Newest research connecting the oral microbiome to systemic diseases such as heart and lung diseases, cancer, autoimmune diseases, and even possibly Alzheimer's disease, has shed new light on the importance of oral health. Joining the 2nd AIRS International Conference on Genomics and Microbiomics in Barcelona, DrBonnie presents new discoveries in research, technology, and upcoming companies focusing on bringing oral care to the forefront of health and well-being.

1. Chew on this!
The oral health
revolution

2. What
happens
when you
kiss?

3. Did you
know?
the human oral cavity is
home to a rich microbial
flora, including bacteria,
fungi, and viruses.

4. Living in
microbial
sub-habitats:
tongue
teeth
saliva
gums
ear, nose, throat
Operative Dentistry

5. The oral
microbiome
is influenced
by numerous
factors:
Journal of Dental Research

6. These factors
affect the
balance
and imbalance
of the oral
microbiome
Balance – characterized by
healthy diet, plaque control,
good oral hygiene.
Imbalance – influenced by
poor diet, inadequate plaque
control, lifestyle risk factors,
bad oral hygiene.

7. The transition
in biofilm from
Balance
Imbalance
Journal of Fungi

8. Imbalance
can lead to oral
diseases in varying
biogeographies of
the mouth.
Protein and Cell

9. Dental caries
occur when acid
from bacteria
demineralize
the enamel.
Frontiers in Microbiology

10. The Ecological Plaque Hypothesis
Caries (Tooth Decay)
Stres
s
Environmental
Change
Ecological
Shift
Disease
Increased
acid
production
Increased
low pH
challenges
mutans streps
lactobacilli
bifidobacteria
(others)
Caries risk
https://www.cda.org/Portals/0/journal/journal_102017.pdfAdapted from:

11. Periodontal
disease
occurs
when bacteria
infiltrate the
gum crevices.
Frontiers in Microbiology

12. Stress
Host
Response
Environmental
Change
Ecological
Shift Disease
Increased
plaque
Increased
inflammation
High GCF
flow,
bleeding,
raised pH
& C˚
Gram-
negative
bacteria;
anaerobic;
proteolytic
Gingivitis/
periodontal
disease
The Ecological Plaque Hypothesis
Periodontal Disease
https://www.cda.org/Portals/0/journal/journal_102017.pdfAdapted from:

13. An estimated
47.2% of
American
adults have
mild to severe
gum disease.

14. The mouth
is the first
meeting place
between the outside
environment and our
immune systems.

15. The mouth –
body
connection
oral vascularization
allows bad bacteria to
travel to other parts of
the body.
Protein and Cell

16. Autoimmune
diseases with
links to the oral
microbiome
Sjogren’s Syndrome
Rheumatoid
Arthritis
Inflammatory Bowel
Disease (IBD)
Lupus

17. So, what
can we do?

18. Food can help
maintain the
balance
of the oral
microbiome
Drink water– Healthy human
saliva has a pH of 7.4. Water
helps to normalize the pH of
your mouth.
Eat Alkaline – Foods such as
broccoli, cucumber, and
Himalayan salt are high pH (>7)
and help to offset
acidic foods.

19. Saliva production is reduced
at night time. Night eating
correlates with increased
dental plaque and gingival
inflammation.
Limit eating
during
night time
Operative Dentistry

20. Exercise…but
choose low-sugar
sports drinks
Exercise may improve
periodontal disease through
activation of the immune
system and reduction in
inflammatory cytokines.
Therapeutics and Clinical Risk Management

21. What’s new
in
oral care?

22. Consumer - based Science - based
Convergence of consumer demand and
science-based discoveries in oral care

23. 1. Oral care
tools
Oral care is now easier and
cooler than ever with
subscription-based
toothbrush plans and a
NASA space compound
toothpaste formula.

24. 2. Rinses and
mouthwashes
New developments and
breakthroughs in nanotechnology
have offered preventative
alternatives which target biofilms
and harmful bacteria while
promoting re-mineralization.

25. 3. Supplements
The newest products in
oral care: probiotics and
prebiotics to help balance
the oral microbiome and
support the growth of ‘good’
bacteria.

