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REVIEW
Focus on Alternative and
Complementary Therapies
Volume 18(3) September 2013 118–125
© 2013 Royal Pharmaceutical Society
DOI 10.1111/fct.12034
ISSN 1465-3753

Role of propolis in dentistry: review of the literature

Divesh Sardana, KR InduShekar, Sheetal Manchanda, Bhavna Gupta Saraf,

Neha Sheoran

Abstract
Background Propolis (also called bee glue) is a resinous substance derived from bees. It has long been used in medicine
for its beneficial properties, including antimicrobial, anti-inflammatory, antidiabetic and local anaesthetic effects. In dentistry,
propolis has been used for the prevention of dental caries and periodontal diseases, as an interim transport medium for
avulsed teeth, and in endodontics, orthodontics and periodontics.
Objective To highlight the role of propolis in dentistry.
Methods A PubMed search was made using the keywords propolis, bee glue, antimicrobial, dental and herbs without
any limits on the date of publication. No specific inclusion or exclusion criteria were applied as the purpose of the review
was to make it as comprehensive as possible.
Discussion The role of propolis is discussed in various branches of dentistry, including: preventive dentistry, dental
traumatology, endodontics, periodontology, orthodontics and oral oncology.
Conclusion Although most research published in the dental literature on propolis is based on in-vitro studies or animal
studies, extrapolating the results of these present studies to clinical practice may be too early as these results may not be
necessarily replicated in human trials. In future, propolis may find a definitive role in one or more applications in dentistry;
however, clinical trials are necessary to isolate the individual components responsible for its beneficial effects and to study
them.

Keywords
Antimicrobial • bee glue • dental • interim-transport media • propolis

Introduction Egyptians have long known about the medical prop-

Propolis (also called bee glue) is a resinous substance
derived from honey bees (Apis mellifera), and has long
been used in medicine for its beneficial properties.
The term ‘propolis’ is a Greek word meaning ‘in front
of the city’ (‘pro’ – in front and ‘polis’ – city), which
emphasises the protective role of propolis in bee
colonies. The medical literature is vast regarding the
potential benefits of propolis and its constituents,
with a range of effects reported to date including
anti-inflammatory,1 antioxidant,2,3 anti-ulcer,4 anti-
tumour,5 antidiabetic,6,7 cardio-protective8 and local-
anaesthetic effects.9 The Greeks, Arabs, Romans and
erties of propolis, however the use of propolis in
dentistry is relatively new; but considering the effects
of propolis on infection, inflammation and carcino-
genesis, it may have more potential uses in the treat-
ment as well as the prevention of oral disease.
Propolis is mainly composed of plant resins and
exudates that are gathered by bees. Some wax, bee
secretions and pollen are added later by the bees to
give the final complex product, viz propolis. The
colour of the propolis may vary from yellowish-green
to dark brown depending on its source and age. Like
other waxes, it is hard and brittle when cold but
becomes soft and sticky when warmed.

