Evidence-Based Studies and Perspectives of the Use of Brazilian Green and Red Propolis in Dentistry

Fluoride Content, Availability, and Stability in a Propolis-Based Dentifrice

Purpose: This study aims to verify the stability of different types of fluoride in a dentifrice containing Brazilian red propolis (BRP). Methods: The dentifrice formulation was developed with calcium carbonate (CaCO3) and sodium monofluorophosphate (MFP) (patent INPI BR1020170110974). Nominal fluoride content was 1500 μg/g. Batches of five lots were selected and analyzed for 2 consecutive years (fresh, with 12 and 24 months). Dentifrices from each tube were analyzed in duplicate using an ion-specific electrode (ISE). The concentrations of fluoride (total fluoride [TF], total soluble fluoride [TSF], and ionizable fluoride [IF]) were determined, and the results were expressed in ppm F (μgF/g). Results: After 12 months of aging, the samples showed TF concentration ranging from 1198.9 ± 26.9 to 1443.6 ± 33.4 ppm F, TSF ranging from 869.6 ± 105.5 to 965.8 ± 149.8 ppm F, and IF ranging from 223.5 ± 14.8 to 269.7 ± 10.1 ppm F. After 24 months of aging, the samples showed TF concentration ranging from 763.5 ± 73.2 to 1083.1 ± 32.4 ppm F, TSF ranging from 552.3 ± 39.9 to 758.4 ± 141.1 ppm F, and IF ranging from 102.2 ± 4.0 to 174.7 ± 4.9 ppm F. Conclusion: Soluble fluoride remained relatively stable until 12 months of aging; however, at 24 months of aging, the concentration reduced.

Efficacy of toothpaste containing Brazilian green propolis extracts with an optimal kaempferide/betuletol ratio for improving oral microbiota: A randomized, controlled, paired crossover study

ETHNOPHARMACOLOGICAL RELEVANCE

Propolis is a resinous substance collected by honeybees from various plant sources and has been used in traditional folk medicine for centuries. Propolis has various biological properties, including antibacterial, antiviral, anti-inflammatory, and anti-tumor properties. The use of propolis in oral health care is attributable to its antimicrobial and anti-inflammatory effects. However, limited evidence exists on the in vivo efficacy of propolis against periodontal pathogens.

AIM OF THE STUDY

We aimed to evaluate the efficacy of Brazilian green propolis (BGP)-containing toothpaste for improving the oral environment and define its antibacterial compounds.

MATERIALS AND METHODS

Overall, 48 student volunteers aged 18-40 years (24 females and 24 males) were randomly categorized into the BGP and placebo groups. The BGP and placebo groups received toothpaste with and without BGP, respectively. After a baseline assessment, the plaque index (PI) score, gingival index (GI) score, and proportion of periodontal pathogens on the tongue surface were analyzed at 0, 1, and 2 weeks. Antibacterial compounds were identified using liquid-liquid partitioning, high-performance liquid chromatography purification, and nuclear magnetic resonance methods.

RESULTS

The concentration of BGP in the toothpaste was set at 0.0347 w/v%. Compared with the placebo group, the BGP group demonstrated a reduction in the PI score (p < 0.05) but not in the GI score, as well as a reduction in Porphyromonas gingivalis (Pg)/Total bacteria (Tb), Fusobacterium nucleatum (Fn)/Tb, and Aggregatibacter actinomycetemcomitans (Aa)/Tb (p < 0.05) but not in Streptococcus salivalius/Tb. Effect sizes for Pg, Fn and Aa were 0.360, 0.556, and 0.164, respectively. The antibacterial compounds of the BGP-containing toothpaste included a mixture of kaempferide/betuletol.

CONCLUSIONS

We confirmed the efficacy of propolis toothpaste with an optimal kaempferide/betuletol ratio for improving oral microbiota, thereby suggesting that BGP toothpaste is clinically useful in maintaining oral health and preventing periodontal disease.

Effects of aqueous and ethanolic extracts of Chinese propolis on dental pulp stem cell viability, migration and cytokine expression

Background

Propolis is a natural substance produced by honeybees that has various biological properties including, anti-inflammatory, antioxidant and antimicrobial properties. Although previous studies have evaluated the antimicrobial effects of propolis in dentistry, its effects on dental pulp stem cell (DPSC) viability, migration, and differentiation are yet not well understood. The objective of this study was to investigate the effects of Chinese propolis on viability/proliferation, migration, differentiation and cytokine expression in DPSCs.