26. Company What Product Learn more
Boka combines natural
ingredients & modern science
to heal your mouth & nourish
your body.
Toothpaste
Contains: nano-
hydroxyapatite
https://www.boka.com/
quip is an oral care company
that believes good design in
products produces better oral
health outcomes.
Toothbrush
Vibrating brush
with automated
upkeep
https://www.getquip.com/
Elementa utilizes a new
generation of plant based
nanosilver technology to
neutralize oral acids and reset
the biofilm environment in a
healthy way.
Mouthrinse
Nano Silver
technology
penetrates
through plaque
barriers, &
neutralizes oral acid.
https://elementasilver.com/

27. Company What Product Learn more
A biotechnology company that
developed the world’s first
oral probiotic to support
mouth and throat health.
Probiotic
2.5 billon CFU of
S. salivarius strains
K12 & M18
https://blis.co.nz
Natural and time-released
probiotic formulas for women,
children, immune support, oral
probiotics, and gut health.
Probiotic
3 billon CFU of
S. salivarius strains
K12 & M18
https://www.hyperbiotics.com/
Supplemental oral care
prebiotics using microbial
science to manage bacteria
and balance oral ecology.
Prebiotic
(SMMRT)
to manage
oral bacteria
https://dailydentalcares.co
m/site/

28. Phage Therapy

29. Using phage
therapy to
manage
biofilm
formation
Journal of Oral Microbiology

30. Potential
bacterial targets
for phage
therapeutics
Journal of Biotechnology

31. Want to
discover
more?
Email drbonnie360@gmail.com for
sample inquiries of oral products
Download oral microbiome ebook for
more information and tips on how to
maintain oral microbial balance
Explore all of the research in our
visual annotated bibliography
(attached to slides below)

32. Dr. Bonnie Feldman, DDS, MBA
As Your Autoimmunity Connection, we
consult with startup companies and
entrepreneurs who are bringing new
products and services that will improve
research, diagnosis, and treatment for
autoimmunity.
DrBonnie360’s mission is to create a
digitally connected world of personalized
care for autoimmune patients.
drbonnie360.com
drbonnie360@gmail.com
http://bit.ly/2iKVEQj
@DrBonnie360
linkedin.com/in/bonniefeldman
(310)666-5312
Content & Visual Design by: Hailey Motooka

33. Exploring the
Oral
Microbial
Ecosystem

34. Marsh, Philip D. “Ecological Events in Oral Health and Disease: New
Opportunities for Prevention and Disease Control?” CDA Journal,
vol. 45, no. 10, Oct. 2017.
Changes to the oral environment
drive deleterious shifts in the
microbiome (dysbiosis).
Prevention of oral diseases such
as dental caries and periodontal
disease depend not only on
biofilm control but also eliminating
drivers of dysbiosis.
Host-microbe
interactions perturbed
Oral disease
Systemic disease
Bad diet
Poor plaque control
Low saliva flow
Altered host defense
Lifestyle risk factors
Broad spectrum antibiotics
Dysbiosis

35. Biological properties that confer stability in the microbiome are important for the prevention of
dysbiosis—a microbial shift towards disease. Oral health reflects the ability of the oral
ecosystem to adapt to and counteract perturbing stresses, where the oral ecosystem is
defined as the oral microbiota, the saliva and host (mucosal) immunity.
The oral cavity harbors approximately 700 different, mostly anaerobic species. This study
investigated the effects of intimate kissing on the oral microbiota of 21 couples. In controlled
experiments of bacterial transfer, researchers determined there was an average total
bacterial transfer of 80 million bacteria per intimate kiss of 10 seconds.
Kort, Remco, et al. “Shaping the Oral Microbiota through Intimate Kissing.”
Microbiome vol. 2, no. 1, 2014, p. 41., doi:10.1186/2049-2618-2-41.
Egija Zaura et al. “Acquiring and maintaining a normal oral microbiome: current
perspective,” Frontiers in Cellular and Infection Microbiology (2014): 85. https://.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4071637/

