Introduction
Microbiota refers to the community of living microorganisms in a specific environment, while the microbiome is the collection of their genomes, metabolites, and structural components. A dysbiotic microbiome indicates a harmful shift in the healthy microbial composition. Pathobionts are opportunistic microorganisms that flourish in a dysbiotic environment when the beneficial relationship between the host and the microbiota is disrupted. Environmental changes, such as alterations in diet, the use of antibiotics, and other medications, can lead to the growth of pathobionts.
The oral microbiome is one of the richest and most diverse microbial communities in the human body. Periodontal disease represents a significant dysbiotic shift in the microbiome. Periodontal therapies aim to reduce the levels and proportions of pathogens and promote recolonization of the surfaces with commensal species. Systemic antibiotics are widely used in adjunctive periodontal therapy.
Antibiotics have extended human life expectancy by successfully treating systemic infectious diseases. They have also greatly improved periodontal treatment outcomes as an adjunct therapy. The role of systemic antibiotics in periodontal therapy is well established. Antibiotic-resistant bacteria emerged as a result of their overuse and misuse. By 2050, infections caused by multidrug-resistant bacteria could result in the deaths of 10 million people annually. Beyond promoting the expansion of resistant species, broad-spectrum antimicrobials also eliminate commensal microorganisms and disrupt the microbial balance in distant organs, both of which are essential for maintaining overall health.
Antimicrobial resistance (AMR) is a major global health concern, as antibiotics are becoming less effective against infectious organisms that have developed resistance. The World Health Organization (WHO) has warned about the widespread resistance to common antibiotics worldwide. During the 2015 World Health Assembly, countries adopted a Global Action Plan on AMR, pledging to create and implement multisectoral national action plans using a One Health approach to combat AMR. The goal of this plan is to ensure the continued success of treating and preventing infectious diseases with effective, safe medicines that are used responsibly and accessible to everyone who needs them.
Objective
This narrative review discusses emerging and targeted therapeutic methods aimed at mitigating AMR.
Methods
A literature search was conducted using the National Library of Medicine (MEDLINE/PubMed) database to identify publications on new and emerging antimicrobial approaches for treating oral infections that do not induce antibiotic resistance or dysbiosis in other areas of the body.
Results
Previous studies indicate that targeted antimicrobials aimed at oral pathobionts, as well as locally effective antibiotics applied directly to disease sites, may be effective strategies in reducing the widespread emergence of antimicrobial resistance and minimizing disruption to the microbiota. Selective action is essential for developing a targeted antimicrobial strategy. An ideal antimicrobial treatment should be highly specific to pathogenic microorganisms while preserving the host and its commensal microbiota. In addition to targeted antibiotics and localized drug delivery systems, other promising approaches for addressing issues related to broad-spectrum antibiotics include probiotics, antibodies, phage therapy, photodynamic therapy, and vaccination.
Conclusion
WHO has recommended a global action plan that emphasizes the need for developing novel antimicrobials and innovative therapeutic approaches for treating infectious diseases. Addressing AMR requires a comprehensive approach involving multiple disciplines. Oral health professionals should actively participate in the fight against AMR. There is a need for new methods, the establishment of global education programs, and the development of stricter criteria for dental antibiotics.
