Microbiota-based therapies in oral health and disorders

The human oral microbiome is a complex, dynamic ecosystem critically involved in maintaining oral health and contributing to systemic well-being. Many bacteria and fungi are involved in oral cavities such as Penicillium, Rhodotorula, Saccharomycetales, Streptococcus, Veillonella, Neisseria, Actinomyces, and Schizophyllum. Disruption of microbial homeostasis, or dysbiosis, underpins a wide spectrum of oral diseases, including dental caries, periodontal disease, endodontic infections, and mucosal conditions. Recent advances in microbiome research have elucidated the mechanisms by which pathogenic microbial consortia, such as the red complex (Porphyromonas gingivalis, Tannerella. forsythia, and Treponema denticola), synergistically promote disease progression through virulence factors, metabolic interactions, and biofilm formation. Emerging microbiome-based therapies, comprising probiotics, postbiotics, predatory bacteria, and using bacteriophages, offer promising adjuncts or alternatives to traditional antimicrobial approaches by restoring microbial balance, reducing pathogenic load, and modulating host immune responses. For instance, probiotic strains like Streptococcus salivarius and Lactobacillus spp. have demonstrated efficacy in reducing plaque, gingival inflammation, and pathogenic bacteria, as well as having significant immunological modulation, while postbiotics provide similar benefits with enhanced safety and stability. Additionally, predatory bacteria such as Bdellovibrio bacteriovorus show potential for selective bacterial elimination and combating periodontal diseases that are driven by Gram-negative anaerobes. Bacteriophages offer another precision tool for targeting oral pathogens by lysing bacteria upon replication. Finally, oral microbiota transplantation aimed at treating periodontal disease by restoring a balanced microbial community in the oral cavity. These innovative strategies, combined with a nuanced understanding of biofilm dynamics and host-microbe interactions, pave the way for personalized and ecologically sustainable oral health interventions. Continued research is essential to translate these promising approaches into clinical practice, optimize delivery systems, and elucidate long-term safety and efficacy.