Introduction

Propolis is a resinous substance produced and used by honeybees to maintain hive sterility and structural integrity. It is often referred to as “bee glue” due to its sticky consistency. Bees collect this material from tree sap flows, buds, and various other botanical sources [1]. Ancient Egyptians used propolis in various applications, including mummification and wound healing [2]. It was also highly valued in traditional Chinese medicine, where it was utilized to treat a wide range of ailments. In ancient Greece, propolis was applied to disinfect wounds and prevent infections [3]. Despite its long history of use, scientific investigations into propolis’ pro­perties did not begin until the 20th century. Kivalkina’s discovery in the 1940s marked a turning point, leading to further research and the recognition of propolis’ antimicrobial potential [4].

The conventional oral care products currently available contain synthetic chemicals that, while effective in various aspects of oral healthcare, can also lead to adverse reactions and long-term complications, including systemic effects, sensitivity, and allergies. Children are particularly susceptible to the effects of synthetic drug formulations due to developmental differences causing changes in pharmacokinetics [5]. Therefore, the inclusion of herbal materials into contemporary dental practices presents a promising avenue for exploring natural-based therapies that may complement or augment conventional treatments, addressing the evolving demands for safe, effective, and accessible oral healthcare in a more holistic and sustainable manner. The search for safer alternatives to synthetic drugs in oral healthcare has spurred a significant surge in interest and demand for herbal products, such as propolis, which shows promise in pediatric dentistry [6].

The increasing interest in propolis stems from its health benefits, especially in oral health and wound care, where it is gaining popularity [7]. Rich in bioactive phytochemicals, such as flavonoids, phenolic acids, and essential oils, propolis exhibits potent antimicro­bial, antioxidant, anti-inflammatory, and antiproliferative properties, making it a potential therapeutic agent for humans [8] (Figure 1). Propolis is a complex mixture of various compounds, including resins (approximately 50%), waxes (30%), essential oils (10%), pollen, and trace amounts of other substances [9].

The antibacterial property of propolis has direct the­rapeutic applications in the prevention and management of oral diseases and wound healing. This is achieved through various mechanisms, such as disruption of bacterial cell wall and membranes, inhibition of bacterial RNA polymerase and suppression of quorum sensing, and formation of biofilms. Its anti-inflammatory effects are mediated through suppression of COX and LOX pathways, reducing cytokine production. In addition, propolis acts as a strong antioxidant, scavenging free radicals and enhancing cellular defense enzymes. Its immunomodulatory effects help boost host defense mechanisms through phagocytic activity, increased production of interferons, and immunoglobulins [10-12].

The role of propolis in wound healing is attributed to enhanced fibroblast activity, collagen synthesis, angio­genesis, and antimicrobial protection. These multi­faceted actions make propolis a valuable natural agent in preventive and therapeutic medicine. Moreover, propolis exhibits antifungal activity through alteration of fungal cell membrane permeability and inhibition of ergosterol synthesis. Its antiviral activity is mediated through inhibition of viral entry, replication, and assembly [10-12].

In pediatric dentistry, there is an increasing demand for natural products due to the high risk of synthetic drug ingestion and toxicity in children. Propolis offers a safer alternative, reducing the risk of adverse reactions while maintaining its therapeutic effectiveness. Given its broad range of beneficial properties, propolis has been known to possess significant potential in dentistry and oral health management, especially for pediatric applications where safety is paramount [13]. This review paper aimed to explore the various applications of propolis in pediatric dentistry.

Material and methods

A comprehensive and meticulous electronic litera­ture search was conducted on existing published data of systematic reviews, review articles, and original research using five databases, including PubMed, Cochrane, Scopus, Scholar, and Web of Science. The search time period extended from 1990 to 2025. Search terms, such as propolis, pediatric dentistry, bee wax extract, were used while conducting the literature review. Stu­dies included were clinical trials, systematic reviews, narrative reviews, case reports, animal studies, and in vitro studies. Only full-text articles written in English language were selected. LZ and IG performed the search, while VS verified the results. The flow chart depicting the search strategy is shown in Figure 2. The included studies primarily focused on the applications of propolis in pediatric dentistry, such as a tooth storage medium, mouthwash, intracanal medicament, and irrigant. Additionally, the role of propolis in caries prevention and pulp therapy were investigated. These studies explored the potential benefits of propolis in terms of its antimicrobial, anti-inflammatory, and wound-healing properties in various pediatric dental procedures.

