ADJUNCTIVE MANUKA HONEY ORAL RINSE IN NONSURGICAL PERIODONTAL THERAPY FOR HEMODIALYSIS PATIENTS: A RANDOMIZED CONTROLLED CLINICAL STUDY.

To evaluate the clinical effectiveness of adjunctive Manuka honey oral rinse following nonsurgical periodontal therapy (NSPT) in hemodialysis patients with periodontitis, and to explore associated changes in periodontal clinical parameters (clinical attachment level [CAL], probing depth [PD], bleeding on probing [BOP], and plaque index [PI]), selected inflammatory biomarkers (gingival crevicular fluid fibroblast growth factor-23 [FGF23] and serum C-reactive protein [CRP]), and oral health-related quality of life (OHIP-14). In this randomized, blinded, controlled clinical trial, 140 hemodialysis patients with Stage III periodontitis were allocated to NSPT with Manuka honey oral rinse (n = 70) or NSPT with saline rinse (n = 70). CAL was the primary outcome. Secondary outcomes included PD, BOP, PI, gingival crevicular fluid FGF23, serum CRP, and OHIP-14. Periodontal parameters were assessed at baseline, 3, and 6 months. Gingival crevicular fluid and venous blood samples were collected with sterile paper strips and before the hemodialysis session, respectively. The periodontal parameters were recorded at baseline, 3, and 6 months, whereas the biomarkers and OHIP-14 were recorded at baseline and 6 months. Both groups showed significant intragroup improvements in periodontal parameters over time (P < .001). At 6 months, the Manuka group demonstrated significantly greater improvements compared with controls in CAL mean difference = -0.5 mm (95% CI: -0.86 to -0.14; P = .008), PD (P = .013), and BOP (P = .005), while plaque index did not differ significantly between groups (P > .05). In addition, the Manuka group showed a greater reduction in GCF FGF23 and serum CRP levels (P ≤ .001). Improvements in OHIP-14 scores were also significantly greater in the Manuka group (P = .003). Adjunctive use of Manuka honey oral rinse with NSPT was associated with modest additional improvements in periodontal clinical outcomes and reductions in inflammatory biomarkers in hemodialysis patients. These findings suggest a potential supportive role for Manuka honey as an adjunctive periodontal therapy in medically compromised populations; however, the observed biomarker changes should be interpreted with caution, as systemic clinical outcomes were not assessed. The study was registered at Clinical Trials.gov on December 9, 2024 with the number (NCT06726876).