Tahera Ayub1, Navid Rashid Qureshi2, Mehwash Kashif3
How to CITE:
Ayub T, Qureshi NR, Kashif M.Effect Of Honey On Post Extraction Soft Tissue Healing Of TheSocket. JPakDent
Todeterminetheeffectofhoneyinenhancingthesofttissuehealingofthesocketandprevention of infection after tooth extraction
Total100patientsrequiringextractionofmandibularfirstandsecondmolarfulfillingtheinclusioncriteriawereselectedanddividedintotwogroups, n=50)incontrolgroupand(n=50)inexperimentalgroup.Bothgroupsunderwentforcepsextractionunderlocalanesthesia.Honeyinterventionwasdoneonlyinexperimentalgroup,whereasnointerventionwasperformedincontrolgroup.Nopostoperativeantibioticcoverwasgivenineithergroupandpatientswereinstructedtotakeananalgesicasperneed.Followingparameterswereassessedimmediatepostoperativelyandsubsequentlyatday10and21;distancebetweenmucosaledges,mucosalhealingandsignsofinfection.DatawasanalyzedusingSPSSversion15.0.Categoricalvariableslikegenderandsignsofinfectionwerepresentedaspercentages.Continuousvariableslikeageandclinicaldistanceb/wmucosaledges(mm)werereportedasmean±S.Dandindependent”t”testwasappliedonmainoutcomevariablestocomparethemeandifferencebetweenthegroups.Pvalue< 0.05wasconsideredsignificant.
Tooth extraction is a routine dental procedure. The reported incidence of complications after exodontia is 15 to 20%1. Many materials were used previously to cover extraction socket in an attempt to enhance healing or prevent post-operative complications associated with extractions.2 Among many therapeutic agents honey is a carbohydrate-rich syrup produced by bees from floral nectar. According to the recent studies honey is effective when used as a dressing on infected or non-infected wounds. It is antibacterial, anti-inflammatory and odorless. It helps in granulation and epithelialization, shedding of necrotic tissue and has an analgesic and antioxidant effect.3-9 Honey helps to keep the wound moist, in addition it stimulates white blood cells to produce cytokines, particularly interlukin 1, interlukin-6 and tumor necrosis factor. Honey also helps to speeds up the healing process and reduces scarring. 10 It is the choice of material to be used in the treatment of dry socket. Honey dehydrates bacteria due to its hygroscopic property , rendering them inactive. The Potassium withdraws moisture from the bacteria. Aluminium sulphate and sucrose present in honey also accelerates normal healing process.11 In a study by “Elbagoury et al” in 1985, honey when used as a dressing material after surgical removal of impacted third molars resulted in less pain. Incidence of postoperative complications and swelling in honey treated group were found to be less than in the control group.12 Due to scant availability of local data, our study focused on the role of honey in the soft tissue healing of the post extraction socket.The objective of this study was to assess the effect of honey application in post-operative soft tissue healing of extraction socket.
This quasi-experimental study was conducted at oral & maxillofacial surgery outpatient department, Liaquat College of medicine & dentistry and darul-sehat hospital, Karachi. The study was approved by the Research and Ethics Committee of the hospital. The one year study comprised of 100 patients selected through purposive sampling, undergoing non-surgical extraction of mandibular 1st or 2nd molar. The inclusion criteria was patients undergoing non-surgical extraction of mandibular first or second molar/s only using forceps, age between 20 and 40 years belonging to either gender. hereas,
those patients were excluded who did not comply with the research protocol, patients with ebilitating disease, cases requiring surgical removal of teeth (broken down roots & impactions), patients allergic to honey, patients whose local or systemic conditions affecting the wound healing, patients on antibiotics or those who have taken antibiotics in previous one week, patients with poor oral hygiene,smokers, paan, gutka and tobacco chewers.
A total of 100 subjects fulfilling the inclusion criteria were included. Informed consent was obtained from each subject in the study. They were allocated in two groups; i.e. Control and experimental groups based on post-operative wound management. For each patient the relevant pre-operative information included name, age and gender of the patient, reason for the tooth extraction (the diagnosis was based on both clinical and radiographic examinations) and tooth/teeth removed.
Extractions were performed under L/A (2% xylocaine with epinephrine 1:80,000) with dental forceps.The patients allocated to control group were given the usual post-operative instructions. While in the experimental group 2 ml of local honey was applied in the socket after extraction & irrigated with 10 ml of saline. Extraction wound was covered with 1 inch folded sterile gauze in both groups. Subjects in both groups were provided with the usual written and verbal post-operative instructions. Subjects in experimental groups were advised to apply honey on extraction wound three times/day for the period of fourteen days provided by the researcher. No postoperative antibiotics were prescribed in either groups. A mild analgesic was prescribed to the subjects of both the group to be taken as per need. Immediately after extraction mucosal edges of the socket was measured in all patients, and were reviewed for alveolus healing and signs of infection on 10thand 21stday subsequently.