118
 Review 119

Several hundred compounds have been character- Table 1 Propolis and its role in dentistry
ised in different propolis types; however, the main
Composition (may vary Flavonoids
chemical constituents of propolis are flavonoids,
depending on Phenolic and aromatic
various phenolic and aromatic compounds, amino the source) compounds
acids, minerals and vitamins A, E and B complex. Amino acids
These constituents appear in various concentrations Minerals
depending on geographical location and botanical Vitamins
origin. Howsoever the exact composition of propolis Physical characteristics Colour: yellowish-green to dark
from different botanical origins may vary, the biologi- brown depending on source
cal effects are similar. This may be because of similar and age
active ingredients in different types of propolis. Hard and brittle when cold
Soft and sticky when warmed
The purpose of this review is to highlight the role
Health-enhancing Anti-inflammatory
of propolis in dentistry and to discuss any future
benefits Antioxidant
perspectives of this new ‘Api-herbal drug’. Anti-ulcer
Antidiabetic
Antibacterial
Methods Antifungal
Although propolis has been used in dentistry for Antiviral
Anti-tumour
various indications, evidence from RCTs and control-
Cardio-protective
led clinical trials are lacking. Hence, no specific cri- Dental uses Anti-caries agent
teria were applied a priori as to what articles would be Interim transport media for
selected for this review. The purpose was to make this avulsed teeth
review as comprehensive as possible, although only Anti-plaque agent
articles indexed in PubMed were considered for inclu- Anti-calculus agent
sion. A PubMed search was made using the keywords Intra-canal medicament
propolis, bee glue, antimicrobial, dental and herbs Intra-canal irrigant
without any limits on the date of publication. Pulp capping agent
Adjunct to radiotherapy
Reduction of dentinal
hypersensitivity
Discussion
Treatment of stomatitis
Propolis has been widely used in dentistry; the earli- Anti-herpetic
est reference to its use was probably a medical book Antifungal
named ‘The Carbadini’ published in the 13th century, Repair of oral wounds
where its beneficial role had been suggested in tooth
decay. Since then, possibly due to its wide antimicro-
bial activity (including antibacterial, antifungal and propolis depends on its composition and, thus, the
antiviral activity), propolis has been used for the region of collection of the propolis sample.19,20
treatment and prevention of dental caries and peri- Although propolis demonstrates in vitro inhibitory
odontal diseases, as an interim transport medium for activity against streptococcus and lactobacillus, long-
avulsed teeth, and for dental hypersensitivity and term clinical studies showing changes in decayed,
denture and apthous stomatitis (Table 1). missing, filled teeth (DMFT) and decayed, missing,
filled surfaces (DMFS) are lacking. The exact dosage
Preventive dentistry and concentration of propolis that should be used
As an anti-caries agent also needs to be conclusively determined. Propolis
Apart from the numerous approaches already avail- has already been tested as an adjuvant to vaccines21
able for the prevention of dental caries (e.g. fluorides, and hence, may have a future role in caries vaccina-
dietary counselling, povidone-iodine, probiotics, tion or as adjuvant therapy to other anti-caries
caries vaccine), which affect one or more steps in the agents [e.g. fluorides, povidone-iodine, casein
caries process, propolis is a useful addition to this list phosphopeptide – amorphous calcium phosphate
as it inhibits water-insoluble glucan synthesis and (CPP-ACP)].
affects acid production and the acid tolerance of
micro-organisms.10 Two mechanisms of action have Dental trauma
been associated with the anti-caries11 and anti- Interim-transport media for avulsed teeth
plaque12 properties of propolis: the first is the anti- Dental avulsion is a consequence of injury that
microbial activity against cariogenic bacteria;13,14 the results in the complete displacement of a tooth from
second is the inhibition of glucosyltransferase its alveolar socket and damaging the adjacent
enzyme activity.15–18 However; the cariostatic effect of hard and soft periodontal tissues. Various interim
120 Focus on Alternative and Complementary Therapies
transport media for avulsed teeth have been used to
preserve the vitality of periodontal ligament (PDL)
cells; propolis is one of them. Propolis has been
found to be an effective storage media for periods of
6 h and above.22,23 However, the results do not appear
very promising for shorter periods of storage.
Propolis increases the metabolic activity and pro-
liferation of PDL cells and decreases apoptosis, sug-
gesting it has a beneficial role on the viability and
physiological health of periodontal ligament cells.24
Propolis has also been shown to inhibit external
