Exploring the potential of extracellular matrix modulation to modify oral biofilm architecture

Biofilms are well-organized, surface-attached colonies of microorganisms that can thrive in host cavities. A balanced, diverse mix of protective microbes in these biofilms helps preserve host health. Dysbiosis in biofilms is responsible for consequential diseases in associated tissues. Dietary factors and other xenobiotics can cause ecological dysbiosis in the oral cavity that underpins dental caries, periodontal diseases, halitosis, and periapical infections. Although the gold standard for oral biofilm elimination remains mechanical removal, it is achieved with manual curettage or an ultrasonic scaler. However, the removal of non-pathogenic microorganisms, which contribute to chemical signaling and metabolic complementation of the host, thereby produces deleterious side effects. Therefore, to maintain ecological balance, alternatives are a major area of research. A 'control without killing' approach to modulating biofilms focuses on maintaining biofilm ecology rather than indiscriminately using antimicrobial agents. The extracellular matrix (ECM) of a biofilm protects the embedded microbial communities; measures that disintegrate it can emerge as a promising modality to control the growth of pathogenic microbes in them. Currently, research focuses on limiting virulence traits (acid production, protease activity, or quorum sensing) to degrade the ECM and slow pathogen growth without eliminating commensals. This article highlights current research on approaches to managing oral cavity biofilms and the translational challenges they pose. Understanding these alternative approaches can help formulation researchers, microbiologists, and materials science experts work integratively to manage microbial biofilms. This article opens gateways to implementing oral biofilm-modulating strategies in the management of other biofilm-associated infections.