Periodontal Ecosystem and Clinical Implications of the Oral Microbiome: A Narrative Review

Periodontal disease, although widely documented, remains one of the leading causes of tooth loss worldwide. This situation can be attributed to patients' difficulty in following treatment protocols and to an incomplete understanding of the disease's mechanisms, which could be explored to develop new therapies.

The present study aimed to summarize the main advances in understanding the periodontal microbiome, especially concerning the development of genetic sequencing technologies and metabolite analysis, as well as new treatment methods that have emerged from these innovations.

A narrative literature review was conducted through searches in the PubMed, Scopus, Web of Science, and SciELO databases, prioritizing publications from the past 15 years while also including classic and foundational studies relevant to the theoretical framework.

Periodontal microbiome results from the synergistic interaction among different microorganisms, rather than just the sum of their individual metabolites. This synergy can create structural microarrangements that resist biofilm disruption, such as fungal barriers surrounding Gram-negative bacteria. Innovative treatments-such as host response modulation with resolvins and oral microbiome modulation, particularly using prebiotics derived from plant extracts (nitrate metabolism)-offer promising prospects. However, limitations remain regarding their clinical use and the challenge of managing refractory cases, highlighting the need for further research to support these findings.