The Effect of Propolis Tablet on Oral Mucositis Caused by Chemotherapy

  • Maede Salehi
  • Majid Saeedi
  • Anahita Ghorbani
  • Parisa Ghodrati
  • Mahmoud Moosazadeh
  • Sohrab Rostamkalaei
  • Mahdi Babaei Hatkehlouei
  • Tahereh Molania
Keywords: Propolis, mucositis, chemotherapy


Background: Oral mucositis is defined as oral mucosal inflammation in cancer patients that is caused by chemotherapy and/or radiotherapy. Propolis is a natural product produced by bees and has antimicrobial, antioxidant, and anti-inflammatory effects. Therefore, considering the anti-inflammatory properties of Propolis, the aim of this study is to evaluate the efficacy of Propolis tablet on oral mucositis caused by chemotherapy. Materials and Methods: In this randomized, double-blinded, placebo-controlled study, 50 patients were enrolled in the study, and samples were taken from patients on Folfox chemotherapy regimen with colon cancer who were admitted to the Oncology Center of Imam Khomeini Hospital in Sari. The patients were then divided into two groups of 25. The first group received 50 mg Propolis tablets as 2 tablets per day for 21 days and the second group received placebo. All patients were examined by oral medicine specialist after initial examination, weekly and for 3 weeks, and the severity of mucositis was recorded according to WHO criteria. Data analysis was performed in SPSS ver. 22 software using T test and Mann-Whitney and Kruskal-Wallis tests. Results: The age range of the participants in the study was between 26-72 years. In the intervention group 13 women (52%) and 12 men (48%) and in the control group 13 women (52%) and 12 men (48%) participated .In this study, there was a significant difference in the mean of oral mucositis severity in the Propolis group compared to placebo group. In the intervention group, oral mucositis grade was significantly lower in the 2nd and 3rd follow up sessions than in the placebo group (p <0.05). No negative complications were reported by patients. Conclusion: This clinical trial study showed that Propolis tablet could play an important role in preventing and improving the oral mucositis caused by chemotherapy.


Tomaževič T, Jazbec J. A double blind randomised placebo controlled study of propolis (bee glue) effectiveness in the treatment of severe oral mucositis in chemotherapy treated children. Complementary therapies in medicine. 2013;21:306-12.

Mamdoh J,Eman A.Evaluation of anti-inflammatory and antimicrobial effects of Iraqi propolis mouthwash in mucositis patients induced by chemotherapy. International Journal of Enhanced Research in SienceTechnology&Engineering. 2015;4:115.

Gonzalez-Barca E, Carratala J, Mykietiuk A, Fernandez-Sevilla A, Gudiol F. Predisposing factors and outcome of Staphylococcus aureus bacteremia in neutropenic patients with cancer. European Journal of Clinical Microbiology & Infectious Diseases. 2001;20:117-9.

Sonis ST. Mucositis: the impact, biology and therapeutic opportunities of oral mucositis. Oral oncology. 2009;45:1015-20.

RAS Noronha V, S Araujo G, T Gomes R, H Iwanaga S, C Barbosa M, N Abdo E, et al. Mucoadhesive propolis gel for prevention of radiation-induced oral mucositis. Current clinical pharmacology. 2014;9:359-64.

Turner L, Mupparapu M, Akintoye SO. Review of the complications associated with treatment of oropharyngeal cancer: a guide to the dental practitioner. Quintessence international (Berlin, Germany: 1985). 2013;44:267.

Satheeshkumar P, Chamba MS, Balan A, Sreelatha K, Bhatathiri V, Bose T. Effectiveness of triclosan in the management of radiation-induced oral mucositis: a randomized clinical trial. Journal of cancer research and therapeutics. 2010;6:466.

Parolia A, Thomas MS, Kundabala M, Mohan M. Propolis and its potential uses in oral health. International Journal of Medicine and Medical Science. 2010;2:210-5.

