01 ahuja

J. Academy Adv Dental Research REVIEW ARTICLE

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Journal of Academy of Advanced Dental Research, Vol 2; Issue 2: May 2011 www.ispcd.org JAADR is the new name of JADR (Journal of Advanced Dental Research). JAADR/JADR is not affiliated with any international organization like International Association

of Dental Research (IADR)/American Association of Dental Research (AADR), or any other international organization unless otherwise specified

Apitherapy - A sweet approach to dental

diseases. Part II: Propolis V Ahuja* A Ahuja

†

*M.D.S, Senior Lecturer, Department of Pedodontics & Preventive Dentistry, †M.D.S,

Senior, Department of Periodontics & Implant Dentistry, Sharad Pawar Dental College

and Hospital, Wardha, Maharashtra, India. Email: [email protected]

Abstract:

“Look back into the nature and then you

will understand everything better.” This quote by

Albert Einstein clearly point towards the

paradigm shift from costlier antibiotic therapies to

the old tradition remedies with minimum side

effects like apitherapy. Apitherapy is the medicinal

use of products made by honeybees. Therapies

involving the honeybee have existed for thousands

of years and some may be as old as human

medicine itself. This can include the use of honey,

propolis, pollen, royal jelly, and bee venom. This

piece of writing throws a light on proplis and its

clinical importance in medicine and dentistry.

Key Words: Apitherapy, Propolis, Phytotherapy,

Plant.

Introduction:

Apitherapy, or ―bee therapy‖ is the medicinal

use of products made by honeybees. Bees have been

in existence for 125 million years and their

evolutionary success has allowed them to become

perennial species that can exploit virtually all habitats

on Earth. This success is largely because of the

chemistry and application of the specific products that

bees manufacture: honey, beeswax, venom, propolis,

pollen and royal jelly1. According to Dr. Stefan

Stangaciu, Apitherapy is defined as, ‗the art and

science of treatment and holistic healing through the

honey bee and her products for the benefit of mankind

and all the animal kingdom.‘2

Honey is defined as a sweet liquid substance produced

by bees from the nectar gathered from flowers and

stores by them for food. The color and flavor are

determined by the flowers used. It was the early

man‘s source of sugar. About 80% of honey is

levulose and dextrose, the remainder mostly water. It

is dextrose and levulose that give honey its high-

energy content because they can be put to use

immediately. Athletes can use honey diluted with

orange juice to give them a boost of energy. Honey

can be used as a health food because of its high

content of energy giving sugars.3

As the most important ‗chemical weapon‘ of

bees against pathogenic microorganisms, propolis has

been used as a remedy by humans since ancient times.

Propolis is a sticky, resinous substance collected by

honey bees from the sap, leaves, and buds of plants,

and then mixed with secreted beeswax. Propolis has

been used as a folk medicine in many countries from

ancient times especially in Brazil and Eastern Europe.

It has been characterized variously as an anti-

bacterial, anti-viral, anti-inflammatory, anti-oxidant,

and anti-carcinogenesis agent. Though bees use

propolis to reinforce their hive walls and protect the

hives from infection, humans use these products to

boost their immune system.4

Pollen (reproductive spores of seed-bearing plants) is

collected by bees from flowers. Benefits of bee pollen

extracts include detection and immunization against

allergies. Pollen is considered as part of the

apitherapy foods since it provide relief for bodily

weakness, premature aging, constipation and weight

loss.5

Royal jelly is a thick, milky mix of nutrients,

which is produced from a combination of honey and

pollen. All of the bees in a hive consume this

substance, but larvae that consume it exclusively and

in high doses grow larger than the other bees, thus

enabling them to become queens of the hive.5

Bee venom therapy can be administered two ways:

directly from a bee sting or by a prepared injection.

Bee venom causes inflammation where it is

introduced on the body. The inflammation triggers the

body to increase circulation to that point and to create

anti-inflammatory hormones to relieve pain. By

injecting bee venom directly to the joint that is

Serial Listing: Print- ISSN(2229-4112) Online-ISSN (2229-4120) Formerly Known as Journal of Advanced Dental Research Bibliographic Listing: Indian National Medical

Library, Index Copernicus, EBSCO Publishing

Database, Proquest., Open J-Gate.

2

Journal of Academy of Advanced Dental Research, Vol 2; Issue 2: May 2011 www.ispcd.org

painful, the body‘s anti-inflammatory response can

treat the arthritic joint.6

Honey has been discussed in the last review article –

―Apitherapy- a sweet approach to dental diseases. Part

I: Honey. And this paper will talk about propolis and

its clinical significance in medicine and dentistry.