Methods

Commercially available DPSCs (Lonza) were treated with aqueous extract of propolis (AEP) or ethanolic extract of propolis (EEP), and viability/proliferation was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays and quantification of nuclear staining. DPSC differentiation into mineralizing cells was evaluated with Alizarin red staining and cell migration was assessed using Boyden Chamber Transwell inserts. Cytokine expression was measured by RT-qPCR. AEP and EEP at 0.03 and 0.1 mg/mL did not affect DPSC viability/proliferation for up to 7-days treatment.

Results

Higher doses (0.33-33 mg/mL) induced a dose dependent decrease in DPSC viability/proliferation with a more prominent effect with EEP at 7 days. Neither AEP nor EEP induced DPSC differentiation into mineralizing cells, but both AEP and EEP (0.03-0.1 mg/ml) induced a dose dependent increase in DPSC migration. In addition, EEP prevents the upregulation of IL1b and IL6 but not IL8 and CCL2 in response to lipopolysaccharide stimulation. AEP has less potent anti-inflammatory effects and prevents only IL1b upregulation.

Conclusion

This study provides new information about the biologic properties of ethanolic and aqueous extracts of propolis and shows that propolis, at doses that do not affect cell viability, induces DPSC migration and has anti-inflammatory properties. These data highlight the potential use of propolis as an alternative intra-canal medicament for regenerative endodontic procedures.

Propolis as a functional food and promising agent for oral health and microbiota balance: A review study

Bee Propolis has been used for its therapeutic properties, including anti-inflammatory, antibacterial, antifungal, and immune-stimulating properties, for centuries as a functional food. This study reviewed the effectiveness of propolis as a functional food on oral-related diseases as a rich bioflavonoid produced by honey bees. A literature search was conducted to identify studies published that investigated the effects of propolis on oral health and its ability to treat related diseases. The search was performed in electronic databases using relevant keywords. Initially, 3429 studies were identified through database searching, and based on the inclusion and exclusion criteria, 22 articles were eligible to be included. Reviewing the articles, propolis was recognized as a functional food and promising agent to balance oral microbiota and prevent oral diseases due to its effectiveness on related bacteria, its anti-inflammatory properties, and its activity against Porphyromonas gingivalis and Actinomyces Oris allowed it to be an effective substance to prevent periodontal diseases. Based on our findings, Propolis is a desirable preventive option for various oral health conditions, including dental caries and periodontal diseases. Therefore, it is recommended to be consumed as a functional food in our daily diet, which can reduce the risk of oral disease and improve oral health.

bibliometric analysis of the top 100 most-cited articles concerning the use of propolis in dentistry

Aim: The objective of this bibliometric analysis was to identify and analyze the key characteristics of the 100 most-cited articles related to the use of propolis in dentistry. Methods: The search was conducted in the Web of Science Core Collection, and two independent reviewers selected the articles, excluding meeting articles. The number of citations for each article was compared across the Scopus and Google Scholar databases. The extracted data included the number and density of citations, year of publication, journal and impact factor, study design and theme, country and continent, institution, keywords, and authors. VOSviewer software was employed to generate collaborative network maps. Spearman correlation and Poisson regression analyses were performed on the data. Results: The number of citations ranged from 26 to 247, with a citation density varying between 1.08 and 20.00. Articles were published between 1991 and 2021, with laboratory studies (70%) and antimicrobial activity (39%) being the most prevalent study design and theme, respectively. The most discussed dental specialty was microbiology (49%). Rosalen PL (27%) emerged as the author with the highest number of articles, and the University of Campinas (Brazil) was the most prolific institution. Poisson regression indicated a declining trend in citations over the years, though literature reviews exhibited higher citation performance. Brazil contributed the highest percentage of articles (41%). Conclusion: In conclusion, the 100 most-cited articles predominantly comprised laboratory studies investigating the antimicrobial activity of propolis, primarily originating from Brazil, with notable emphasis on the University of Campinas.

