Is microbiome analysis the future of periodontal diagnostics?

In recent years the microbiome, which means all bacteria, or the total microbiota, occurring in a specific ecosystem, has reached the focus of scientific attention.

New molecular biological methods, above all the "next generation sequencing" (NGS), enable the analysis of the microbiome, and thus provide an overview of all bacterial species that are found in an certain habitat of the human body, e.g. in the intestine or in the oral cavity.

Recently, various research groups have also analyzed the microbiome of periodontal pockets. As a result of these studies, it was occasionally postulated that the current approach of analyzing selected marker bacteria of periodontitis is not effective, since only a detection of all microorganisms in the oral cavity would make it possible to measure the efficacy of the chosen therapy.

Max Koltzscher, microbiologist and laboratory manager at Carpegen GmbH is an expert in molecular biology and comments on this theory as follows: "Most certainly the etiology of periodontitis is extremely complex and a large number of bacterial species can be found in periodontal pockets as it is shown in new NGS studies. However, the detection of all these pathogens with the aim of optimizing and monitoring periodontal therapy is still not useful for a variety of reasons: To this date the clinical situation cannot be correlated to a specific composition of the microbiome as well as the available bioinformatics is not yet able to analyze the enormous amount of data with relevance to periodontal therapy. "

In addition, extensive microbiome studies also show that in severe periodontitis, which correlates with a comprehensive conversion of the subgingival biofilm, in particular the numbers of the bacteria of the orange and red complex – associated in the nineties by Socransky with periodontitis – increase significantly.

According to the scientist this is not surprising: “The results of decades of scientific research on these pathogens are not becoming invalid simply because of the nowadays possibility of undirected microbiome analyzes. Future studies will show whether the additional bacteria identified using the new methods have a pathogenic potential comparable to the classical marker bacteria, or whether they are mostly opportunistic commensals."

"By applying a validated and quantitative microbiological diagnostic test, such as Carpegen Perio Diagnostics, the conversion of the biofilm can be reliably analyzed by the detection of some marker pathogens. At the same time, diagnostics meets an important requirement for avoiding resistances: the selection of the most efficient antibiotic targeted at the pathogen in question and with the narrowest spectrum of efficacy and few side effects,”says Koltzscher. This would also comply with the principles of antibiotic therapy by the "Commission Anti-Infectives, Resistance and Therapy" at the Robert Koch Institute: "Microbiological diagnostics is of great importance, since the best possible therapy can only be carried out if the causative agent is known."