Oral mucositis is a type of oral complication that occurs in patients undergoing anticancer therapies like chemotherapy, radiation therapy and stem cell transplant.
It affects the patient’s quality of life. It arises due to inflammatory response of mucosal tissue to the toxic effect of chemicals and radiations.
It is characterised by the development of lesions and ulcers in the mouth. Mucositis can also affect other areas of gut,then it is called as gastrointestinal mucositis. It affects almost 51% of the patients receiving chemotherapy.
Effects of oral mucositis:
- Painful lesions
- Nutritional intake is affected
- Quality of life declines
- Special mouth care and treatment required
- It also make mouth prone to several other local infections
Oral mucositis mainly occur due to generation of reactive oxygen species due to radiation and chemotherapy, inflammation due to alteration in immune system and infection by local opportunistic microbes.
What is Manuka honey?
Manuka honey is a special kind of honey which honey bees made by using the nectar from wild Manuka trees related to Leptospermum species. These Manuka trees are native to New Zealand and Australia. Manuka honey has many special properties which are absent in other honey.
It is this special Manuka factor of Manuka honey which generates the interest of many scientists. Now Manuka honey is the most widely studied form of honey for its various medicinal uses.
Almost all variety of honey possess antibacterial properties because of osmotic effect of their high sugar content but Manuka honey has most potent antibacterial, antimicrobial, anti-inflammatory, antiseptic activities.
It also possesses anti-oxidant properties because of the presence of high levels of methylglyoxal. It has the capability to treat many diseases.
6 Benefits Of Manuka Honey In Oral Ulcers/Mucositis
Manuka honey prevents the growth of local bacteria like Pseudomonas aeroginosa and Porphyromonas gingivalis in the oral cavity by the effect of its anti-bacterial activity.
It removes the biofilm form by these bacteria in the mouth to grow. Also the low pH, osmotic potential and high viscosity help in effective killing of bacteria.
The antioxidant property of manuka degrades the reactive oxygen moiety formed by the effect of radiation and chemicals. The anti-inflammatory nature of manuka honey prevents inflammation and reduces the chances of painful ulcer formation.
1.Manuka honey has anti bacterial activity
Manuka honey is considered as a potent anti-bacterial agent due to various properties it possesses which can kill various oral bacteria. The low pH of manuka honey prevents the growth of bacteria which are adapted to grow in the neutral environment of the oral cavity.
High viscosity slows down the movement of bacteria in mouth and high osmotic concentration create osmotic pressure lyse the bacterial cell.
Also then presence of hydrogen peroxide and methylglyoxal and various other components like phenolic acid, flavonoids etc. play a major role in killing the bacterial colonies develop in mouth.
A study was conducted to prove the antibacterial potential of manuka honey against oral bacteria. In this study it was found that manuka honey possess a significantly high anti-bacterial effect on oral bacteria compared to other honeys.
In a study conducted on children to test the effect of manuka honey on salivary level of bacteria it was found that manuka honey shows significant reduction in salivary bacterial level after 10and 21 days.
What does it mean?
Manuka honey is a potent antibacterial agent against various oral bacteria.
2. Manuka honey eradicates oral biofilms
Oral biofilms are thin film of mucilaginous compounds containing high amount of bacteria in it. Oral biofilms are also known as dental plaque.
These biofilms help in adherence of bacteria to the mucosal wall. Manuka honey removes this biofilm and kills the bacteria present in it.This has been proved in various studies.
A study conducted to check the effect of natural anti-microbial (including manuka honey) on oral a positive correlation was observed between therapies and eradication of multispecies oral biofilms.
In another study conducted to check the effect of methylglyoxal (active agent of manuka honey) on bacterial biofilm, it was found that manuka honey is an effective antimicrobial agent against all bacterial biofilm.
In a study conducted to compare the effect of manuka honey and other chemicals on dental plaque level in male student of 21-25 year of age. It was found that manuka honey reduced plaque formation significantly better than other chemicals.
Oral bacteria adhere to the mucosal wall so that they can multiply by taking nutrition from the tissue. So it is very beneficial if the adherence of bacteria can be prevented in reducing oral ulcers.
In a study conducted to test the effect of manuka honey on adherence of oral bacteria in dental plaque it was found that manuka honey reduces oral pathogen in dental plaque and also control biofilm deposit.
What does this mean?
This indicates that manuka honey can take care of dental plaque which is very common in individuals of almost every age. Dental plaque can contribute to oral infections that cause ulcers.
3.Manuka honey acts against drug resistant pathogen
The most common local oral pathogens are Pseudomonas aeroginosa and Porphyromonas gingivalis. Infection due to both the bacteria is very common in patients undergoing anticancer therapy and can worsen the oral mucositis.
Also both the bacteria are resistant to antibiotics so can’t be eradicated easily.
In a study conducted to check the effect of honey on P. gingivalis it was found that honey can act against the bacteria and reduce its growth.