PROPOLIS:

Overview

Chemical composition

Types

Antibacterial Potential

Clinical significance in medicine and dentistry

Overview:

The word ‗Propolis‘ is believed to have been

coined by Aristotle who identified how propolis was

used to protect and defend the hive. Propolis(from the

Greek) means 'Before the City' or 'Defender of the

City'. In the beginning of the Greek civilization,

Aristotle observed that propolis had the ability to

defend a city with thousands of inhabitants, the

beehive. This defense exists for both the architectural

structural repair of the beehive and maintenance of the

species, preparing aseptic places for laying off the

eggs of the queen bee.7

Propolis is resinous material/sap that is

collected after it oozes out from tree bark and bud.

After bees have collected propolis they mix it with

wax flakes and their saliva in the hive. This mixture is

what they use to cover the interior of the hive. The

bees not only use propolis as a building material and

structural defence mechanism but their health is

maintained as a result of its immune system

enhancing properties. Propolis forms the bees external

immune defence system, making the beehive one of

the most sterile environments known to nature.4

There are over 180 different chemicals in

propolis which vary according to the type of bees

collecting it, the climatic zone, the local trees and

plants and even the time of day it is collected.

Effectively the bees select and collect from the local

environment all the products they need to stay well. If

a mouse or large insect invades the hive the bees can

kill it but cannot remove it. They prevent the corpse

from becoming a source of disease in the hive by

coating the body with propolis. By mummifying the

mouse or insect in this way the source of infection is

sealed off from the hive. Years later the "body"

remains perfectly preserved. So, in addition to filling

in cracks in the hive, it helps to protect against

predators, maintain temperature, and promote

hygienic conditions.7

Propolis is a resin widely used in folk medicine for

centuries. The Egyptians used propolis, honey and

other resins to mummify their pharaohs preserving

them, as far as possible, for the next life. Propolis has

been used by man since these times in one form or

another to stay well and to treat disease.

It is known

that propolis exhibits several pharmacological

properties such as antimicrobial, anti-inflammatory,

healing, anesthetic, cytostatic and cariostatic

properties. In China, propoils was authorized as a new

material medicine and embodied in the Chinese

pharmacopeia in 2005. 8

In Dentistry, propolis has been used for the

treatment of aphthous ulcers, candidiasis, acute

necrotizing ulcerative gingivitis (ANUG), gingivitis,

periodontitis and pulpitis. Studies on propolis

applications have increased because of its therapeutic

and biological properties. Current research involving

propolis in dentistry spans many fields and highlights

its antimicrobial and antiinflammatory activities,

particularly in cariology, oral surgery, pathology,

periodontics, endodontics and pedodontics.9

Chemical composition: 1,9

The chemical composition of this atoxic

natural substance is complex. More than 300

components have been found in propolis, mainly

composed of phenolic compounds (e.g. flavonoids,

aromatic compounds), terpenes and essential oil.

Flavonoids and cinnamic acid derivatives have

been considered as the main primary biologically

active components. Flavonoids, also collectively

known as Vitamin P and citrin, are a class of plant

secondary metabolites. They are all ketone-containing

compounds, and are the most important plant

pigments for flower coloration producing yellow or

red/blue pigmentation in petals designed to attract

pollinator animals. Flavonoids are the most common

group of polyphenolic compounds in the human diet

and are found ubiquitously in plants. They are divided

into four subgroups: Flavones, Flavonol, Flavonones,

Flavononol.

Cinnamic acid has the formula

C6H5CHCHCOOH and is a white crystalline acid,

which is slightly soluble in water. It is obtained from

oil of cinnamon, or from balsams. In biological

chemistry, cinnamic acid is a key intermediate in

phenylpropanoid pathway. Phenylpropanoid are a

class of plant metabolites based on phenylalanine.

They are widely distributed in plants fulfilling many

functions including plant defense mechanism,

pigmentation and external signaling system.

Phenylalanine is first converted to cinnamates,

coumarines, caffeic acids, ferulic acids, and sinapic

acids. Cinnamic acid is the precursor of these acids.

Commercial cinnamic acid, a phenylacrylic acid

structure compound, is used in converting to its esters

such as methyl, ethyl, and benzyl cinnamate for the

perfume and flavour application.

3


Ethanolic extract of propolis inhibits

hyaluronidase activity and hence have a great

potential as an anti-inflammatory agent.