36. Devine, Deirdre A. et al. "Modulation of host responses by oral commensal bacteria.”
Journal of oral microbiology 7 (2015). <http://www.journaloforalmicrobiology.net/>
Immunomodulatory commensal bacteria are proposed to be essential for maintaining healthy
tissues, including priming immune responses to ensure rapid and efficient defenses against
pathogens. The default state of oral tissues is one of inflammation, which may be balanced by
regulatory mechanisms and anti-inflammatory resident bacteria.
Bacteria within the oral cavity play an integral role in biofilm formation. The formation of
biofilm of the plaque is a complex and rapidly evolving process involving several stages of
development. Bacteria first bind irreversibly to solid surfaces. Once bound, they mature,
disperse, and are able to colonize new habitats within the mouth.
Krzyściak, Wirginia et al. "The Role of Human Oral Microbiome in Dental Biofilm
Formation.” InTech. N.p., n.d. Web. <http://www.intechopen.com/books/microbial-
biofilms-importance-and-applications/the-role-of-human-oral-microbiome-in-
dental-biofilm-formation>

37. The Biomes
of the
Oral Cavity
TONGUE
TEETH
SALIVA
GUMS
EAR, NOSE, THROAT

38. Hall, Michael W., et al. “Inter-Personal Diversity and Temporal Dynamics of
Dental, Tongue, and Salivary Microbiota in the Healthy Oral Cavity.” Npj
Biofilms and Microbiomes, vol. 3, no. 1, 2017, doi:10.1038/s41522-016-0011-
0.
Oral bacterial communities that inhabit
supragingival plaque, and saliva are
clearly distinct from one another. The
difference in biological and physical
properties of the tongue dorsum and
supragingival surface reflects the
distinctiveness of the corresponding
microbial communities.

39. Sun, Beili, et al. “Evaluation of the Bacterial Diversity in the Human Tongue
Coating Based on Genus-Specific Primers for16S RRNA Sequencing.”
BioMed Research International, vol. 2017, 2017, pp.1–12.,
doi:10.1155/2017/8184160.
The characteristics of tongue coating are potential determinants for disease diagnosis in
traditional Chinese medicine (TCM). Through 16 rRna sequencing, results indicated that the
richness of the bacterial communities in the patients with thin tongue coating and healthy
controls was higher than in patients with thick tongue coating.

40. Costalonga, Massimo, and Mark C. Herzberg. “The Oral Microbiome and
the Immunobiology of Periodontal Disease and Caries.” Immunology
Letters, vol. 162, no. 2, 2014, pp. 22–38., doi:10.1016/j.imlet.2014.08.017.
Microbial communities of the tooth
surface and irregularities in the
enamel differ depending on diversity
and richness. Surfaces and sites with
highest diversity and richness within
ecological niches are most
susceptible to caries. When caries
are established, the acid environment
reduces the diversity and richness of
the local microbiota.

41. Struzycka, Izabela. “The Oral Microbiome in Dental Caries.” Polish
Journal of Microbiology, vol. 63, no. 2, Feb. 2014, pp. 127–135.
Caries develop as a result of an ecological imbalance in the stable oral microbiome.
Oral microorganisms form dental plaque on the surfaces of teeth, which is the cause of the
caries process, and shows features of the classic biofilm.
Nasry, Bishoy, et al. “Diversity of the Oral Microbiome and Dental Health and
Disease.” International Journal of Clinical & Medical Microbiology, vol. 1, no. 2,
2016, doi:10.15344/2456-4028/2016/108.
During conditions of health or disease, the oral environment experiences cycles of
demineralization and remineralization that occurs on tooth surfaces. When the
demineralization and remineralization equilibrium shifts to a net loss of hydroxyapatite,
tooth decay occurs.

42. Zaura, Egija et al. "On the ecosystemic network of saliva in healthy
young adults." The ISME Journal (2017). <http://www.nature.
com/ismej/journal/vaop/ncurrent/ full/ismej2016199a.html>.
The saliva ecosystem is composed
mainly of the salivary microbiome,
salivary metabolome, and host
related biochemical salivary
parameters. An over-specialization
toward either a proteolytic or a
saccharolytic ecotype may indicate a
shift toward a dysbiotic state.

43. Glurich, Ingrid et al. “Progress in Oral Personalized Medicine: Contribution of
‘omics.’” Journal of Oral Microbiology 7.0 (2015): 28223.
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561229/>.
Recent advances in genomics and related ‘omics’ are providing evolving understanding of
oral personalized medicine. Functional gene signatures detected in caries-associated saliva
microbiome profiles have been associated with systemic disease, suggesting that these
profiles can also help to predict diseases as well.
Yang, Fang et al. “Characterization of Saliva Microbiota’s Functional Feature Based
on Metagenomic Sequencing.” SpringerPlus 5.1 (2016): 2098. PMC. Web. 18 Jan.
2017. <http://link.springer.com/article/10.1186/s40064-016-3728-6>.
Research suggests organismal structure of saliva microbiota is correlated with disease states
such as caries, gingivitis and periodontal disease. Thus, organismal structure of saliva
microbiota can potentially serve as a proxy for the oral health of the host through site-specific
signatures and functional profiles of the saliva microbiota.

