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Table of Contents
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 54-58

The effect of 10% forest honey rinsing on dental plaque score for children aged 9–12 years

1 Department of Pediatric Dentistry, Dentistry Study Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
2 Department of Periodontics, Dentistry Study Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
3 Department of Dental Public Health, Dentistry Study Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
4 Dentistry Study Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia

Date of Submission20-Nov-2019
Date of Decision09-Jan-2020
Date of Acceptance15-Mar-2020
Date of Web Publication8-Jun-2020

Correspondence Address:
Dr. Ulfa Yasmin
Department of Pediatric Dentistry, Dentistry Study Program, Faculty of Medicine, Sriwijaya University, Palembang
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_49_19

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Background: Effective plaque control can be achieved mechanically (by toothbrushing), but there are alternatives such as mouthwashes. However, recently, mouthwashes have been shown to have adverse effects on oral health. Honey is an herbal medicine that is easy to find, and it has antibacterial and has no side effects on oral health. Objectives: This study aimed to determine the effect of rinsing with a 10% forest honey mouthwash on the dental plaque score of children aged 9–12 years. Methods: The study was quasi-experimental and used a pre- and posttest, control group design. A total of 52 children (students 9–12 years) were divided into two groups with identical mean plaque scores. The control group rinsed with distilled water and the test group rinsed with a forest honey (10%) solution. The children were instructed to rinse three times daily for 30 s with 10 ml of mouthwash and to continue for 4 days. The data were analyzed using the dependent and independent t-test. Results: The results showed a significant difference in the dental plaque score for the test group (P < 0.001): the pretest average was 2.22 ± 0.59 and the posttest (after 4 days of rinsing) was 1.51 ± 0.57. The dental plaque score for the control group (rinsing with distilled water) showed an insignificant increase (P > 0.05) from the pretest (2.18 ± 0.73) to the posttest (2.22 ± 0.89).
Conclusion: Rinsing with a forest honey solution has a positive effect on the reduction of dental plaque in children aged 9–12 years.

Keywords: Dental plaque score, forest honey, herbal medicine

How to cite this article:
Yasmin U, Sulistiawati, Awalia H, Asri B, Mudiah F. The effect of 10% forest honey rinsing on dental plaque score for children aged 9–12 years. Sci Dent J 2020;4:54-8

How to cite this URL:
Yasmin U, Sulistiawati, Awalia H, Asri B, Mudiah F. The effect of 10% forest honey rinsing on dental plaque score for children aged 9–12 years. Sci Dent J [serial online] 2020 [cited 2022 Dec 3];4:54-8. Available from: https://www.scidentj.com/text.asp?2020/4/2/54/286189

  Background Top

Dental plaque is the main cause of dental caries and periodontal disease.[1],[2],[3] Dental plaque is an accumulation of biofilm-formed microorganisms found on the teeth or on other hard tissues in the oral cavity.[4] Effective plaque control can be achieved with regular toothbrushing; however, a high percentage of individuals do not practice an acceptable standard of mechanical plaque removal due to their lack of dexterity in performing their oral hygiene methods. Children, in particular, need support and alternatives, which include rinsing with mouthwash.[3],[5],[6],[7] There are two types of mouthwash: the chemical and the natural. Common mouthwashes are normally chemical based, but their long-term side effects include changes in the normal flora of the oral cavity, in the color of the teeth, and in taste sensation.[3],[6] Natural mouthwashes can be used to maintain oral health and resolve the negative side effects.[3] Natural materials such as honey are easy to obtain as they are available in almost all regions, and they are, therefore, often used as mouthwashes.[6] Honey contains water, sugars, amino acids, vitamins, minerals, and enzymes.[8],[9],[10] The main antibacterial effect of honey is due to the hydrogen peroxide (H2O2) produced by the activity of the glucose oxidation enzymes.[11],[12]

Most honey production in Indonesia comes from natural forests.[6],[8] Forest honey is easily obtained in several regions.[6] A study by Sugianto showed that gargling with a 15% forest honey solution is effective in reducing the number of bacteria in saliva.[6] Nurdiana et al. (2016) showed that honey preparations with a concentration of 50% had a stronger antibacterial effect than those with concentrations of 12.5% and 25%.[8]

The author was interested to examine the effect of rinsing with a forest honey solution of 10% on the dental plaque scores of children aged 9–12 years. The children consisted of elementary school-age children as, at this level, children frequently do not know or understand how to maintain their oral health.

  Materials and Methods Top

The study had a quasi-experimental design with a pre- and posttest with a control group and a single blind. The study was conducted after registration with the Ethics Committee of Medical Faculty of Sriwijaya University (No. 324/kepkrsmhfkunsri/2018). The children were 52 elementary school students aged 9–12 years in Palembang city. There were 14 males and 38 females. All children have fulfilled the inclusion criteria and signed the consent form.