The Problem of Chemical Variability of Propolis: 1

Numerous studies, carried out with the

combined efforts of phytochemists and

pharmacologists, led in recent years to the idea that

different propolis samples could be completely

different in their chemistry and biological activity.

To understand what causes the differences in

chemical composition, it is necessary to keep in mind

the plant origin of propolis. For propolis production,

bees use materials resulting from a variety of

botanical processes in different parts of plants. These

are substances actively secreted by plants as well as

substances exuded from wounds in plants: lipophilic

materials on leaves and leaf buds, gums, resins,

latices, etc.. The plant origin of propolis determines

its chemical diversity. Its chemical composition

depends on the specificity of the local flora at the site

of collection and thus on the geographic and climatic

characteristics of this site. This fact results in the

striking diversity of propolis chemical composition,

especially of propolis originating from tropical

regions.

Nowadays, it is well documented that in the

temperate zone all over the world, the main source is

the resinous exudate of the buds of poplar trees,

mainly the black poplar Populus nigra. For this

reason, European propolis contains the typical ‗poplar

bud‘ phenolics: flavonoid aglycones (flavones and

flavanones), phenolic acids and their esters.

Poplar trees are common only in the temperate zone;

they cannot grow in tropical and subtropical regions.

For this reason, in these habitats, bees have to find

other plant sources of propolis to replace their beloved

poplar. As a result, propolis from tropical regions has

a different chemical composition from that of poplar

type propolis. In the last decade, Brazilian propolis

attracted both commercial and scientific interest. The

main source of Brazilian propolis turned out to be the

leaf resin of Baccharis dracunculifolia. Among the

main compound classes found in Brazilian propolis

are prenylated derivatives of p-coumaric acid and of

acetophenone. Diterpenes, lignans and flavonoids

(different from those in ‗poplar type‘ propolis) have

also been found. However, in Brazil, several types of

propolis were registered in recent studies, that come

from plant sources different from B.dracunculifolia

and containing compounds other than those

mentioned above.

Recently the chemistry of Cuban propolis

caught the attention of scientists. Its main components

are polyisoprenylated benzophenones, and this makes

Cuban propolis different from both European and

Brazilian propolis. The plant source of this propolis

type was detected to be the floral resin of Clusia

rosea, from where came the prenylated

benzophenones.

Actually, propolis is the defense of bees

against infections, and the antibacterial and antifungal

activity of all samples is not surprising. The similarity

in many of the other types of activity is less obvious

but it is a fact. Of course, the responsible compounds

are different, as shown in Table 1: mainly favanones,

flavones, phenolic acid and their esters in poplar type

(European) propolis, prenylated p-coumaric acis and

diterpenes in Baccharis type (Brazilian) propolis;

prenylated benzophenones in Cuban red propolis, etc.

Antibacterial Potential:

Many authors have demonstrated that

propolis has significant antimicrobial activities

against Gram-positive bacteria and yeasts. Flavonoids

and phenolic acids present in propolis are

pharmacologically active compounds that have effects

on bacteria, fungi, and viruses. Propolis had shown

antibacterial activity against Enterococcus sp,

Escherichia coli, and, especially, Staphylococcus

aureus. Reports have pointed out its activity against

Gram-positive bacteria and limited action against

Gram-negative bacteria.

A study was done to compare the antibacterial

activity of ethanolic extract of propolis produced in

two different regions of Brazil against Salmonella

enteritidis (isolated from food) and Salmonella

typhimurium (isolated from human infections). It was

concluded that Salmonella growth was only inhibited

by higher propolis concentration (10.0% v/v), what is

in accordance with the results in literature, showing

propolis limited action on Gram-negative bacteria.

The bacteriostatic activity of 70% ethanol on both

strains suggested that propolis action was only due to

its components. A possible explanation for propolis

action mechanism may be the fact that one or some of

its constituents caused a significant inhibition of

bacterial mobility, besides ion permeability alteration

on the inner bacterial membrane. Takaisi-Kikuni and

Schilcher proposed that ethanolic extract of propolis

interferes with Streptococcus agalactiae division,

promoting cytoplasm disorganization and protein

synthesis inhibition. This effect of ethanolic extract of

propolis reflects its antibiotic action on Salmonella,

4


Types: 1

*Prenylation or lipidation is the addition of hydrophobic molecules to a protein. It is usually assumed that

prenyl groups (3-methyl-2-buten-1-yl) facilitate attachment to cell membranes.