root resorption similar to 2% acidulated-phosphate
sodium fluoride solution,25 although in another
study propolis caused time-dependent replacement
resorption similar to teeth maintained in saliva and
dry conditions.23 Lastly, propolis inhibits osteoclas-
togenesis and osteoclast activation in tissue culture
and may prove useful in future as a medicament to
reduce resorption associated with traumatic injuries
to the teeth.26
Various concentrations of propolis (either alone or
in combinations)27–29 with varied time periods have
been studied to determine its effectiveness in main-
taining PDL cell viability utilising different meth-
ods.30,31 Although found to be effective, the exact
concentration is yet to be conclusively determined.
Moreover, its ease of availability remains a question
when compared to other easily available and effective
media such as milk, coconut water and oral rehydra-
tion solution. Based on the data available for propolis
as an interim transport medium, it may be concluded
that propolis is an acceptable long-term storage
medium for avulsed teeth. However, long-term
human trials are necessary to term it the ‘best’ storage
medium for avulsed teeth.
Periodontology
A large number of mouth rinses have been used for
their ability to disrupt the formation of plaque. In a
double-blind cross-over study, propolis was found to
be significantly more efficacious than placebo in
reducing the plaque index and the concentration of
insoluble polysachharide.12 Reduction of insoluble
polysaccharide by propolis may not only reduce the
bulk of plaque but also affect the cariogenic potential
of plaque.32 In rat models, propolis when adminis-
tered systemically reduced alveolar bone loss when
assessed by morphologic and histologic parameters.33
Sub-gingival irrigation with propolis extract as an
adjuvant to periodontal treatment was found to be
more effective than conventional treatment accord-
ing to both microbiological and clinical para-
meters34,35 and, hence, may be recommended in cases
of gingivitis and periodontitis. Propolis has also been
studied for its effectiveness in reducing malodour
production and found to be ineffective,36 but it still
may find a future role in toothpastes and mouth
rinses as an anti-calculus agent (due to its inhibitory
September 2013 18(3)
effect on both the rate of amorphous calcium
phosphate transformation to hydroxyapatite and the
induction time)37 and anti-plaque agent. However,
propolis may have a limited role when compared to
chlorhexidine (CHX) as an anti-plaque agent.38
Endodontics
Intra-canal medicament
Calcium hydroxide [Ca(OH)2] has remained a stand-
ard treatment against which intra-canal medica-
ments (ICMs) are compared.39,40 However, Ca(OH)2
has some disadvantages, like its longer time require-
ments for action41 and its inability to eliminate a
whole spectrum of micro-organisms.42 Propolis has
reportedly a greater inhibitory effect on Enterococcus
faecalis compared to Ca(OH)2, tri-antibiotic mixture,
ethanol and saline.43–45 However, in these studies the
methodologies differed in regard to antimicrobial
testing, duration of the study, strain of E. faecalis and
the concentration of propolis used. Although propo-
lis had better inhibitory activity against E. faecalis,
CHX and povidone iodine were found to be better
than propolis and Ca(OH)2.46 However, in another
study, Ca(OH)2 paste containing propolis extract
was found to be better than Ca(OH)2 alone against
polymicrobial cultures.47
Apart from the antimicrobial action of intra-canal
medicaments, another issue to be considered is the
peri-apical response of the ICM. Long-term studies on
peri-apical response of propolis are lacking, however,
when compared with corticosteroid–antibiotic paste,
it caused less peri-apical inflammation over a period
of 28 days in dogs’ teeth.48 As an ICM, both propolis
and Ca(OH)2 have similar physical properties,49
although propolis has been reported to be 10 times
less cytotoxic to fibroblasts of the periodontal liga-
ment and dental pulp.50
Intra-canal irrigant
Propolis may be used as an intra-canal irrigant and
has been found to be effective in reducing endotox-
ins and inhibiting E. faecalis, Streptococcus aureus,
Candida albicans and E. coli.51–53
Pulp-capping agent/pulpotomy
Propolis has been used as a pulp-capping agent in
permanent teeth54 and as a pulpotomy agent in
primary teeth.55,56 It was found that teeth capped
with propolis form a hard tissue barrier. The probable
components of propolis responsible for the forma-
tion of the hard tissue barrier are the flavonoids,
which have been shown to cause less inflammation
and harder tissue formation than non-flavonoid
components.57 Flavonoids have anti-inflammatory
properties by virtue of their suppression of immune
cell activation, macrophage-derived nitric oxide and
cytokine production and neutrophil activation. Also,