Following parameters were assessed on follow up visit clinically:
1. Measurement of distance between the mucosal edges of the socket bucco-lingually with the help of a vernier calipers in mm.
2. Assessment of signs of infection in the socket in terms of pain, swelling and redness.
All the relevant information about patients’ general data and post extraction clinical findings were recorded in a proforma, specially designed for research purpose. Patients were questioned and examined on each recall visit and the data was recorded by the researcher.
All the collected data was entered in SPSS version 15. Categorical variables like gender and signs of infection were presented as percentages between groups. Continuous variables like age and clinical distance b/w mucosal edges (mm) were reported as mean ± S.D and independent “t” test was applied on the main outcome variables to compare the mean difference between groups. P-value < 0.05
was considered significant.
Hundred patients fulfilling the inclusion criteria were evaluated. These subjects were divided into two groups. Fifty subjects were in honey group and other 50 subjects were in non-honey group.
Twenty four (48%) subjects were male while 26 (52%) subjects were females in honey group. While in
non-honey group 27 (54%) were male and, 23 (46%) subjects were females.In a group of patients treated with honey, the mean age was 30.76 ± 6.57 years while in a non-honey group, the mean age was 31.02 ± 5.97 years.
On day 10 recall, we found infection in 5 (10%) subjects’ versus 17 (34%) subjects in honey and non-honey groups respectively. This difference was statistically significant.( p-value < 0.05),however on day 21 recall we observed less difference in signs of infection11(22%) subjects’ versus 13 (26%) subjects in honey and non-honey groups).(Table I)
Table I: Comparison of signs of infection between the groups on day 10 and day 21
Average distance of mucosal edges was almost equal on first day in both groups, similarly almost equal average distance of mucosal edges was found on ten days while on twenty first day there was almost complete mucosal coverage of wound in all subjects of either group.
Table II. Comparison of Mucosal edges between groups
From ancient times honey is recognized as a therapeutic agent.13 It is extensively researched and used in medicine as a healing agent; however no local study has been conducted to investigate its efficacy in the oral cavity. The current study was aimed to look at the effects of honey in enhancing healing of the socket after extraction. Healing of the socket is determined by the time taken for the closure of mucosal edges of the socket which was assessed on clinical parameters in sockets treated with honey. The reason to choose Mandibular Molars for research intervention was due to increased incidence of delayed wound healing associated with this group of teeth which may be due to denser bone or poor drainage.14 The average distance of mucosal edges on 10th and 21st day, did not show difference between the two groups. However on day 10 recall, there was a significant difference in he signs of infection between the two groups. This difference was further reduced on day 21 recall. Our results are consistent with a prospective study by “Ikram and colleagues”, the post extraction alveolar socket were treated with honey in 62 patients. Honey soaked 1/4 inch sterile gauze was applied as a dressing material. Healthy granulation tissue formation was noted from 3rd day in 69% cases and in 31% cases granulation tissue appeared on 4th day. They concluded that due to antiseptic, antibiotic and chemical debridement actions honey is an appropriate vinaigrette substance for treatment of alveolar sockets after tooth extraction.15 The limitation of their study was small sample size and their result was based on subjective clinical parameters not including measurement of distance b/w mucosal edges of the socket, which is the advantage of our research with the use of honey. Another study reported the efficacy of honey in producing faster healing rates in chemotherapy induced mucositis. 16 In this study however, honey was used with olive oil and other additives and faster healing rates cannot be attributed to honey only. The results of this study do not agree with our findings, since faster healing was not reported in our subjects. The use of olive oil and other additives can be a reason for this difference and further studies are needed to clarify this issue. A recently published meta-analysis also reported honey to be effective in the treatment of mucositis.17
It appears from the literature review and our findings that the antibacterial effect of honey are more promising than its much acclaimed hastened wound healing properties. It is also a possibility that its anti-infective properties indirectly influences faster healing and its actual curing capabilities are limited in the oral cavity. There is a lack of well controlled research on this topic and further research is recommended to clarify the ambiguity.Many dental professionals believe that only medicines are important in management of oral diseases. It is essential to provide scientific evidence of usefulness of new and alternate products & also to increase recognition of novel forms of cure.
1. The limitation of our study was small sample size.
2. Another limitation of the study was that it only measured the clinical aspects of socket healing. It
is recommended that other researches should be carried out in order to asses other parameters of
socket healing, e.g. hard tissue healing and aver age bone loss.
3. Only one examiner performed the measurements and there was no intra-examiners reliability.
4. Lack of randomization was another limitation of this study
We conclude that the use of honey reduces the incidence of wound infection after tooth extraction, however its effect on hastened wound closure could not be determined.
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