Antibacterial Potential:

Many authors have demonstrated that

propolis has significant antimicrobial activities

against Gram-positive bacteria and yeasts. Flavonoids

and phenolic acids present in propolis are

pharmacologically active compounds that have effects

on bacteria, fungi, and viruses. Propolis had shown

antibacterial activity against Enterococcus sp,

Escherichia coli, and, especially, Staphylococcus

aureus. Reports have pointed out its activity against

Gram-positive bacteria and limited action against

Gram-negative bacteria.

A study was done to compare the antibacterial

activity of ethanolic extract of propolis produced in

two different regions of Brazil against Salmonella

enteritidis (isolated from food) and Salmonella

typhimurium (isolated from human infections). It was

concluded that Salmonella growth was only inhibited

by higher propolis concentration (10.0% v/v), what is

in accordance with the results in literature, showing

propolis limited action on Gram-negative bacteria.

The bacteriostatic activity of 70% ethanol on both

strains suggested that propolis action was only due to

its components. A possible explanation for propolis

action mechanism may be the fact that one or some of

its constituents caused a significant inhibition of

bacterial mobility, besides ion permeability alteration

on the inner bacterial membrane. Takaisi-Kikuni and

Schilcher proposed that ethanolic extract of propolis

interferes with Streptococcus agalactiae division,

promoting cytoplasm disorganization and protein

synthesis inhibition. This effect of ethanolic extract of

propolis reflects its antibiotic action on Salmonella,

suggesting its possible use as an alternative control of

Salmonella infection.10

In another study, propolis showed high

antibacterial activity against Gram-positive cocci

(Staphylococcus aureus), but had weak activity

against Gram-negative bacteria (Escherichia coli and

Pseudomonas aeruginosa) and yeasts (Candida

albicans). Furthermore, Jordanian propolis can

effectively eliminate Enterococcus faecalis from

infected dentin models ex vivo. Current studies

involving propolis had used different microbiological

methods, such as agar dilution, agar well diffusion,

agar disc diffusion techniques, as well as several

concentrations of the propolis extract, which in

general ranged from 11% to 30% weight to volume.11

A study was done to evaluate the in vivo antimicrobial

activity of an extract prepared with propolis produced

by Melipona compressipes fasciculate bees and used

as mouthrinse on the concentration of S. mutans

present in the oral cavity of young individuals. It was

concluded that the propolis extract tested possesses

antimicrobial activity against S. mutans present in the

oral cavity. The extract might be used as an

alternative measure to prevent dental caries.12

Clinical significance in medicine:

1. Antioxidant

Previous experiments reported that propolis

can prevent tissue damage from oxidative stress by

decreasing the overproduction of superoxide anion

and by restoring respiratory control ration in

mitochondrial tissue. According to an Italian Study,

Propolis extract (with and without CAPE) and its

active components showed a dose-dependent free

radical scavenging effect, a significant inhibition of

xanthine oxidase activity, and an antilipoperoxidative

capacity. Propolis extract with CAPE was more active

than propolis extract without CAPE. The

experimental evidence, therefore, suggests that CAPE

plays an important role in the antioxidant activity of

propolis.13

2.Anti-inflammatory

PROPOLIS

TYPE

Antibacterial

activity

Antiinflammatory

activity

Antitumor activity Hepatoprotective

activity

Antioxidant

activity

Allergenic

activity

European (poplar

type)

Flavanones,

flavones,

phenolic acids

and their esters

Flavanones,flavones,

phenolic acids and

their esters

Caffeic acid

phenethyl ester

(CAPE)

Caffeic acid, ferulic

acids acid, caffeic

acid phenethyl

ester

Flavonoids,

phenolic and

their esters

3,3-Dimethylallyl

caffeate

Braziliian

(Baccharis type)

Prenylated* p-

coumaric acids,

labdane

diterpenes,

Unidentified Prenylated p-

coumaric

acids,clerodane

diterpenes,

benzofuranes

Prenylated

p-coumaric acis,

flavonoids, lignans,

caffeoyl quinic

acids

Prenylated p-

coumaric acis,

flavonoids,

Not tested

Cuban Prenylated

benzophenones

Not tested Prenylated

benzophenones

Unidentified Not tested

Taiwaneese Not tested Not tested Prenylated

flavanones

Not tested Prenylated

flavanones

Not tested

5


Ethanolic extract of propolis inhibits

hyaluronidase activity. As this enzyme is responsible

for several inflammatory processes, propolis holds a

great potential as an anti-inflammatory agent.

