested
important bacteria (Bonvehı́ and Coll, 1994; Digrak et al., that topical application/chewing of honey might help prevent
1995; Gebara et al., 1996; Grange and Davey, 1990; Ikeno gingivitis and caries in patients undergoing orthodontic treat-
et al., 1991; Lindenfelser, 1967; Steinberg et al., 1996). How- ment. Further studies will be required to substantiate these
ever, few studies have investigated its activity against oral preliminary observations.
pathogens (Burdock, 1998; Gebara et al., 1996; Lindenfelser,
1967; Steinberg et al., 1996). Conflict of interest
Previous studies suggested that the antibacterial spectrum
of honey is fairly broad, acting against Gram-positive and -
The authors declare no conflict of interest and/or financial
negative rods and cocci, yeast, and fungi (Duailibe et al.,
support.
2007). Results described in the present study demonstrated
that the number of S. mutans, P. gingivalis, and L. acidophilus
References
were significantly reduced after chewing honey, supporting
previously published reports (Hayacibara et al., 2005; Ozan Agerbaek, N., Melsen, B., Rolla, G., 1975. Application of chlorhex-
et al., 2007; White et al., 1963). idine by oral irrigation systems. Scand. J. Dent. Res. 83, 284–287.
Antibiotic susceptibility testing demonstrated that the iso- Ahuja, V., Ahuja, A., 2011. Apitherapy––a sweet approach to dental
lated microorganisms in the present study were more sensitive diseases. Part II: propolis. J. Acad. Adv. Dent. Res. 2, 1–8.
Effect of honey in preventing gingivitis and dental caries 113

Ali, A.M., 2003. Prevention of ammonia-induced gastric lesions in rats Hayacibara, M.F., Koo, H., Rosalen, P.L., Duarte, S., Franco, E.M.,
by natural honey. J. Nutr. Environ. Med. 13, 239–246. Bowen, W.H., Ikegaki, M., Cury, J.A., 2005. In vitro and in vivo
Bonvehı́, J.S., Coll, F.V., 1994. The composition, active components effects of isolated fractions of Brazilian propolis on caries devel-
and bacteriostatic activity of propolis in dietetics. J. Am. Oil. opment. J. Ethnopharmacol. 101, 110–115.
Chem. Soc. 71, 529–532. Ikeno, K., Ikeno, T., Miyazawa, C., 1991. Effects of propolis on dental
Bowen, W.H., Lawrence, R.A., 2005. Comparison of the cariogenicity caries in rats. Caries Res. 25, 347–351.
of cola, honey, cow milk, human milk, and sucrose. Pediatrics 116, Konig, K.G., 1967. Caries induced in laboratory rats. Post-eruptive
921–926. effect of sucrose and of bread of different degrees of refinement. Br.
Burdock, G.A., 1998. Review of the biological properties and toxicity Dent. J. 123, 585–589.
of bee propolis (propolis). Food Chem. Toxicol. 36, 347–363. Koo, H., Cury, J.A., Rosalen, P.L., Ambrosano, G.M., Ikegaki, M.,
Cai, L., Wu, C.D., 1996. Compounds from Syzygium aromaticum Park, Y.K., 2002. Effect of a mouthrinse containing selected
possessing growth inhibitory activity against oral pathogens. J. propolis on 3-day dental plaque accumulation and polysaccharide
Nat. Prod. 59, 987–990. formation. Caries Res. 36, 445–448.
Coutinho, A., 2012. Honeybee propolis extract in periodontal treat- Kujumgiev, A., Tsvetkova, I., Serkedjieva, Y., Bankova, V., Christov,
ment: a clinical and microbiological study of propolis in periodon- R., Popov, S., 1999. Antibacterial, antifungal and antiviral activity
tal treatment. Indian J. Dent. Res. 23, 294. of propolis of different geographic origin. J. Ethnopharmacol. 64,
Cowan, S.T., Steel, K.J., Barrow, G., Feltham, R., 2004. Cowan and 235–240.
