Abstract

Background: Periodontitis is a biofilm-associated inflammatory disease characterized by dysbiosis
of the oral microbial community and increased pathogenic bacteria, including Porphyromonas
gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans. The increasing
concern regarding antimicrobial resistance has encouraged investigation of natural antimicrobial
agents. Manuka honey contains methylglyoxal (MGO), which has demonstrated antimicrobial
activity against important periodontal pathogens in previous in-vitro studies.
Objectives: To evaluate the clinical effectiveness of adjunctive Manuka honey oral rinse following
nonsurgical periodontal therapy (NSPT) in hemodialysis patients with Stage III periodontitis and to
investigate changes in periodontal parameters and inflammatory biomarkers.
Methods: A randomized, blinded, controlled clinical trial included 140 hemodialysis patients with
Stage III periodontitis. Participants received NSPT followed by either Manuka honey oral rinse
(n=70) or saline rinse (n=70) for 6 months. Clinical attachment level (CAL), probing depth (PD),
bleeding on probing (BOP), plaque index, gingival crevicular fluid FGF23, serum C-reactive
protein (CRP), and oral health-related quality of life were assessed.
Results: At 6 months, the Manuka honey group demonstrated significantly greater improvements in
CAL, PD, and BOP compared with controls. Significant reductions in GCF FGF23 and serum CRP
were also observed, together with improved oral health-related quality of life.
Conclusion: Adjunctive Manuka honey oral rinse produced additional clinical and inflammatory
improvements following NSPT in hemodialysis patients with periodontitis. Its potential
antimicrobial activity against periodontal pathogens supports further microbiological investigation
of Manuka honey as a non-antibiotic adjunctive approach to periodontal infection management.