Title: Bacteriophages in the treatment and management of periodontal disease
Abstract:
Antibiotics have been used for more than 70 years and have reduced illnesses and deaths caused by infectious diseases. However, inconsistent and careless use of antibiotics caused bacterial resistance became a matter of major concern and such concern has renewed the interest in bacteriophages. Bacteriophages due to their ability to attack only host bacteria and not human cells are considered as an option for human bacterial diseases treatment. Phage uses a bacterial virulence factor as receptor targeting the “virulent” microbes only. This shows the great potential of using phages as precise tools for microbiota-based therapy. Phage therapy was widely used in the Soviet Union due to the collaboration between Felix d’Herelle and his Georgian colleagues, especially George Eliava(1933 -1934 y). As a result of their studies of bacteriophages, the Institute of Vaccine and Sera in Tbilisi, Georgia produced the first commercial anticholera phage preparation, which reduced the mortality due to cholera in India to 10%. Nowadays Eliava Phage Therapy Center located in Tbilisi, is one of the few centers in the world dedicated to phage therapy. The Eliava Phage Therapy Center has specialists in the fields of Pediatrics, Internal Medicine, Urology, Gynecology and offers treatment strategies with the emphasis of bacteriophages use in the management of many different infectious diseases. A growing number of studies have been conducted in respect of possible applications of phage therapy against oral cavity infections. Infections induced by oral biofilms include caries, as well as periodontal, and peri-implant disease. Biofilm matrix reduces the penetration of antimicrobials. Furthermore, Antibiotic treatment of dysbiotic biofilm also affects protective non-pathogenic flora and can facilitate secondary infections, e.g. candidiasis. Alternatively, microbiota-targeted therapy can be applied to specifically eliminate oral pathogens and re-establish homeostasis. Dental caries and periodontitis affect 91% and 46% of adult western populations, respectively (Dye et al., 2015; Eke et al., 2015), Prevalences of peri-implant mucositis and and peri-implantitis have been estimated as 43% and 22% respectively (Derks and Tomasi, 2015). Epidemiological study conducted in Georgia in 2013-2014 years showed rather high prevalence of periodontal disease and caries respectively 70% and 98%. Good oral hygiene, low dietary carbohydrate intake and non-smoking favor but do not always guarantee oral health due to multifactorial nature of these diseases. If disease develops, conventional therapy is applied. Dysbiotic biofilms are mechanically removed (using dental burs, ultrasonic instruments, periodontal scalers and curettes) and moreover antiseptics, and sometimes antibiotics are added as an adjunct to therapy. Different studies emphasize the possible uses of Bacteriophages in cariology, endodontics and periodontology. The literature review providing the evidence of effective use of bacteriophages in the treatment modalities of oral infectious disorders inspired and motivated our team to find the alternatives of antibiotic therapy in form bacteriophages that could be the perfect adjunct to conventional therapy in the management of periodontal diseases, maximally improving microbiologic parameters and long-term maintenance of periodontal health.