Steel’s Manual for the Identification of Medical Bacteria. Cam- Lehl, G., Taneja, J.R., Chopra, S.L., 1993. Evaluation of the
bridge University Press. cariogenicity of sugar containing drinks by estimating changes in
Cruickshank, R., 1968. Medical Microbiology: A Guide to Diagnosis pH of human dental plaque and saliva. J. Indian Soc. Pedod. Prev.
and Control of Infection, 11th ed. E and S Livingston Ltd., Dent. 11, 9–14.
Edinburgh and London, 888. Lindenfelser, L., 1967. Antimicrobial activity of propolis. Am. Bee J.
Curzon, M., Hefferren, J., 2001. Nutrition: modern methods for 107, 90–92.
assessing the cariogenic and erosive potential of foods. Br. Dent. J. Menezes, H., Bacci Jr, M., Oliveira, S., Pagnocca, F., 1997. Antibac-
191, 41–46. terial properties of propolis and products containing propolis from
Cutting, K.F., 2007. Honey and contemporary wound care: an Brazil. Apidologie 28, 71–76.
overview. Ostomy Wound Manage. 53, 49–54. Mizrahi, E., 1988. Glass ionomer cements in orthodontics––an update.
de Rezende, G.P., da Costa, L.R., Pimenta, F.C., Baroni, D.A., 2008. Am. J. Orthod. Dentofac. Orthop. 93, 505–507.
In vitro antimicrobial activity of endodontic pastes with propolis Molan, P.C., 2001. The potential of honey to promote oral wellness.
extracts and calcium hydroxide: a preliminary study. Braz. Dent. J. Gen. Dent. 49, 584–589.
19, 301–305. Moore, O.A., Smith, L.A., Campbell, F., Seers, K., McQuay, H.J.,
Digrak, M., Yilmaz, O., Ozcelik, S., 1995. In vitro antimicrobial effect Moore, R.A., 2001. Systematic review of the use of honey as a
of propolis collected in Elazig region. Turk. J. Biol. 19, 249–257. wound dressing. BMC Complement. Altern. Med. 1, 2.
do Amaral, R.C., Gomes, R.T., Rocha, W.M.S., Lemos, S., Abreu, R., Mundo, M.A., Padilla-Zakour, O.I., Worobo, R.W., 2004. Growth
Santos, V.R., 2006. Periodontitis treatment with Brazilian green inhibition of foodborne pathogens and food spoilage organisms by
propolis gel. Pharmacology (online), 336–341. select raw honeys. Int. J. Food Microbiol. 97, 1–8.
Duailibe, S.A., Goncalves, A.G., Ahid, F.J., 2007. Effect of a propolis Nayak, P.A., Nayak, U.A., Mythili, R., 2010. Effect of Manuka
extract on Streptococcus mutans counts in vivo. J. Appl. Oral Sci. honey, chlorhexidine gluconate and xylitol on the clinical levels of
15, 420–423. dental plaque. Contemp. Clin. Dent. 1, 214–217.
Edwards, M., Creanor, S.L., Foye, R.H., Gilmour, W.H., 1999. Norden, C.W., Kass, E.H., 1968. Bacteriuria of pregnancy–a critical
Buffering capacities of soft drinks: the potential influence on dental appraisal. Annu. Rev. Med. 19, 431–470.
erosion. J. Oral Rehabil. 26, 923–927. O’Reilly, M.M., Featherstone, J.D., 1987. Demineralization and
Emarah, M.H.A., 1982. Clinical study of the topical use of bee honey remineralization around orthodontic appliances: an in vivo study.
in the treatment of some ocular diseases. Bull. Islam. Med. 2, 422– Am. J. Orthod. Dentofacial Orthop. 92, 33–40.
425. Ozan, F., Sumer, Z., Polat, Z.A., Er, K., Ozan, U., Deger, O., 2007.
English, H.K., Pack, A.R., Molan, P.C., 2004. The effects of manuka Effect of mouthrinse containing propolis on oral microorganisms
honey on plaque and gingivitis: a pilot study. J. Int. Acad. and human gingival fibroblasts. Eur. J. Dent. 1, 195–201.