The sampling technique was purposive sampling. The inclusion criteria were children aged 9–12 years, those who had not recorded systemic periodontal disease, and those who had neither used mouthwash for the last 2 weeks nor have an orthodontic appliance. The exclusion criteria were children having crowded teeth; buccal, lingual, or palatal caries; partial eruption; or a bad habit such as one-sided chewing. The children were instructed to maintain their oral hygiene as usual. On the 1st day, their plaque score was taken, and this formed the initial plaque score value. The children in the sample were asked to use a disclosing agent (GC Tri Plaque ID Gel, Tokyo, Japan), and their initial plaque score was determined using the Turesky–Gilmore–Glickman Modified Plaque Index from the Quigley Hein Plaque Index. A total of 52 children were divided into two groups in such that each group had the same mean plaque score. Group 1 rinsed with a forest honey solution of 10%. The children were instructed to rinse with 10 ml of the forest honey solution for 30 s,[13] three times a day for roughly 4 days (10 times in all).[10] Group 2 was a control group who rinsed with distilled water. These participants were instructed to rinse with 10 ml of distilled water for 30 s,[13] three times a day, for roughly 4 days (10 times in all).[10] After <4 days, the plaque scores were re-evaluated by the previous procedure. Data from the study were tested for normality using the Shapiro–Wilk test and were analyzed using the parametric test, the paired t-test, and the unpaired t-test (SPSS Software 20, SPSS Science, Chicago, USA).

  Results Top

The Shapiro–Wilk normality test results on the plaque scores before and after rinsing showed a normal distribution of data (P > 0.05). A comparison was done of the plaque scores before and after treatment in the control group (using distilled water) and in the treatment group (using forest honey solution, 10%) using the paired t-test. [Table 1] shows that in the treatment group, after rinsing with the 10% forest honey solution, the plaque score was significantly lower than the before rinsing score (P < 0.05). The plaque score in the control group was higher after rinsing with the distilled water, but the difference was not significant compared to the before rinsing score (P > 0.05).
Table 1: Comparison of plaque scores before and after treatment

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A comparison of the plaque scores of the two groups after rinsing using the unpaired t-test is shown in [Table 2]. This shows that the mean plaque score after rinsing with forest honey solution (10%) was significantly lower than the mean plaque score after rinsing with distilled water (P < 0.05). Rinsing with the forest honey solution (10%) had reduced the plaque score. These results were obtained after the children had rinsed for approximately 4 days (10 times). All children were asked to rinse for 30 s, Group 1 rinsed with 10 ml of forest honey solution (10%), and Group 2 rinsed with 10 ml of distilled water. During the study, the children were instructed to keep brushing their teeth as usual. The results of the data analysis using the paired t-test show that the mean plaque score after rinsing with the 10% forest honey solution was lower than before rinsing. The mean plaque score after rinsing with distilled water was higher than before rinsing, but the difference was not significant [Table 1].
Table 2: Comparison of plaque scores after rinsing between groups

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  Discussion Top

The results of this study indicate that rinsing with a 10% forest honey solution affected the formation of dental plaque and that the plaque score decreased over 4 days. In addition to its osmotic effects, honey contains several antibacterial substances including H2O2, a low pH, and flavonoids.[14],[15] A study by Singhal et al. confirms our results as that study showed that rinsing with Manuka honey and raw honey caused a significant decrease in plaque scores. The decrease was associated to honey's low pH, high osmotic pressure, and antibacterial activity derived from the effects of H2O2, which causes damage to the membranes, protein, enzymes, and DNA of the bacteria.[16] A study by Alibasyah et al. (2018) also showed a decrease in plaque scores (P < 0.05) in samples after rinsing with a Tongra honey solution. The decrease was attributed to the antibacterial properties of the honey.[15]

The results from the data analysis using the independent t-test for comparison confirm that after rinsing with 10% forest honey solution, the plaque score was lower than after rinsing with distilled water [Table 2]. Rinsing with 10% forest honey solution is more effective than rinsing with distilled water because the honey causes antibacterial activity.

Honey has an osmotic effect because it contains very high (80%) glucose and fructose levels, resulting in a very hypertonic solution compared to the bacterial environment.[14] This causes a strong interaction between the sugar molecules and the water molecules so that the bacteria become deficient in water (dehydration occurs), and the cell remains alive for only a short period.[14],[17],[18] The drastically decreased water content makes it impossible for the bacteria to live.[18] This osmotic effect decreases when the honey is diluted.