Nevertheless, propolis showed to be more effective

than the other drugs for reduction of the acute anti-

inflammatory exudate. Application of 5% ethanolic

extracts of propolis in the dental cavity of dogs

showed its anti-inflammatory reaction, tissue

reorganization in the superficial level, as well as

antibacterial activity.9

3.Anti tumor activity

Recently, propolis has received the special

interest in the areas of oncology research as a source

for prevention and treatment of cancer. Accordingly, a

large number of compounds possessing the anticancer

activity such as CAPE, artepillin C, and propolin A—

C have been reported from propolis. CAPE, a

phenolic antioxidant, is potent and specific inhibitor

of activation of the nuclear transcription factor (NF-

κB). In angiogenesis, CAPE has been shown to

prevent VEGF expression in CT26 colon

adenocarcinoma cells. CAPE also suppresses the

induction of prostaglandin E 2 synthesis mediated by

12-O-tetradecanoylphorbol-13-acetate and calcium

ionophores. Therefore, CAPE can be considered as a

potential anti-angiogenic agent that can reduce

neovascularization.14

4.Healing activity

Propolis has been reported to promote

epithelial formation as well as vascular and

fibroblastic neoformation of the connective tissue.

Thus it can be hypothesized that the topical

application of propolis on surgical wounds may

promote faster epithelium and connective tissue

healing.14

5.Anti-diabetic and antihypertensive:

Recent studies have reported that propolis

prevented and mitigated diabetes and hypertension,

but it remains unclear whether propolis similarly

prevents and mitigates the accumulation of visceral

adipose tissues and hyperlipidemia. One study

demonstrates that oral administration of propolis

extract suppressed overall weight gain in mice, the

accumulation of visceral adipose tissue weight, and

the increase in serum and liver triglycerides that

normally result from feeding a high-fat diet to mice.

Previous studies have shown that Chinese propolis

helped to reduce fasting blood glucose (FBG) and

improve oxidative stress and lipid metabolism in

alloxan-induced diabetic rats.4

6.Protective action of Propolis on Cartilage:

An Italian study states that this natural

compound and its active principle, caffeic acid

phenethyl ester (CAPE), were able to contrast the

harmful effects of IL-1beta. The data clearly

demonstrated the protective action of propolis in

cartilage alteration, that appears greater than that

elicited by indomethacin, commonly employed in

joint diseases.15

7.Vaccines:

To be effective, most vaccines typically

depend on the inclusion of substances known as

adjuvants that stimulate an immune response.

Researchers seeking to develop a vaccine against Suid

herpesvirus type1 (SuHV-1), which causes an

infectious disease among swine, combined green

propolis with an ethanol extract and tested it on mice.

The mice showed an increased cellular immune

response and increased protection against SuHV-1.

This response did not occur with propolis alone, but

only when the antigen was absorbed in a particulate

adjuvant, like aluminum hydroxide. Thus, when

associated with auxiliary substances like aluminum

hydroxide, green propolis extract may increase the

potency of vaccines, especially those that depend on

the cellular immune response for protection.16

Clinical significance in dentistry:

1. Anticaries

Few microorganisms found in the oral cavity

are able to adhere to the teeth and, among these, a

limited group is cariogenic. The specific cariogenic

microbiota consists of Streptococcus mutans,

Lactobacillus and some Actinomyces species.

However, during the initial phase of caries disease, S.

mutans is the most frequently associated

microorganism. In addition to its ability to adhere to

teeth and survive in acid environment, S. mutans is

transmissible, as first demonstrated by Keyes (1960).

