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Gum disease /Periodontitis

The oral microbiome – an update for oral healthcare professionals

Kilian.et.al - 2016

Relevance :

1212 in 2024

Conclusion :

Improved understanding of the holobiont – current and future implications for clinical practice

The diverse community that makes up the oral microbiome is finely tuned by nature to protect from disease, and it is of great importance to maintain its natural diversity. Modern lifestyles can disturb and upset the natural balance of our oral microbiome, and our clinical goal should be to re-establish its symbiotic equilibrium by whatever means are necessary and appropriate in the individual patient.

Thus, it is pivotal that both patients and healthcare professionals embrace the concept of a balanced oral microbiome and its importance in oral and systemic health. Treatment sessions should include prevention strategies, such as advice on oral hygiene practices and on diet and smoking. As a first approach, active maintenance of health rather than management of disease should be the primary concern for caregivers and patients alike.

Oral healthcare professionals can achieve this by educating patients on appropriate lifestyle choices and the application of effective plaque control techniques that preserve dental biofilms at levels compatible with oral health. This approach allows for the beneficial properties of the resident microbiota to be maintained while the risk of dental disease from excessive plaque accumulation is reduced. Once dysbiosis occurs, the treatment goal should be to re-establish the lost harmonious balance by keeping good oral hygiene and modifying lifestyle factors such as diet and smoking. Indiscriminate use of antibiotics for the treatment of oral diseases should be avoided, aiming to safeguard the beneficial oral microbiota and avoid antibiotic resistance.

For the control of caries, in addition to use of topical fluoride, measures should be taken that encourage a shift away from an acidic environment, through reduction in the amount and frequency of the consumption of sucrose and acidic drinks (even if the latter are sugar-free), together with supplementation with agents that can reduce acid production and/or promote alkali generation within dental plaque. For periodontal disease, treatment strategies should aim for mechanical reduction of accumulated biofilm by mechanical removal of plaque back to levels compatible with oral health.

This would reduce inflammation and the accompanying flow of GCF, and promote a favourable microenvironment to support formation of a balanced microbiome. Where relevant, patients should also be advised on smoking cessation and control of diabetes.

Our current understanding of this rapidly evolving scientific field supports the notion that clinical practice needs to shift from its historical focus on management of caries and periodontitis by elimination of the microbiota, to a new focus on proactive management of oral health through an ecological approach to the holobiont. Future directions may include individual assessment of the microbiome and the host response for the early detection of subjects at high risk, and personalised approaches to restore a health-associated oral microbiome after dysbiosis – potentially tantalising developments that would have direct implications for patient management in clinical practice.

Keywords:

oral healthcare oral microbiome

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