Evaluating the Therapeutic Properties of Natural Products in Orthodontic and Surgical Treatment of Dentofacial Deformities: A Systematic Review of Clinical Trials

The use of natural products as alternatives to traditional pharmacological treatments in orthodontics is gaining interest due to their anti-inflammatory, antibacterial, and antioxidant properties. This systematic review synthesizes evidence from clinical trials to evaluate the efficacy of natural products in reducing inflammation and bacterial presence in orthodontic and orthognathic treatment settings. The database search was conducted across PubMed, Scopus, and Embase up to January 2024. The review focused on randomized controlled trials only. The selected studies centered on the anti-inflammatory, antibacterial, and antioxidant effects of natural products, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction. Nine studies, totaling 358 participants, were included. Significant findings demonstrated a reduction in gingival inflammation by over 40% with the use of Aloe vera compared to chlorhexidine. Another study noted a decrease in bleeding on probing by 13.6 points in the treatment group over placebo. Additionally, honey showed a rapid modulation of plaque pH and significantly reduced bacterial counts of Streptococcus mutans. Furthermore, the use of resveratrol emulgel was linked to substantial improvements in gingival health, with a reduction in the gingival index and probing pocket depth. The results indicate that natural products can significantly enhance orthodontic treatment outcomes by reducing inflammation and bacterial levels. These products offer effective alternatives to traditional treatments and show potential for integration into routine orthodontic care protocols. Further research is encouraged to standardize application methods and dosages to maximize clinical benefits and patient satisfaction.

Evaluation of Propolis Hydrogel for the Treatment of Dentinal Sensitivity: A Clinical Study

BACKGROUND

Propolis is a natural resinous substance collected by honeybees, chiefly from buds and the leaves, branches, and bark of trees. Its role as a wound-healing gel has been studied, but the use of a propolis hydrogel in the treatment of dentinal hypersensitivity has not been evaluated. Dentin hypersensitivity (DH) is commonly treated via iontophoresis using fluoridated desensitizers. The aim of the present study was to compare and evaluate the effects of a 10% propolis hydrogel, 2% sodium fluoride (NaF), and 1.23% acidulated phosphate fluoride (APF) when used in conjunction with iontophoresis for the treatment of cervical dentin hypersensitivity (DH).

METHODS

Systemically healthy patients complaining of DH were selected for this single-centre, parallel, double-blind randomized clinical trial. Three substances were selected as desensitizers for study in the present trial: a 10% propolis hydrogel, 2% sodium fluoride, and 1.23% acidulated phosphate fluoride, all in conjunction with iontophoresis. Any decrease in DH following the application of specific stimuli was assessed at baseline, before and after application, on the 14th day following use, and on the 28th day following the intervention.

RESULTS

Intra-group comparisons show diminished values of DH at maximum post-op follow-up intervals which were significantly trimmed down from the baseline (p < 0.05). The 2% NaF demonstrated a significant reduction in DH over 1.23% APF and the 10% propolis hydrogel (p < 0.05). However, there was no statistically significant difference in the mean difference between the APF and propolis hydrogel groups assessed via tactile, cold, and air tests (p > 0.05).

CONCLUSION

All three desensitizers have proved to be useful when used in conjugation with iontophoresis. Within the limitations of this study, a 10% propolis hydrogel can be used as a naturally occurring alternative to commercially available fluoridated desensitizers.

Salivary Fluoride Bioavailability after Brushing with Brazilian Red Propolis Dentifrice: A Clinical Study

Introduction

Fluoride plays an important role in the control of dental caries, and currently new dentifrices are being associated with natural products.

Objective

This study aimed to evaluate the availability of fluoride in saliva samples after using a dentifrice incorporated with Brazilian red propolis (BRP, INPI Patent no. BR1020170110974) and to compare it to a conventional fluoridated dentifrice in healthy participants.

Methods

This study was conducted implementing a double-blind, randomized, controlled, and crossover design. Saliva samples of participants were collected at the following time points: 0 at baseline and 5, 15, 30, 45, and 60 minutes after brushing with each dentifrice. Salivary fluoride concentrations showed no statistically significant difference when comparing the two treatments (p > 0.05). All available fluoride concentrations in saliva decreased after one hour, with no significant difference between BRP and conventional fluoridated dentifrice treatment samples (p > 0.05).

Results

The results showed that there was no difference between the analyzed fluoride concentrations 1 hour after brushing with the different dentifrices.

Conclusions

The results of this study suggest that the propolis incorporated in the dentifrice did not interfere with the kinetics and bioavailability of the fluoride ion in saliva samples, enabling its integration with the pharmaceutical formula and thereby promoting its anti-inflammatory and antimicrobial benefits without compromising the anticaries activity of the formulation.

