Other Novel Approaches

With what we now know about the polymicrobial nature of the oral microbiome and the importance of maintaining a symbiotic relationship, controlling disease must include not only maintenance of good oral hygiene, but must focus on environmental and inflammatory/immune factors that drive dysbiosis. These other approaches involve interfering with environmental factors that may drive dysbiosis such as inhibiting growth of pathobionts such as P. gingivalis, reducing nutrient supply of GCF, increasing alkalinity of plaque, inhibiting destructive host pathways, and decreasing inflammatory markers.

Varying the oxygen concentration, pH, and nutrient availability in plaque have all been shown to modulate biofilm microflora and may prove useful. For example, periodontal pathogens require a low redox potential for growth. Addition of a redox agent, such as methylene blue, to periodontal pockets has been shown to inhibit the growth of P. Gingivalis.³⁷ Since increased gingival crevicular flow (GCF) increases the nutrient supply for subgingival biofilm, control of GCF may be used in the future to control subgingival biofilm. Use of novel anti-inflammatory agents such as lipoxins, resolvins, and protectins³⁸ may not only help inhibit destructive host pathways, these anti-inflammatory agents may also reduce the nutrient supply of GCF for the biofilm community. Other popular strategies being introduced are the use of oral probiotics designed to increase the alkalinity of the plaque, while others are targeted towards specific pathogenic organisms eg. S. mutans.¹⁴ A major source of alkalinity occurs during the breakdown of arginine in the oral cavity. Some studies have shown that addition of arginine supplements have been able to inhibit the occurrence of dental caries. Lactobacillus brevis is one probiotic species that has been shown to have superior ability to produce arginine deaminase and has shown substantial decreases in inflammatory markers for periodontal pathogens.^14,39