The antibacterial efficacy of isolated bacteriophages against periodontal biofilms: A systematic review of in vitro studies

Abstract

Background and aim: Periodontitis is a widespread, irreversible disease that threatens the oral health and quality of life of adult individuals. Antibiotics have been used to systemically treat periodontitis in combination with mechanical therapy, but they are increasingly resisted by the human microbiome. Phage therapy has been proposed to exhibit antibacterial activity, consequently, replace the use of antibiotic drugs. This study aimed to identify and summarise the current in vitro evidence of phage therapy’s effectiveness against periodontal biofilm.

Methods: The PubMed, Web of Science, and Ovid (Embase) databases were searched to identify in vitro literature that investigated phage therapy as a treatment for periodontal biofilm using search terms referring to periodontal biofilm and bacteriophages. The literature was screened by reading the titles and abstracts to identify studies to be read fully, and inclusion and exclusion criteria were also applied. Thereafter, the included studies were processed to extract relevant study characteristics and general outcomes before performing quality assessments.

Results: Ten publications were found to meet the inclusion criteria. All of these studies indicated that bacteriophages exhibited significant antibacterial activity against monospecies biofilms comprised of the micro-organisms F. nucleatum, E. faecalis, S. mutans, or A. actinomycetemcomitans. Regarding bacteriophage resistance, only one study reported resistance of E. faecalis biofilm after 24 hours, and the remaining studies did not report resistance activity.

Discussion and conclusion: Recent in vitro studies suggest the use of phage therapy as a novel systemic periodontal treatment. However, a specific phage for use against P. gingivalis remains undetected. Moreover, the antibacterial efficacy of phage therapy against complex periodontal biofilms is still unclear.