Surgical removal of the third molar is considered the most frequent operation performed in oral and maxillofacial surgery, most often involving mandibular third molars (Jerjes et al., 2010). Postoperative pain, swelling, and trismus are acute reversible sequelae of the procedure, and they are generally regarded as short-term outcomes of third molar disimpaction (Anighoro et al., 2013). Postoperative complications, including localized alveolar osteitis (AO), infection, bleeding, and paresthesia, may occur following third molar surgery. These associated postoperative sequelae and complications influence recovery, and affect patients’ quality of life (Colorado-Bonnin et al., 2006). Therefore, the surgical objective in the removal of impacted mandibular third molars should be the removal of the tooth with minimal sequelae and complications (Renton et al., 2001).

Several attempts have been directed at exploring postoperative sequelae and complications, to discover the most suitable way to prevent or minimize them, and thus improve the postoperative quality of life of patients (Chukwuneke and Onyejiaka, 2007). Several studies have explored different methods of mitigating postoperative sequelae following third molar surgery, with the most commonly researched areas including different surgical closure techniques with or without the incorporation of drains, and the use of drugs such as analgesics, corticosteroids, and antibiotics (Chukwuneke and Onyejiaka, 2007; Obimakinde et al., 2010; Osunde et al., 2011). However, the studies reviewed have not shown the efficacy of any agents used systemically or locally in preventing or reducing postoperative sequelae without other undesirable effects (Tiwana et al., 2005; Chukwuneke and Onyejiaka, 2007; Osunde et al., 2011). Furthermore, observations of the majority of the manifest side-effects, such as a tendency to systemic bleeding, gastrointestinal irritation, and allergic reactions, justify efforts to find a new method of controlling postoperative sequelae that does not induce side-effects (Kazancioglu et al., 2013).

Ample evidence exists to recommend the use of honey in the management of wounds. The beneficial effects of honey in wound healing have been attributed to its antibacterial, anti-inflammatory, and antioxidant properties (Molan, 2002, 2006; Olaitan et al., 2007; Vandamme et al., 2013). Its bioactivity promotes wound healing by helping to keep the wound moist; in addition, it stimulates white blood cells to produce cytokines, particularly interleukin-1, interleukin-6, and tumor necrosis factor, which help to initiate the healing process (Ayub et al., 2013). Moreover, honey has been reported to lower prostaglandin levels and elevate nitric oxide and other products, which play a major role in regulating inflammation (Al-waili et al., 2011).

Honey has been found to be useful in the reduction of acute postoperative pain and the need for analgesics in post-tonsillectomy patients (Hwang et al., 2016), as well as in the management of the pain of alveolar osteitis (Singh et al., 2014). A study by Ayub et al. showed that the application of honey resulted in reduced incidence of wound infection in postextraction sockets (Ayub et al., 2013). Elbagoury and Fayed studied the effects of intrasocket application of natural honey before flap closure after surgical extraction of impacted third molars, and reported less pain and less swelling, as well as a lower incidence of postoperative complications in the honey group compared with the control group, who did not have honey applied (Elbagoury and Fayed, 1985). Moreover, Elbagoury and Rasmy reported that natural honey showed antibacterial action against anaerobic Bacteroides present in dental abscesses and osteomyelitis (Elbagoury and Rasmy, 1993).

The absence of any adverse effects with the use of honey is positively reported in the literature (Al-Waili and Saloom, 1999). Manuka honey is approved for clinical application as a major medical-grade honey (Al-Khanati and Al-Moudallal, 2019), and has been reported to affect the healing of wounds (Malhotra et al., 2017). The analgesic and anti-inflammatory effects of Manuka honey have also been reported in the literature (Al-Khanati and Al-Moudallal, 2019). Furthermore, it has been shown experimentally to be free of any type of microorganism (Schneider et al., 2013).

Despite the reported use and efficacy of honey in managing wounds, there are few studies regarding the effects of honey in treating oral wounds, as well as its application in third molar surgery (Elbagoury and Fayed, 1985; Ayub et al., 2013; Anyanechi and Saheeb, 2015). Our study aimed to examine the effects of honey on surgical extraction wound healing and on postoperative sequelae and complications following mandibular third molar surgery, in order to establish whether the application of manuka honey to the surgical wound following third molar extraction reduced the postoperative sequelae and complications following third molar surgery.