Review Explores Potential Alternative Non-Antibiotic Therapies to Manage Periodontal Disease

In a publication in the Journal of Applied Microbiology, the authors reviewed possible alternative strategies for managing periodontal disease (PD), especially advanced stages of PD, including PD infections.

The authors noted that the inability to eliminate periodontal pathogens entirely often results in a recurrence of PD, and due to the insufficiency of current therapy and augmented rates of microbial resistance against existing antimicrobial agents and lack of novel antimicrobial agents, there is a necessity to develop more effective agents and therapy options for the management of PD.

The authors also indicated that numerous alternative/non-conventional means of treating PD infections have revealed promising results in both in vitro and preclinical studies, and in small clinical trials, a few of these alternative therapies have demonstrated meaningful clinical outcomes.

The authors wrote, “This review provides an overview of the possible use of bacteriophages, lysins, honey, plant extracts, metallic salts, nanoparticles, and vaccines as alternative therapeutic agents against periodontal infections. The information provided here could help in designing alternative therapeutics for the treatment of periodontal infections.”

The review indicated that bacteriophages, phytochemicals, phototherapy, probiotics, prebiotics, nanoparticles (NPs), and vaccines might have roles as alternate therapies for the management and treatment of PD, and while there are advantages, there are also disadvantages and limitations associated with these therapies.

Examples of critical points noted by the authors include the following:

• The critical disadvantage to phage therapy is the potential for developing phage-resistant bacteria, and experimental data have demonstrated the development of phage-resistant bacteria in different animal and human studies.
• They wrote, “ Phytochemicals and phyto-extracts may act as better alternatives than conventional antibiotics and bacteriophages against periodontal pathogens as most of them act on multiple targets, so it is very unlikely that microbes will develop resistance against them. However, herbal therapies may take longer to cure.” The authors also indicated that, in some cases, the use of phytochemicals and plant extracts has the potential to trigger allergic reactions and other ADRs.
• Clinical trial results showed that probiotic strains can provide oral health benefits; however, there are some incidences where probiotic strains became pathogenic, although the incidence is rare.
• Metallic salts and nanoparticles (NPs), while effective, when used at higher concentrations, can produce toxic/harmful effects to host cells.
• Vaccine development against pathogens is always optimal for the prevention/reduction of infectious disease development; nevertheless, since a large number of different pathogens causes PD infections, the authors wrote, “ it will not be so easy to target and develop vaccines against individual pathogens.”

The authors concluded, “Despite these few disadvantages, alternative therapeutics possess great opportunities to be considered for the treatment of periodontal infections, as they can act on existing antibiotic-resistant microbes. “

Finally, the authors indicated that large clinical trials involving alternative therapies are warranted to validate their efficacy and safety. When applicable, the clinical data obtained from large trials can be employed to ascertain the best approach to managing and treating PD with these alternative therapies.

Reference:

Vishnu Das, Vivek Vinod, Lalitha Biswas, Anil Kumar, Raja Biswas, An update on possible alternative therapeutics for future periodontal disease management, Journal of Applied Microbiology, Volume 134, Issue 1, January 2023, lxac039, https://doi.org/10.1093/jambio/lxac039.