In a study conducted to test the effect of manuka honey on P.aeruginosa it was found that manuka honey is bactericidal against this bacteria and acts at the genetic level to kill the bacteria.
What does this means?
This means that manuka honey kills the local bacteria which are very common in immune suppressed patients undergoing anti-cancer therapy.
4.Manuka honey boosts antioxidant defences
The harmful radiation and chemical used in the anti-cancer therapy produce many reactive oxygen species, free radicles and superoxide which are responsible for inducing infection and inflammation and can further harm the mucosal lining. So it is very important to eliminate these reactive species.
Methylglyoxal present in manuka honey is a potent superoxide scavenger and add to the antioxidant property of manuka honey along with other polyphenols.
In a study conducted to test the antioxidant potency of different samples of honey taken from different locations it was found that manukahoney possesses maximum activity against oral bacteria and has maximum polyphenol content (antioxidant).
What does this mean?
This means that antioxidant property of manuka honey is very effective and can eliminate the chances of inflammation due to reactive oxidative species produce by bacteria and hence also prevent oral ulcer.
5. Manuka honey reduces inflammation
Inflammation is very common in patients with oral mucositis because the harmful radiations and chemicals interfere with the normal functioning of immune system of the patients. Hence the immune activity got altered and results in inflammation.
Manuka honey possesses a potent anti-inflammatory activity. In a study conducted on mice it was found that Manuka honey suppress arachidinoic acid induce ear oedema (fluid build-up in ear) and leukocyte (immune cells) infiltration. This indicates the presence of anti-inflammatory activity in Manuka honey.
In another study conducted on four different types of honey to study the potential anti-inflammatory pathway of manuka honey. It was found that manuka honey have anti-inflammatory effect due to its phenolic content and act through toll-like receptor signalling pathway.
A case study on 80 year old women with oral cancer was given home treatment with manuka honey shows that manuka honey is safe, effective treatment to reduce odour and inflammation of oral wounds in this patient.
What does this mean?
This means anti-inflammatory action of manuka honey is very effective in treating oral ulcer and wounds by reducing inflammation.
6. Manuka honey may help in radiation mucositis in cancer
A direct effect of natural honey has been observed in few studies on oral mucositis in cancer patients.
In a study on head and cancer patients undergoing radiotherapy it was observed that oral administration of honey could prevent mucositis and weight loss.
In another study conducted on 40 patients it was further confirmed that topical use of honey can show effective reduce in mucositis cause due to radiation therapy.
What does this mean?
This means that honey is very effective in treating side effects of anticancer therapy like oral mucositis.
However some scientists feel that manuka honey may not benefit in oral mucositis
A study was conducted on 131 patients undergoing radiation therapy for head and neck cancer and had developed mucositis. Use of manuka honey for treatment in such patients did not improve mucositis but only caused reduction in bacterial infection.
In another study on 81 patients with head and neck cancer undergoing radiation therapy a high dropout rate of 57% was observed due to nausea. The high percentage of dropouts indicates that manuka honey was intolerable to some patients and had side effects on them.
What does this mean?
This means that manuka honey can be harmful for some patients undergoing anti-cancer therapy this is because the effect of therapy is different in different individuals. It also depends on the stage and severity of the disease. Hence, it is better to test it before using.
Dosage of Manuka Honey In Oral Ulcers
Manuka honey is marketed as the Unique Manuka Factor (UMF). The UMF rating determines the non-peroxide antibacterial activity of the Manuka honey. The UMF value represents the concentration of phenol having same antibacterial activity as the same concentration of honey.
UMF is a registered trademark for ensuring quality of honey and test its standard to avoid its misuse. The UMF 15-20 is mostly use for their antibacterial activity even for research purposes. UMF 18+is best used for its antibacterial activity and wound care.
Manuka honey can be consumed by either dissolving it in cold or lukewarm water or directly 1 teaspoon twice a day. Avoid using it with tea and hot water as high temperature would degrade essential enzymes present in it and hence affect the quality of honey.
Precautions
Manuka honey is safe but a few precautions must be noted.
While in normal healthy person Manuka honey seems to cause no adverse effects so they can consume it on regular basis to get its benefits. While certain people might be allergic to honey they must take precautions while consuming honey.
It is better to first test the effect of Manuka honey before using it by initially consuming a very less amount and look for any sign of allergy for 1-2 days.
Diabetic patients should either avoid its consumption or if necessary should consume at very low concentrations.
For children special medical advice should be taken before its use as it can cause botulism in children below 12 months.
A very high dose should be avoided in any case. Store honey in glass or plastic bottles at room temperature in the dark for better use and longer shelf life.
Conclusion
Use of manuka honey at low concentration have no adverse effect but beneficial in treating oral mucositis to great extent. It prevents the infection from local bacteria and also helps in effective healing of wound in patients with oral ulcers.
If using manuka honey to treat radiation mucositis please consult a doctor first and use medical grade honey. Also it is advisable to start with low doses in such cases.