Results

Table 1 summarizes the 28 included studies exploring propolis as a natural therapeutic agent in dentistry, conducted between 1993 and 2025 across various countries, including India, Iran, Indonesia, Brazil, Syria, the US, China, Poland, and Saudi Arabia [12, 14, 16, 17, 19, 22-34, 38, 40-42, 47-52]. The studies were tabulated in the following order: clinical trials, systematic reviews, narrative reviews, case reports, animal studies, and in vitro studies. These studies investigated different aspects of propolis’ efficacy, safety, and applications.

Propolis was tested in multiple formulations, such as mouthwashes, gels, hydrogels, toothpastes, varnishes, intracanal medicaments, and as a pulp capping agent. Some papers investigated propolis alone and others evaluated propolis in combination with other materials, such as chlorhexidine, calcium hydroxide, MTA, fluoride, and aloe vera. The following specific outcomes were assessed in the studies included: reduction of plaque and gingival inflammation, maintaining periodontal cell viability, reduction in bacterial counts, pulp tissue repair, inducing root formation, and disinfection of root canal during endodontic treatment. Expression of inflammatory markers, such as COX-2, IL-10, TGF-β, and VEGF were also determined.

Clinical outcomes reported in the studies included reduction in the following parameters: bacterial counts, dental plaque, gingival inflammation, dentin hypersensitivity, and inhibition of caries development. Across the studies, propolis consistently was shown to exhibit strong antimicrobial, anti-inflammatory, antioxidant, and wound-healing properties. Its efficacy was often comparable to conventional agents, such as chlorhexidine and calcium hydroxide, with the added advantage of fewer side effects. In wound healing, propolis enhanced tissue healing and supported cell proliferation. It showed excellent compatibility when used in regenerative endodontics and pulp therapy. Its use as a storage medium for avulsed teeth also demonstrated superior preservation of periodontal cell viability.

Discussion

Applications of propolis in pediatric dentistry

Propolis in caries prevention

Propolis has emerged as a promising natural agent for caries prevention due to its antimicrobial and antibiofilm properties. In vitro studies have consistently demonstrated its ability to inhibit the growth of Streptococcus mutans, a key cariogenic bacterium. Additionally, propolis has been shown to interfere with the production of bacterial biofilms, which play a crucial role in caries development [14, 15].

Clinical trials in pediatric group have provided further evidence for the efficacy of propolis in caries prevention [15-17]. Current studies have found that a mouthwash containing propolis extract significantly reduce dental plaque and gingival inflammation compared to placebo [15, 17]. Listyasari and Santoso study [16] demonstrated the effectiveness of propolis-containing dental varnish in preventing caries in children.

The mechanism of action of propolis in caries prevention involves multiple factors, including its ability to disrupt bacterial metabolism, inhibit biofilm formation, and enhance remineralization of tooth enamel. Propolis may also exhibit synergistic effects with other caries-preventive agents, such as fluoride and xylitol [14]. The optimal dosage and formulation of propolis for caries prevention may vary depending on the specific product and target population.

Propolis in pulp therapy

Two primary methods for managing deep dentinal caries are pulp capping and root canal therapy. Pulp capping preserves tooth vitality, halts carious lesion progression, reduces dentin permeability, encourages tertiary dentin formation, and facilitates remineralization [18]. Propolis inhibits cyclooxygenases and lipoxygenases, promoting sclerosis and remineralization, while flavonoids in propolis stimulate reparative dentin formation and delay inflammation. Both in vitro and in vivo investigations in children have demonstrated the ability to promote pulp healing and dentin bridge formation [19-21]. Recent studies have found that a combination of propolis and calcium hydroxide was as effective as MTA in promoting pulp healing and dentin bridge formation [19, 20].