Based on literature reports showing that propolis resin

is a product with antiinflammatory and bactericidal

activity, several in vitro and some in vivo studies have

demonstrated its potential use in the treatment of

bacterial diseases. It was concluded in one study that

the propolis extract used as mouthrinse possesses

antimicrobial activity against S. mutans present in the

oral cavity. The extract might be used as an

alternative measure to prevent dental caries.12

2.Antiplaque

Koo H et al studied the effect of a mouthrinse

containing selected propolis on 3-day dental plaque

accumulation and polysaccharide formation. Six

volunteers took part in a double-blind crossover study

performed in two phases of 3 days. During each phase

the volunteers refrained from all oral hygiene and

rinsed with 20% sucrose solution 5 times a day to

6


enhance dental plaque formation and with mouthrinse

(placebo or experimental) twice a day. On the 4th day,

the plaque index (PI) of the volunteers was scored and

the supragingival dental plaque was analyzed for

insoluble polysaccharide (IP). The PI for the

experimental group was significantly less than for the

placebo group. The experimental mouthrinse reduced

the IP concentration in dental plaque by 61.7%

compared to placebo (p < 0.05). An experimental

mouthrinse containing propolis was thus efficient in

reducing supragingival plaque formation and IP

formation under conditions of high plaque

accumulation.17

3. Chronic periodontitis

Researchers in Brazil have found that

periodontal diseases are amendable to treatment by

green propolis. A study was conducted on four

patients at a periodontics clinic in southeastern Brazil

who had varying degrees of dental problems: calculus,

gingivitis, bleeding, fluid accumulation, gingival

recession, tooth mobility, pus formation, and bone

loss. Treatment consisted of daily tooth brushing with

propolis and washing the mouth with a propolis

solution. The propolis was applied in certain

periodontal pockets once a week for five weeks. All

the periodontal pockets irrigated with propolis

showed a 95% decline in gingivitis and pus. Because

propolis is cheap and accessible to the population, its

effectiveness in treating periodontal disease is

extremely relevant to public health. The authors

therefore recommend that 10% Brazilian green

propolis be used in conjunction with treatment of

chronic periodontitis.18

A study was done in KLE‘s VK institiute of

dental sciences, Belgaum, Karnataka, India, to explore

the efficacy of propolis extract as a subgingival

irrigant in periodontal treatment. And it was

concluded that subgingival irrigation with propolis

extract as an adjuvant to periodontal treatment was

more effective than scaling and root planning both by

clinical and microbiological parameters.19

4.Oral candiadiasis:

According to Brazilian researchers, green

propolis is effective against oral candidiasis. Green

propolis is collected from honeybees in southeastern

Brazil. In one study, twelve patients were treated with

propolis. After cleaning their prosthesis and their oral

cavity, they dried the infected area and applied the

propolis extract topically in candidiasis oral mucosa

lesions with a swab, four times daily for a week. A

control group of six patients performed the same

treatment with Nystatin, a standard antifungal

product. All 18 patients—whether treated with

propolis extract or Nystatin—showed a remission of

the candidiasis lesion in less than three weeks: 11

patients after 7 days, and 6 patients after 15 days.20

5.Pulp therapy in primary and permanent teeth

According to Sabir et al20

, direct pulp capping

with propolis in rats may delay dental pulp

inflammation and stimulate reparative dentin. Partial

dentinal bridge formation was seen in these animals

after application of propolis in this study. Another

study in Manipal College of Dental Sciences,

Manipal, conducted on premolars for direct pulp

capping also showed that propolis is equally

efficacious as calcium hydroxide. It has been

concluded in a study that propolis can be used along

with calcium hydroxide as an intracanal

medicament.21

According to Estrela et al., ‗oily vehicles‘

become an issue if a calcium hydroxide paste is used

as an intracanal medicament because oily substances

have low solubility in water and do not allow

immediate availability of the hydroxyl ions released

from calcium hydroxide. Thereby, a less effective

antimicrobial action is expected. Otherwise, oily

vehicles could be an option when calcium hydroxide

is used as an obturation agent. One could consider

associating calcium hydroxide with propolis in order

to add all beneficial biological properties of propolis,

particularly its antiinflammatory, immunomodulating,

antibacterial, antifungal and antiviral properties to

those of calcium hydroxide. Moreover, as an oily

substance, propolis may promote low-speed

dissociation and diffusion when used as a component

in an endodontic paste for primary teeth. It is also

important for endodontic compounds to accompany

the physiological resorption of primary teeth. The

association of propolis with calcium hydroxide could

aggregate the benefits of each material. However,

propolis would not jeopardize the antimicrobial

activity of calcium hydroxide.22

By testing a mixture

of propolis and calcium hydroxide against a

polymicrobial culture extracted from primary tooth

root canals, better results were observed than those

obtained with calcium hydroxide plus propylene

glycol. Calcium hydroxide was chosen because it is

well established as an endodontic dressing, but its use

is still controversial in primary teeth. However it was

confirmed in this study that association of calcium

hydroxide with propolis can be beneficial in terms of

antimicrobial activity.22

Conclusion: It is therefore comprehensible that we should

now switch on to ―back to nature approach‖ where

propolis seems to be a promising alternative for the

control of oral diseases in terms of antimicrobial

response and lower associated risks.

7


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Source of Support: Nil

Conflict of Interest: No Conflict of Interest

Received: December 2010

Accepted: April 2011

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