Integrated anaerobic culture and molecular approaches for periodontal pathogens: Advancements in microbial detection...

Periodontal diseases are polymicrobial infections driven by complex interactions between anaerobic pathogens and host immune responses within the periodontal pocket. Accurate detection and characterization of these pathogens are critical for early diagnosis, disease risk assessment, and effective therapeutic intervention. This review aims to critically evaluate conventional anaerobic culture and advanced molecular diagnostic techniques for the detection and characterization of periodontal pathogens, highlighting their respective advantages, limitations, and clinical relevance. A comprehensive analysis of existing literature was conducted focusing on traditional culture-based approaches and emerging molecular technologies, including polymerase chain reaction (PCR), quantitative PCR (qPCR), 16S rRNA gene sequencing, next-generation sequencing (NGS), and multi-omics strategies such as metagenomics, metatranscriptomics, proteomics, and metabolomics. Anaerobic culture remains the gold standard for microbial isolation, enabling phenotypic characterization, antimicrobial susceptibility testing, and functional studies. However, it is labor-intensive, time-consuming, and limited in detecting fastidious, slow-growing, or viable-but-non-culturable microorganisms. In contrast, molecular techniques offer rapid, sensitive, and comprehensive detection of key periodontal pathogens, including Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Advanced omics approaches further provide insights into microbial functionality, virulence, and host-microbe interactions. Nevertheless, molecular methods are limited in assessing microbial viability and antimicrobial susceptibility. The integration of culture-based and molecular diagnostic approaches enhances diagnostic accuracy and supports early, targeted therapeutic interventions. This combined strategy facilitates personalized treatment planning, improves clinical outcomes, and helps reduce inappropriate antimicrobial use in periodontal therapy. Both anaerobic culture and molecular diagnostics possess distinct yet complementary strengths. An integrated diagnostic approach combining phenotypic and high-resolution molecular techniques is essential for improving diagnostic accuracy, enabling personalized treatment strategies, advancing precision periodontal care, and contributing to Good Health and Well-Being through improved oral health outcomes and responsible antimicrobial stewardship.