The mechanism of action of propolis in pulp therapy includes its ability to inhibit inflammation, modulate immune responses, and stimulate the production of growth factors. Propolis may also have synergistic effects with other materials used in pulp therapy, such as calcium hydroxide [22]. While initial results are promising, further studies are required to establish its long-term efficacy and compare it to traditional materials, such as zinc oxide eugenol in pulp therapy.

Propolis as an intracanal medicament

Dental pulp injury is primarily caused by bacterial assault, and effective root canal cleaning is crucial for successful endodontic therapy. Propolis, a naturally derived medication, has gained interest for its antimicro­bial properties, antioxidant, and anti-inflammatory properties. Its antioxidant and anti-inflammatory pro­perties, combined with its antibacterial features, make propolis effective in managing oral microflora and stimulating high quality tubular dentin production [23]. Studies have evaluated the efficacy of propolis as an intracanal medicament, and found that it is comparable to traditional materials, such as calcium hydroxide and triple antibiotic paste [24, 25]. Other research have observed that propolis was as effective as calcium hydro­xide in reducing bacterial counts and promoting root canal healing [25, 26]. In addition, Parolia and Kundabala study [27] demonstrated the superior antimicrobial activity of propolis compared to triple antibiotic paste.

Propolis plays a multifaceted role in root canal treatment by disrupting bacterial cell walls, inhibiting key bacterial enzymes, and modulating inflammatory responses, thereby enhancing disinfection and promoting periapical healing. Propolis may also have synergistic effects with other intracanal medicaments, such as chlorhexidine [28]. Long-term follow-up studies are necessary to evaluate the durability of root canal treatment using propolis.

Propolis as an intracanal irrigant

Pulp chambers and root canals of carious teeth with pulpal involvement often contain necrotic pulp remnants and bacteria, potentially causing periapical infection. To prevent its occurrence, root canals are irrigated with disinfecting solutions, which aid in debriding and lubricating instruments, inhibiting fungal cell division. Studies have reported that propolis is comparable to NaOCl and CHX in terms of its antimicrobial efficacy against common endodontic pathogens. Propolis may also possess synergistic effects with these irrigants, enhancing their antimicrobial activity [29].

Propolis has antioxidant properties, which can help protect the root canal tissues from oxidative damage. More clinical trials are needed to evaluate the efficacy of propolis as an intracanal irrigant in humans to establish its lasting clinical effectiveness, and compare it to traditional irrigants.

Propolis as a storage medium for avulsed tooth

Avulsion is a traumatic injury affecting permanent teeth, occurring in 1-16% of cases. The duration of avulsion and storage medium can protect periodontal ligament cells, thus impacting the prognosis of treatment. Flavonoids, a primary component of propolis, can enhance replantation success by counteracting oxygen radicals, protecting cell membranes, acting as anti-inflammatory agents, repairing bleeding tissue, and enhancing collagen synthesis. Moreover, propolis exhibits antibacterial properties, aiding in effective replantation and reducing inflammation [30].

Propolis demonstrated its effectiveness in preserving periodontal ligament cell viability and promoting replantation success in many in vitro studies. Also, recent research have confirmed that propolis is superior to other commonly used storage media, such as milk and saline, in terms of its ability to protect periodontal ligament cells and reduce inflammation [31-33].

A recent network meta-analysis has ranked propolis as the top storage medium for avulsed teeth, ranking first among 10 common options [34]. However, it is not easily accessible in low- and middle-income countries and can be difficult to obtain commercially. If propolis or Hank’s balanced salt solution (HBSS) are unavailable, other less optimal mediums, such as oral rehydration solution (ORS) and milk may be used.

Propolis in oral ulcers and wound healing

Oral ulceration is a painful, inflammatory condition affecting 20% of the world’s population. In particular, a condition known as recurrent aphthous stomatitis presents with itching, burning, and local pain before ulceration. It is more common in females and higher socioeconomic status. Treatment aims to reduce symptoms, decrease ulcer size, and extend disease-free periods.

Propolis showed potential in treating oral ulcers and promoting wound healing due to its antifungal, antibacterial, and antiviral activity, while flavonoids and other components may be involved in inflammatory or immune systems [35]. In vitro and in vivo studies in children have reported its effectiveness in reducing inflammation, promoting tissue regeneration, and accelerating wound healing [36, 37].

