# Study of the Antimicrobial Effect of an Ethanolic Extract of Propolis in Periodantal Disease
## 4 Discussion
Propolis showed an antibacterial activity similar to chlorhexidine in a study that evaluated the ability of these chemicals to inhibit microbial growth obtained from the saliva of healthy and those with chronic periodontitis [34], in agreement with the results of the current study. [PERSON] et al. [35] reported that an ethanolic extract of propolis (EEP) similar to the used in the current study inhibited the growth of all planktonic species as much as chlorhexidine. These authors discussed the antibacterial effects of propolis against many microorganisms. This effect is multifactorial, and as a result, the cytoplasm disintegrates cell membranes and cell walls collapse, bacteria are partially degraded and protein synthesis is inhibited. A previous study has shown that solvents and acidic solutions of propolis are more effective against bacteria and can change the pH and concentration of propolis [36]. In addition, bacterial cell wall and their biofilm properties were concluded as adjunct factors, which determine the bactericidal effect of propolis [37]. Furthermore, it was concluded that the cell walls of bacteria and the properties of their biofilms are supporting factors that determine the bactericidal effect of propolis. Chlorhexidine is a widely used disinfectant and is included in various preparations to prevent infections, such as preoperative skin irrigation, incision preparation, and intraoperative irrigation, and hand antisepsis. However, there are several studies on the safety of chlorhexidine as a wound cleanser and as a local antiseptic around the incision. Previous studies have shown cytotoxicity against naturally proliferating cells [38] and also can be cytotoxic to human fibroblasts, osteoblasts, and lymphocytes in a time and dose-dependent manner [38], which may delay wound healing or lead to increased rates of wound dehiscence. Multiple in vitro studies with Chlorhexidine had demonstrated its cytotoxicity to fibroblast cells [39]. While fibroblasts are a critical cell type in wound healing, myoblasts, osteoblasts are crucial for skeletal muscle repair and bone healing, respectively [40]. Taking into account that the safety of propolis is assured not only by its long history of use as a traditional medicine but also by in vitro and in vivo assessment studies, it is a candidate as an adjunct in periodontal therapies. The use of standardized propolis preparations a safe and less toxic than many other synthetic preparations [41]. Due to the evidence of the link between poor oral hygiene, ongoing chronic inflammation, gingivitis, periodontitis, and systemic diseases such as diabetes, cardiovascular diseases, rheumatoid arthritis and osteoporosis [42], it is essential to achieve periodontal health and stability to avoid bacterial recolonization and bleeding in the oral cavity, using adjuvant therapies that can achieve this objective. It is noteworthy the involvement of the patient in their periodontal maintenance, performing correct oral hygiene at home. In this sense, it has been studied that sonic action heads (SAHs) powered toothbrushes appear to be more effective than brushes with oscillating heads [43], the use of products that do not stain the teeth as propolis and periodic check-ups to control plaque accumulation and gingival inflammation. Future clinical trials in which we test the different administrations of propolis, mouthwashes, toothpastes, chewing gums, ointments, gels to use at home and in the dental office are necessary to better understand their effects and applications.