Nafiseh Saghafi؛ Zohre Yousofi؛ Fatemeh Homaei Shandiz؛ Monavar Afzal aghaee؛ Masoumeh Javedanmehr. Comparison of efficacy and side effects of propolis with chemotherapy and chemotherapy alone for neoadjuant therapy of ovarian cancer.IJOGI2015;18:1-5

Engelen MJ, Kos HE, Willemse PH, Aalders JG, de Vries EG, Schaapveld M, et al. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer. 2006;106(3):589-98.

Santos VR. Propolis: alternative medicine for the treatment of oral microbial diseases. Alternative Medicine: InTech; 2012;3:304

Farooqui T, Farooqui AA. Beneficial effects of propolis on human health and neurological diseases. Front Biosci (Elite Ed). 2012;4:779-93.

Özan F, Sümer Z, Polat ZA, Er K, Özan Ü, Deḡer O. Effect of mouthrinse containing propolis on oral microorganisms and human gingival fibroblasts. European journal of dentistry. 2007;1:195.

Sforcin J. Propolis and the immune system: a review. Journal of ethnopharmacology. 2007;113(1):1-14.

Kiderman A, Torten R, Furst A, Reinus K. Bi-lateral eosinophilic ulcers in an infant treated with propolis. Journal of dermatological treatment. 2001;12:29-31.

Samet N, Laurent C, Susarla SM, Samet-Rubinsteen N. The effect of bee propolis on recurrent aphthous stomatitis: a pilot study. Clinical oral investigations. 2007;11(2):14.

Benguedouar L, Boussenane HN, Kebsa W, Alyane M, Rouibah H, Lahouel M. Efficiency of propolis extract against mitochondrial stress induced by antineoplasic agents (doxorubicin and vinblastin) in rats. 2008;10:17.

Bruschi M, Lara E, Martins C, Vinholis A, Casemiro L, Panzeri H, et al. Preparation and Antimicrobial Activityof Gelatin Microparticles Containing Propolis Against Oral Pathogens. Drug development and industrial pharmacy. 2006;32:229-38.

Ota C, Unterkircher C, Fantinato V, Shimizu M. Antifungal activity of propolis on different species of Candida. Mycoses. 2001;44:375-8.

Schnitzler P, Neuner A, Nolkemper S, Zundel C, Nowack H, Sensch KH, et al. Antiviral activity and mode of action of propolis extracts and selected compounds. Phytotherapy Research. 2010;24:129.

Brown CG, Wingard J, editors. Clinical consequences of oral mucositis. Seminars in Oncology Nursing; 2004: Elsevier:116-91.

Carrega G, Castagnola E, Canessa A, Argenta P, Haupt R, Dini G, et al. Herpes simplex virus and oral mucositis in children with cancer. Supportive Care in Cancer. 1994;2:266-9.

Babaee N, Moslemi D, Khalilpour M, Vejdani F, Moghadamnia Y, Bijani A, et al. Antioxidant capacity of calendula officinalis flowers extract and prevention of radiation induced oropharyngeal mucositis in patients with head and neck cancers: a randomized controlled clinical study. DARU Journal of Pharmaceutical Sciences. 2013;21:18.

Bolouri AJ, Pakfetrat A, Tonkaboni A, Aledavood SA, Najafi MF, Delavarian Z, et al. Preventing and Therapeutic Effect of Propolis in Radiotherapy Induced Mucositis of Head and Neck Cancers: A Triple-Blind, Randomized, Placebo-Controlled Trial. Iranian journal of cancer prevention. 2015;8:94-105.

AkhavanKarbassi MH, Yazdi MF, Ahadian H, SadrAbad MJ. Randomized double-blind placebo-controlled trial of propolis for oral mucositis in patients receiving chemotherapy for head and neck cancer. Asian Pac J Cancer Prev. 2016;17:3611-4.

Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient,7 th ed. 2008:448-76.

Chaveli-López B, Bagán-Sebastián JV. Treatment of oral mucositis due to chemotherapy. Journal of clinical and experimental dentistry. 2016;8:e201.

Zahmati AH, Alipoor R, Shahmirzadi AR, Khori V, Abolhasani MM. Chemical Decellularization Methods and Its Effects on Extracellular Matrix. Internal Medicine and Medical Investigation Journal. 2017;2:76-83.

Original Research