Role of propolis in dentinal hypersensitivity

Dentin hypersensitivity is a common dental issue, affecting 4%-74% of the population. It causes acute pain triggered by stimuli from exposed dentin. A recent study by Alqahtani et al. [38] found that 10% propolis hydrogel can be used as a naturally occurring alternative to commercially available fluoridated desensitizers. Moreover, Sales-Peres et al. [39] reported that propolis acts as a desensitizer by interacting with negatively charged flavonoids and dentinal tubules, forming crystals, and participants experienced reduced hypersensitivity and satisfaction with no pain.

Propolis as a mouthwash

Propolis-based mouthwashes showed potential as natural alternatives to traditional chemical mouthwashes due to their antimicrobial and anti-inflammatory properties. A recent systematic review and an in vitro study have reported their effectiveness in reducing plaque, gingivitis, and the growth of pathogenic bacteria [40, 41]. However, their long-term clinical effectiveness needs to be evaluated and compared to chlorhexidine-based mouthwashes.

Other application of propolis

Antifungal property. Propolis, a flavonoid, has been found to possess antifungal and aflatoxigenic properties against various Candida species, including albicans, parapsilosis, tropicalis, and glabrata. It also exhibits fungicidal and fungicidal properties against yeasts, including Aspergillus flavus. Studies have shown that propolis has strong potential for managing and preventing candidiasis, with its pharmacological properties attributed to phenolic compounds, such as pinobanksin-3-acetate, 3-acetylpinobanksin, p-coumaric acid, caffeic acid, and pinocembrin [42].

Antiherpetic property. Herpes simplex virus (HSV) infections are prevalent worldwide, affecting over 3.7 billion people under the age of 50. They are transmitted through contact with lesions, mucosal surfaces, or oral secretions. Common symptoms include pain, burning, itching, fever, and headache. Propolis’ antiviral pro­perties may be due to its ability to inhibit viral absorption [43].

Propolis has antiangiogenic and antiproliferative properties, causing apoptosis in tongue squamous carcinoma cells. Its polyphenol content, including chrysin, caffeic acid, p-coumaric acid, and ferulic acid, has been studied for potential cancer properties, with methylated phenols inhibiting squamous cell carcinoma proliferation [44].

A study on propolis extract from Indian stingless bees showed promising anticancer properties on various cancer cell lines, including MCF-7, HT-29, Caco-2, and B16F1. Cytotoxicity was found to be concentration-dependent, while apoptosis was observed after 24 hours of treatment with 250 μg/ml propolis extract [45]. Additional research is needed to fully understand its pro-apoptotic activity.

Adverse effects of propolis

Propolis can cause side effects in some individuals, but short-term and long-term effects are unknown due to insufficient research. It is recommended to discontinue the use of propolis-containing products if side effects occur, and immediately consult a healthcare provider. Also, propolis should be avoided if allergic to bee products and in individuals undergoing surgery. It is also a strong sensitizer and allergen, causing eczematous contact dermatitis [46].

In some patients, mouthwashes containing propolis may cause certain undesirable effects, such as teeth discoloration, burning sensation, and unpleasant taste.

Preparations with propolis should be avoided by pregnant or breastfeeding women, children with allergies, and those with known allergies due to insufficient research on its effect [46].

Conclusions

As a natural product, propolis is considered safe, accessible, cost-effective, and does not contribute to microbial resistance. Moreover, propolis has demonstrated its wide range of bioactive properties, making it a valuable alternative to traditional chemical treatments, which can significantly improve oral health outcomes in children. Propolis-based products are now available over the counter.

However, future studies are needed to further explore the mechanisms of action of propolis and to evaluate its long-term clinical efficacy in different populations. Standardization of extraction methods and quality control measures will be essential for ensuring the consistency and reproducibility of propolis-based products.

Disclosures

Funding: This research received no external funding.

Institutional Review Board statement: Not applicable.

Informed consent statement: Not applicable.

Data availability statement: All the data generated or analyzed in this study are included in this manuscript. The data generated in this study may be requested from the corresponding author.

Acknowledgments: None.

Conflicts of interest: The authors declare no conflicts of interest.

AI use statement: Not applicable.

References