Treatment

The goal of periodontal treatment is to control biofilm and prevent pathogenic bacteria from spreading within the oral cavity³⁰ and into other body systems. Manual periodontal treatments can be supplemented with local or systemic antibiotics in order to target pathogens in the oral cavity as well as systemically.³⁰ Systemic drugs however should be used as a last resort and only if other treatments have not been successful, given recent concerns with antibiotic resistance. If possible, genomic analysis of the individual patient’s oral microbiome would provide valuable information enabling the clinician to prescribe the appropriate drug that would specifically target the pathogens present.³⁰ Use of salivary microorganisms could also be beneficial in the future for diagnosing diseases, such as periodontal disease, oral squamous cell carcinoma, and pancreatic cancer because the bacterial composition differs from that of healthy individuals.²⁹

Periodontal treatment along with lifestyle modification can be very beneficial when working toward a healthier oral environment. For instance, smoking can negatively affect the composition of subgingival microorganisms, which can increase the risk for developing periodontal disease. In addition, smoking can impact the “symbiotic and commensalistic relationships” between subgingival microbes. However, it is encouraging to note that tobacco cessation can result in a decrease of pathogenic bacteria and an increase in beneficial bacteria, such as Veillonella parvula.²⁹ Therefore, any information that dental professionals can provide patients regarding tobacco cessation will be greatly appreciated. In addition, referrals to local providers who specialize in the subject can be very helpful for patients looking for counseling and guidance in the process.

In the future, BALOs, or Bdellovibrio-and-like organisms, which act as predators that target and kill anaerobic, Gram-negative bacteria may be helpful for treating periodontal disease. Since predator-prey interactions are highly strain specific, it would be imperative to identify which bacteria are present before utilizing BALOs.³⁰ However, there is a drawback, because they have only been studied in laboratory settings, rather than clinical settings. Unfortunately, when tested in a laboratory setting, BALOs had difficulty functioning in anaerobic environments, which would make it impossible to prey on the anaerobic bacteria that reside deep within periodontal pockets.³⁰ Perhaps future scientific advancements will enable BALOs to target periodontal bacteria in a live patient.