A double-blind randomized clinical trial of Brazilian red propolis dentifrice efficacy in orthodontic patients

PURPOSE

The objective was to evaluate the efficacy of a dentifrice containing Brazilian Red Propolis (BRP) against salivary Lactobacillus spp. and plaque formation.

METHODS

This was a randomized, double-blind clinical trial. Forty-two participants were randomized into two groups according to the dentifrice employed: G1 (fluoridated BRP dentifrice) and G2 (fluoridated common dentifrice). Saliva was collected and the visible plaque index (VPI) was recorded at the baseline (D0) and 4 weeks after day 0 (D28). Microbiological analysis was performed using two dilutions. Lactobacillus spp. isolates were identified and their abundance was expressed as log (CFU/mL).

RESULTS

For the first dilution, the counts of Lactobacillus spp. in G1 was 1.15 ± 0.41 at D0 and 0.68 ± 0.15 at D28 (P < 0.05) and in G2 it was 1.33 ± 0.52 at D0 and 1.84 ± 0.39 at D28 (P < 0.05). For the second dilution, the corresponding values in G1 and G2 were 0.87 ± 0.34 and 0.64 ± 0.37, respectively (P = 0.1547), and 1.54 ± 0.47 and 1.62 ± 0.37, respectively (P = 0.9999). The corresponding VPI values for G1 and G2 were 38.10 ± 17.95 and 20.60 ± 16.44, respectively (P < 0.05), and 38.38 ± 19.65 and 27.40 ± 14.63, respectively (P = 0.03).

CONCLUSION

The dentifrice containing BRP showed antimicrobial activity against Lactobacillus spp. and decreased the VPI for up to 4 weeks.

Evaluation of Stabilized Chlorine Dioxide in Terms of Antimicrobial Activity and Dentin Bond Strength

BACKGROUND

Antimicrobial agents are recommended for disinfection of the cavity following mechanical dental caries removal prior to application of restorative material. There is limited information about stabilized chlorine dioxide (ClO2) as a cavity disinfectant.

OBJECTIVE

The objective of this study is to determine the antimicrobial activity and effect on dentin bond strength of ClO2 compared to chlorhexidine digluconate (CHX), sodium hypochlorite (NaOCl) and ethanolic propolis extract (EPE).

METHODS

Antimicrobial activities of agents against oral pathogens (Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans, Lactobacillus acidophilus, Lactobacillus casei, Candida albicans, and Saccharomyces cerevisiae) and analyses of EPE were examined. Seventy-five mandibular third molars were sectioned, prepared and divided into five subgroups (n=15/group). Cavity disinfectants (2% CHX, 2.5% NaOCl, 30% EPE, 0.3% ClO2) were applied to etched dentin prior to adhesive and composite build-up. Shear bond strength (SBS) was evaluated with a universal testing machine at a crosshead speed of 0.5 mm/min. The SBS data were analyzed with one-way analysis of variance (ANOVA) and Tukey's post-hoc test (p <0.05). The failure modes were evaluated with a stereomicroscope.

RESULTS

It was determined that the compared disinfectants were showed different inhibition zone values against oral pathogens. ClO2 exhibited the highest antimicrobial activity, followed by CHX, NaOCI and EPE, respectively. No statistically significant difference was observed in the SBS values between the disinfectant treated groups and control group. The failure modes were predominantly mixed.

CONCLUSION

The use of 0.3% stabilized ClO2 as a cavity disinfectant agent exhibited high antimicrobial activity against oral pathogens and no adverse effects on SBS to etched dentin.

Antiviral, Antibacterial, Antifungal, and Antiparasitic Properties of Propolis: A Review

Propolis is a complex phytocompound made from resinous and balsamic material harvested by bees from flowers, branches, pollen, and tree exudates. Humans have used propolis therapeutically for centuries. The aim of this article is to provide comprehensive review of the antiviral, antibacterial, antifungal, and antiparasitic properties of propolis. The mechanisms of action of propolis are discussed. There are two distinct impacts with regards to antimicrobial and anti-parasitic properties of propolis, on the pathogens and on the host. With regards to the pathogens, propolis acts by disrupting the ability of the pathogens to invade the host cells by forming a physical barrier and inhibiting enzymes and proteins needed for invasion into the host cells. Propolis also inhibits the replication process of the pathogens. Moreover, propolis inhibits the metabolic processes of the pathogens by disrupting cellular organelles and components responsible for energy production. With regard to the host, propolis functions as an immunomodulator. It upregulates the innate immunity and modulates the inflammatory signaling pathways. Propolis also helps maintain the host's cellular antioxidant status. More importantly, a small number of human clinical trials have demonstrated the efficacy and the safety of propolis as an adjuvant therapy for pathogenic infections.

