The Polymicrobial Oral Biofilm

The lengthy search for the identification of specific oral microbes contributing to periodontal disease has progressed over the past 130 years with increasingly newer methods of microbial analysis ranging from darkfield microscopy, transmission electron microscopy, scanning electron microscopy, DNA probes, DNA hybridization, BANA hydrolysis, and immunoassay aiding the search.³¹ Even newer techniques are now available such as metagenomics and meta-transcriptomics, thus enabling researchers to propose that even more diverse periodontitis-associated microbiota may be involved in periodontal disease.³⁴ In addition, the recent discovery of commensal microbial species and their role in maintaining symbiosis, has created a major paradigm shift in the way we now look at oral biofilm. Restoration of microbial symbiosis has now become the focus rather than destruction of all microbes.

Fanas and colleagues in 2021 conducted a study ranking the most prevalent bacterial species present during Stage 2 periodontitis classified according to Socransky’s color complexes and also included a number of health-related species.³⁴ (Table 2) Using newer more advanced techniques and Socransky and Haffajee color complexes, these specific microbe color groups were categorized based on their pathogenicity and prevalence in Stage 2 periodontitis.³⁴