Periodontol. 6, 63–67. Park, Y.K., Koo, M.H., Abreu, J.A., Ikegaki, M., Cury, J.A., Rosalen,
Fischer, G., Conceicao, F.R., Leite, F.P., Dummer, L.A., Vargas, P.L., 1998. Antimicrobial activity of propolis on oral microorgan-
G.D., Hubner Sde, O., Dellagostin, O.A., Paulino, N., Paulino, isms. Curr. Microbiol. 36, 24–28.
A.S., Vidor, T., 2007. Immunomodulation produced by a green Parsons, E.K., 2011. Manuka Honey: An Investigation into the Effect
propolis extract on humoral and cellular responses of mice of Manuka Honey on Oral Mucositis in Patients Receiving
immunized with SuHV-1. Vaccine 25, 1250–1256. Radiation Therapy to the Head and Neck. University of Otago.
Gebara, E.C.E., Zardetto, C.G.D.C., Mayer, M.P.A., 1996. Estudo Patel, R., Thaker, V., Patel, V., Shukla, P., Bhatnagar, P., Patel, A.,
in vitro da açäo antimicrobiana de substâncias naturais sobre S. 2010. In-vitro study of changing antibiotic sensitivity and resistance
mutans e S. sobrinus; in vitro study of the antimicrobial activity of by honey on gingival inflammation during orthodontic treatment-a
natural substances against S. mutans and S. sobrinus. Rev. Odontol. preliminary report. Orthodontic Cyber J., 3–8.
Univ. Säo Paulo 10, 251–256. Rells, G.K., Nizell, A.E., 1973. Cariogenicity of honey. J. Am. Dent.
Grange, J.M., Davey, R.W., 1990. Antibacterial properties of propolis Assoc. 87, 29.
(bee glue). J. R. Soc. Med. 83, 159–160. Rugg-Gunn, A.J., Edgar, W.M., Geddes, D.A., Jenkins, G.N., 1975.
Grenby, T.H., Phillips, A., Desai, T., Mistry, M., 1989. Laboratory The effect of different meal patterns upon plaque pH in human
studies of the dental properties of soft drinks. Br. J. Nutr. 62, 451– subjects. Br. Dent. J. 139, 351–356.
464. Salem, S., 1981. Honey regimen in gastrointestinal disorders. Bull.
Harper, D., Abelson, D., Jensen, M., 1986. Human plaque acidity Islam. Med. 1, 358–362.
models. J. Dent. Res. 65, 1503–1510. Santos, V.R., Pimenta, F.J., Aguiar, M.C., do Carmo, M.A., Naves,
Havsteen, B., 1983. Flavonoids, a class of natural products of high M.D., Mesquita, R.A., 2005. Oral candidiasis treatment with
pharmacological potency. Biochem. Pharmacol. 32, 1141–1148. Brazilian ethanol propolis extract. Phytother. Res. 19, 652–654.
114 AL-Dany A. Atwa et al.

Shannon, I.L., 1980. Comparison of orthodontic cements containing Underwood, M.L., Rawls, H.R., Zimmerman, B.F., 1989. Clinical
sodium fluoride or stannous flouride. Am. J. Orthod. 78, 640–645. evaluation of a fluoride-exchanging resin as an orthodontic
Shannon, I.L., Edmonds, E.J., Madsen, K.O., 1979. Honey: sugar adhesive. Am. J. Orthod. Dentofac. Orthop. 96, 93–99.
content and cariogenicity. ASDC J. Dent. Child. 46, 29–33. Wakeman, E.J., Smith, J.K., et al, 1948. Microorganisms associated
Steinberg, D., Kaine, G., Gedalia, I., 1996. Antibacterial effect of with dental caries in the cotton rat. J. Dent. Res. 27, 489–492.
propolis and honey on oral bacteria. Am. J. Dent. 9, 236–239. White Jr., J.W., Subers, M.H., Schepartz, A.I., 1963. The identification
Tahmassebi, J.F., Duggal, M.S., 1997. The effect of different methods of inhibine, the antibacterial factor in honey, as hydrogen peroxide
of drinking on the pH of dental plaque in vivo. Int. J. Paediatr. and its origin in a honey glucose-oxidase system. Biochim. Biophys.
Dent. 7, 249–254. Acta (BBA) 73, 57–70.