Effects of Propolis on Infectious Diseases of Medical Relevance

Infectious diseases are a significant problem affecting the public health and economic stability of societies all over the world. Treatment is available for most of these diseases; however, many pathogens have developed resistance to drugs, necessitating the development of new therapies with chemical agents, which can have serious side effects and high toxicity. In addition, the severity and aggressiveness of emerging and re-emerging diseases, such as pandemics caused by viral agents, have led to the priority of investigating new therapies to complement the treatment of different infectious diseases. Alternative and complementary medicine is widely used throughout the world due to its low cost and easy access and has been shown to provide a wide repertoire of options for the treatment of various conditions. In this work, we address the relevance of the effects of propolis on the causal pathogens of the main infectious diseases with medical relevance; the existing compiled information shows that propolis has effects on Gram-positive and Gram-negative bacteria, fungi, protozoan parasites and helminths, and viruses; however, challenges remain, such as the assessment of their effects in clinical studies for adequate and safe use.

Efficacy of propolis-based mouthwashes on dental plaque and gingival inflammation: a systematic review

Background

This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and gingival inflammation.

Methods

PubMed, Scopus, and Web of Science databases were searched up to November 2019. Clinical trials that evaluated the efficacy of propolis mouthwashes compared with chlorhexidine (CHX) were included. The primary outcomes comprised dental plaque and/or gingival inflammation. Two authors assessed the risk of bias using the Cochrane tool. Due to marked heterogeneity of the available data, studies were assessed qualitatively, and no metaanalysis was performed.

Results

Nine clinical trials, comprising 333 subjects, fulfilled the eligibility criteria. Most of the included studies showed high risk of bias. Overall, propolis mouthwashes showed good efficacy on plaque and gingivitis in all of the included studies. Out of the eight studies that reported on plaque index, 5 studies found equal efficacy of propolis and CHX in reducing plaque, two studies found superior efficacy in favor of CHX, while one study found superior efficacy in favor of propolis. Six studies assessed gingival inflammation outcome, four of which reported better results with propolis, while two studies reported comparable results.

Conclusions

The results suggest that propolis-based mouthwashes have potential benefits in reducing plaque and gingival inflammation. However, methodological limitations along with small sample sizes in some of the included studies weaken the strength of the evidence. Therefore, further well-designed clinical trials with large sample sizes and adequate follow-up period are recommended to discern the efficacy of propolis mouthwash on plaque and gingivitis.

Tea Tree Oil versus Chlorhexidine Mouthwash in Treatment of Gingivitis: A Pilot Randomized, Double Blinded Clinical Trial

Objective  The study evaluated the efficacy of tea tree oil for the treatment of gingivitis.

Materials and Methods  The tea tree oil was administered in the form of mouthwash and then compared with a mouthwash with chlorhexidine 0.12%. Both treatments were domestic and lasted for 14 days. Patients were chosen according to random criteria, aged between 18 and 60 years, and who showed a clinically evident gingivitis. In clinical evaluation, the following clinical criteria were taken into consideration: gingival index (GI), plaque index (PI), bleeding index (BI), probing depth (PD), the presence of dental dyschromia, and the presence of taste alteration. The subjects were evaluated before (T0) and after the treatment (T1), and the data collected for each patient were recorded on a periodontal chart.

Results  The comparison showed that tea tree oil offered a better improvement in the evaluation of PI, BOP, and PD; furthermore, it did not cause dental dyschromia and taste alteration. In group A, treated with tea tree oil, PI decreased from 53.25 to 5.50% and BI from 38.41 to 4.22%. In group B, treated with chlorhexidine PI decreased from 47.69 to 2.37% and BI from 32.93 to 6.28%. Instead, the subjects using chlorhexidine 0.12% blamed a distaste for the product that caused a slight taste alteration; 20% of them showed iatrogenic dental dyschromia.

Conclusions  The collected data showed the efficacy of both treatments. Although further research works will be necessary, this study showed that tea tree oil could be an effective nontoxic substitute for the therapy of gingivitis.