Oral bacteriophages and their potential as adjunctive treatments for periodontitis: a narrative review.

Background: There is no specific cure for periodontitis and treatment is symptomatic, primarily by physical removal of the subgingival plaque biofilm. Current non-surgical periodontal therapy becomes less effective as the periodontal pocket depth increases and as such new adjunctive treatments are required. The development of antibiotic resistance has driven a recent resurgence of interest in bacteriophage therapy. Methods: Here we review the published literature with a focus on the subgingival phageome, key oral pathobionts and the dysbiotic nature of periodontitis leading to the emergence of synergistic, proteolytic and inflammophilic bacterial species in subgingival plaque. We discuss the opportunities available, the barriers and the steps needed to develop bacteriophage therapy as an adjunctive treatment for periodontitis. Results: The oral phageome (or virome) is diverse, featuring abundant bacteriophage, that could target key subgingival bacteria. Yet to date few bacteriophages have been isolated and characterised from oral bacterial species, although many more have been predicted by genomic analyses. Bacteriophage therapy has yet to be tested against chronic diseases that are caused by dysbiosis of the endogenous microbial communities. Conclusion: To be effective as an adjunctive treatment for periodontitis, bacteriophage therapy must cause the collapse of the dysbiotic bacterial community, thereby resolving inflammation and enabling the reestablishment of a health-associated mutualistic subgingival bacterial community. The isolation and characterisation of novel oral bacteriophage is an essential first step in this process.