Treatment challenges and delivery systems in immunomodulation and probiotic therapies for periodontitis

ABSTRACT

Introduction: Periodontitis is a widespread illness that arises due to disrupted interplay between the oral microbiota and the host immune response. In some cases, conventional therapies can provide temporary remission, although this is often followed by disease relapse. Recent studies of periodontitis pathology have promoted the development of new therapeutics to improve treatment options, together with local application using advanced drug delivery systems.

Areas covered: This paper provides a critical review of the status of current treatment approaches to periodontitis, with a focus on promising immunomodulation and probiotic therapies. These are based on delivery of small molecules, peptides, proteins, DNA or RNA, and probiotics. The key findings on novel treatment strategies and formulation of advanced delivery systems, such as nanoparticles and nanofibers, are highlighted.

Expert opinion: Multitarget therapy based on antimicrobial, immunomodulatory, and probiotic active ingredients incorporated into advanced delivery systems for application to the periodontal pocket can improve periodontitis treatment outcomes. Translation of such adjuvant therapy from laboratory to patient is expected in the future.

KEYWORDS:

• Periodontal disease
• periodontitis
• adjuvant therapy
• immunomodulation
• probiotics
• vaccination
• immunization
• nanotechnology
• nanofibers
• local drug delivery

Article highlights

• Periodontopathogens and over-stimulated host immune response are crucial for periodontitis development, which is hard to treat.

• Promising adjuvant therapies to scaling and root planing are immunomodulation and probiotic treatment.

• Immunomodulatory treatment approaches, such as vaccination and inflammation modulation, are in early stages of development.

• The efficacy of probiotic therapy in treatment of periodontitis depends on the probiotic strain, delivery system, as well as route, dosage, and frequency of administration.

• Advanced local delivery systems have a great potential to considerably improve delivery of small molecular entities and biopharmaceuticals and thus treatment outcomes.

• Translation of adjuvant therapies for periodontitis from laboratory to patient is expected in near future.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in this manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

The peer reviewers for this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was supported by the Slovenian Research Agency (Research Core Funding No. P1-0189, and Project J1-9194).