We thank Dr. Roger Santos-Silva for his interest in our article, Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study. In response to his letter, we wish to highlight some risk factors for the development of radiation-related caries.

In the letter, he mentions that clustering of oral complications reduces patients’ quality of life. We would like to emphasize that in the trial, our use of honey was to reduce the severity of radiation-induced mucositis. By doing so, we wished to address this very concern: quality of life.

Hospitalized patients suffering symptoms of oral mucositis will often be advised a soft, sticky, cariogenic carbohydrate diet to preserve the cheaper oral route of feeding and with such cariogenic dietary alterations, whether the addition of honey oral mouth rinses raises the incidence of caries is questionable and requires to be studied. Provision of a non-cariogenic diet for these patients also merits attention.

Several patients recruited to our trial were edentulous and for them radiation-related caries was not a concern. For those with dentition, the cariogenicity of honey would be a genuine problem and rinsing with water some time after topical applications would clear the mouth. The question is: how soon? Again, a study is needed to strike the right balance between oral hygiene and allowing time for topically applied honey to act on irradiated oral epithelium.

Finally, for the patient who benefits from topical honey applications no effort must be spared to prevent radiation-related caries. The use of fluoride mouthrinse, a standard component of oral care regimen for irradiated patients, remineralizes teeth and reduces the development and progression of caries .

We reiterate that honey appears to be a useful adjunct in alleviating symptoms of radiation-induced mucositis. However, we agree that there is a need for a multicentre trial that periodically evaluates dentition of these patients to determine whether the mucositis-limiting benefits of topical honey application are outweighed by its potential cariogenicity.