flavonoids may inhibit bacterial growth in the pulp
chamber thereby reducing the host response to bac-
terial antigens.58
Orthodontics
Propolis solution was shown to have a positive effect
on bone formation during treatment with a device to
expand the palatine suture. An increased quantity of
osteoblasts and quicker bone remodelling was found
in preparations from rats that received propolis
during the treatment.59
Oral oncology
The radio-sensitising capacity of propolis was evalu-
ated in human head and neck squamous cell carci-
noma (HNSCC) cells and propolis was found to
enhance radio-sensitivity in one of the three HNSCC
lines and also reduced cell growth and clonogenic
survival.60 Hydro-alcoholic extract of green propolis
had a protective role against chemically induced
lingual carcinogenesis in rats61 and may be used as a
preventive agent or as adjunctive treatment for oral
cancers. Propolis may also have a role in reducing or
delaying radiation-induced mucositis.62
Miscellaneous
Dentin hypersensitivity
Dentin hypersensitivity has been defined as a short,
sharp pain arising from exposed dentin in response
to stimuli, typically thermal, evaporative, tactile,
osmotic or chemical, which cannot be ascribed to
any other form of dental pathology.63 Numerous
materials have been used to reduce dentin hypersen-
sitivity; propolis is one of them.64 When compared
with CPP-ACP F and sodium fluoride, topical appli-
cation of propolis was found to be most effective in
reducing hypersensitivity over a period of 90 days.65
The probable mechanism for the reduction in
hypersensitivity may be the occlusion of dentinal
tubules.66,67
Stomatitis
Systemic intake of propolis (500 mg/day) was found
to be effective in reducing the number of disease
outbreaks and improving the QoL of patients suffer-
ing from recurrent aphthous stomatitis.68
Antifungal
Candidiasis is a fungal infection commonly found in
denture wearers and immune-compromised patients.
Propolis has been found to inhibit C. albicans isolated
from HIV-seropositive individuals when compared to
nystatin in an in-vitro study,69 and also in denture
wearers, thus supporting its antifungal activity.70
Antiviral
Propolis may have a future role in the prophylaxis or
treatment of herpes simplex virus (HSV) infections of
Review 121
the oral cavity. The anti-HSV effect of propolis was
tested in an in-vitro and in-vivo study71 and propolis
was found to have an inhibitory effect on viral infec-
tion probably owing to the prevention of virus
absorption into the host cells and/or inhibition of an
internal step(s) during the viral replication cycle,
thus preventing the appearance and development of
symptoms in vivo. In another study, Brazilian propolis
showed not only direct anti-HSV-1 activity but also
immunological activity against intradermal HSV-1
infection in mice.72
Repair of oral wounds
Propolis in aqueous alcohol solution exerted a small
analgesic and anti-inflammatory effect and also aided
repair of intra-buccal surgical wounds after sulculo-
plasty by modified Kazanjian technique.73 Topical
application of propolis hydro-alcoholic solution
was found to accelerate epithelial repair after tooth
extraction but had no effect on socket wound
healing.74
Role in dental materials
Arslan et al.75 evaluated the effect of five cavity disin-
fection agents: chlorhexidine, sodium hypochlorite,
propolis, ozone, and erbium chromium: yttrium-
scandium-gallium garnet (Er,Cr:YSGG) laser on bond
strengths of silorane-based resin composite. However,
no significant difference in mean bond strength was
observed between the groups. Troca et al.76 evaluated
the effect of adding green propolis on the mechanical
properties of glass ionomer cements (GICs). Water
sorption values of the experimental GICs were
increased compared to pure GIC; other mechanical
properties like diametral tensile strength and solubil-
ity were also affected, although the change in prop-
erties were dependent on the GIC material (i.e.
manufacturer). Silva et al.77 evaluated the effect of
nystatin, flucanazole and propolis on the roughness,
free energy and Knoop hardness number of poly-
methyl methacrylate (PMMA) resin (both heat
cured and microwave cured). There was a significant
increase in surface roughness and surface hardness of
PMMA samples treated with propolis compared to
antifungal agents. The increase in surface hardness in
the propolis-treated group was probably due to the
deposition of propolis over the roughened area,
which may have formed a barrier to C. albicans.
Side-effects
Propolis is considered to be a safe medicine; however,
like other honey-bee products, it may be responsible
for causing allergic reactions.78–80 As such, propolis
should be avoided by asthmatic patients, patients
allergic to bee stings and patients allergic to honey
products. Patch testing should be done to rule out
122 Focus on Alternative and Complementary Therapies
allergy to propolis before prescribing it to a patient.
Future studies are needed to identify the individual
components of propolis responsible for causing aller-
gic reactions.
Conclusion
Although most of the dental literature published on
propolis is based on in-vitro studies or animal studies,
extrapolating the results of these present studies to
clinical practice may be too early as these results may
not be necessarily replicated in human trials. In
future, propolis may find a definitive role in one or
more applications in dentistry; however, clinical trials
are necessary to isolate the individual components
responsible for its beneficial effects and to study them.
Further research is also needed to determine its
optimal concentration, time of application, method
of preparation and effects on the oral cavity. Lastly,
allergy to propolis and its constituents should be
considered before prescribing the product to patients.
Conflict of interest None declared.
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 Review 125

Bhavna Gupta Saraf, BDS, MDS, Associate Professor,

Divesh Sardana, BDS, MDS, Senior Lecturer, Department
Department of Pedodontics and Preventive Dentistry, Sudha
of Pedodontics and Preventive Dentistry, Sudha Rustagi
Rustagi College of Dental Sciences and Research, Faridabad
College of Dental Sciences and Research, Faridabad
121002, India.
121002, India.
E-mail: guptabhavna2000@yahoo.com
E-mail: doc_divesh@yahoo.co.in
Neha Sheoran, BDS, MDS, Senior Lecturer, Department of
KR InduShekar, BDS, MDS, Professor and Head, Depart-
Pedodontics and Preventive Dentistry, Sudha Rustagi College
ment of Pedodontics and Preventive Dentistry, Sudha Rustagi
of Dental Sciences and Research, Faridabad 121002, India.
College of Dental Sciences and Research, Faridabad
E-mail: sheoran.neha@yahoo.co.in
121002, India.
E-mail: indushekar66@yahoo.co.in
Sheetal Manchanda, BDS, Private Practitioner, NexGen
Dental Solutions, Gurgaon 122002, India.
E-mail: manchanda_sheetal@yahoo.co.in