Honey contains organic antibacterial compounds, such as flavonoids. The flavonoids found in honey are derivatives of phenol compounds, forming complex compounds with extracellular proteins that interfere with the integrity of bacterial cell membranes.[14],[19],[20] Flavonoids interact with compounds in the bacterial cells through an absorption process involving hydrogen bonds.[19] Flavonoids are able to penetrate the cell, passing through the bacterial cell wall and the cytoplasmic membrane, causing precipitation and denaturation of the protoplasmic proteins and activating the enzymes in the bacterial cell.[14],[17],[19]

Flavonoids are able to break the peptidoglycan bonds when penetrating the cell walls, causing leakage of the cell contents by damaging the hydrophobic binding of the cell membrane components (such as proteins and phospholipids), resulting in increased permeability of the cell membranes and secretion of cell contents.[18] The damage to the cell membrane results in the inhibition of activity and the biosynthesis of enzymes, especially glucosyltransferase, that cause bacterial metabolism to be inactivated, such that bacterial growth is inhibited.[14],[19],[21]

Honey also contains H2O2, which is produced enzymatically by glucose oxidation enzymes. The H2O2 becomes active when honey is diluted.[9],[22] The H2O2 contained in honey is an effective and safe antibacterial for the oral tissues.[23] The glucose oxidation enzyme will be activated by H2O2 and the acids produced.[23]

H2O2 as molecules can inhibit bacterial growth in dental plaque by oxidizing the bacterial proteins and by inactivating bacterial enzymes such as catalase, peroxidase, and superoxide dismutase. These are metabolically active products, and by disruption of the cell membrane permeability and cell proliferation, H2O2 results in protein degradation, lipid peroxidation, and DNA and RNA damage in bacterial cells.[13],[14],[24]

H2O2 also inhibits glycolysis and has antimicrobial activity against Streptococcus mutans.[25],[26] H2O2 causes damage to protein synthesis in S. mutans so that the bacterial cells cannot replace damaged proteins due to the oxidative activity of H2O2.[25],[26]S. mutans is the initial bacterium that colonizes the formation of dental plaque because it has the ability to form extracellular polysaccharides (dextran and levan) produced from glucose and sucrose.[10]S. mutans can attach to the pellicle and form colonies that are firmly attached to the tooth surface, producing lactic acid through the process of homofermentation. They are also more acidogenic than other Streptococcus species.[27] Inhibition of the metabolic processes of S. mutans on dental plaque, and hence the bacterial colonization of dental plaque, decreases cell viability and causes cell death, thereby reducing the accumulation of plaque.[24]

The other honey antibacterial action is due to the honey's pH, which is acidic, 3.2–4.5 with the result that it inhibits the metabolism of Gram-negative bacteria, one of which is Porphyromonas gingivalis. This bacterium can only live in a pH of 6.5–7.0 with a low protein content, so the presence of honey can limit the amount of water available, causing inhibition of bacterial metabolism and causing the lysis of bacteria.[14]

Singh et al. showed that rinsing with 10% honey is effective in controlling plaque and gingivitis.[28] Badet and Quero found that a concentration of 10% Manuka honey can affect plaque formation by inhibiting the bacteria S. mutans.[26] Sugianto noted a decrease in the number of bacterial colonies in samples that rinsed with a honey solution due to the presence of antibacterial activity resulting from honey's osmotic effect, the production of H2O2, and honey's acidity.[6]

This study shows that distilled water (used by the control group) has no inhibitory effect on plaque formation. Distilled water has no antibacterial properties such as honey solution has. The mean plaque score of the control group increased due to an uncontrollable variable, the method used for brushing the teeth. A study by Wiradona et al. commented that knowledge, practice, and attitude toward brushing teeth affect plaque formation. Brushing teeth with an inaccurate technique would be inadequate oral hygiene.[11] A study by Haryanti et al. showed that each individual has a different technique for brushing their teeth and that this affects their plaque scores.[12]

Various studies have shown that a forest honey solution has many benefits, including oral health. The results of this study show that rinsing with a 10% forest honey solution can reduce plaque, but in order to identify more benefits in the field of dental and oral health, further research is needed to analyze at the role of honey in bacteria in plaque and gingival index scores. Honey has the advantage of being easily obtainable and has a sweet taste so is enjoyed by children. The process of making a honey solution is very easy, so it is anticipated that people will be able to apply this approach in their daily lives to improve their oral health.

  Conclusion Top

Rinsing with a 10% forest honey solution is effective when used with children. Rinsing with a forest honey solution contributes to the reduction of dental plaque in children aged 9–12 years.


The financial support of Sriwijaya University is gratefully acknowledged.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2]


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