44. Lof, Marlos, et al. “Metabolic Interactions between Bacteria and Fungi in
Commensal Oral Biofilms.” Journal of Fungi, vol. 3, no. 3, 2017, p. 40.,
doi:10.3390/jof3030040.
The oral microbial interactome is not complete without detailed information about the fungi in
the oral cavity. Fungi have often only been studied in relation to disease, which gives an
overall wrong impression about these microorganisms. Therefore, the beneficial role fungi
may have has been overlooked.
Kolenbrander, Paul E., et al. “Oral Multispecies Biofilm Development and the
Key Role of Cell–Cell Distance.” Nature Reviews Microbiology, vol. 8, no. 7,
Jan. 2010, pp. 471–480., doi:10.1038/nrmicro2381.
Oral bacteria evolved to form biofilms on hard tooth surfaces and on soft epithelial tissues, which
often contain multiple bacterial species. Factors involved in the formation of these biofilms include
the initial adherence to the oral tissues and teeth, cooperation between bacterial species in the
biofilm, the role of signaling between the bacteria in pathogenesis, and the transfer of
DNA between bacteria.

45. Liu, Bo, et al. “Deep Sequencing of the Oral Microbiome
Reveals Signatures of Periodontal Disease.” PLOS ONE,
vol. 7, no. 6, Apr. 2012, doi:10.1371/journal.pone.
A proliferation of pathogenic
bacteria within the mouth gives rise
to periodontitis, an inflammatory
disease known to also constitute a
risk factor for cardiovascular
disease. We reveal the diseased
microbiome to be enriched in
virulence factors, and adapted to a
parasitic lifestyle that takes
advantage of the disrupted host
homeostasis.

46. Schwarzberg, Karen, et al. “The Personal Human Oral Microbiome Obscures
the Effects of Treatment on Periodontal Disease.” PLoS ONE, vol. 9, no. 1, 2014,
doi:10.1371/journal.pone.0086708.
Recent Next-Generation Sequencing (NGS) studies of the microbial diversity associated with
periodontitis have revealed strong, community-level differences in bacterial assemblages associated
with healthy or diseased periodontal sites. Deeper phylogenetic analysis of periodontal pathogen-
containing genera Prevotella and Fusobacterium found both unexpected diversity and differential
treatment response among species.
Yost, Susan, et al. “Potassium Is a Key Signal in Host-Microbiome Dysbiosis in
Periodontitis.” PLOS Pathogens, vol. 13, no. 6, 2017,
doi:10.1371/journal.ppat.1006457.
Periodontitis is a polymicrobial inflammatory disease that affects a large proportion of the world's
population and has been associated with a wide variety of systemic health conditions, such as
diabetes, cardiovascular and respiratory diseases. Levels of potassium in the periodontal pocket
could be an important element in of dysbiosis in the oral microbiome.

47. Hajishengallis, George. “Periodontitis: from Microbial Immune Subversion to
Systemic Inflammation.” Nature Reviews Immunology, vol. 15, no. 1, 2015, pp.
30–44., doi:10.1038/nri3785.
The transition from periodontal health to disease is associated with a dramatic shift from a
symbiotic microbial community to a dysbiotic microbial community composed mainly of
anaerobic genera. Persistence of dysbiotic oral microbial communities can mediate inflammatory
pathology at local as well as distant sites outside of the oral cavity.
Dysbiotic microbial communities of keystone pathogens and pathobionts are thought to exhibit
synergistic virulence whereby not only can they endure the host response but can also thrive by
exploiting tissue-destructive inflammation, which fuels a self-feeding cycle of escalating dysbiosis
and inflammatory bone loss, potentially leading to tooth loss and systemic complications.
Hajishengallis, George. “Immunomicrobial Pathogenesis of Periodontitis:
Keystones, Pathobionts, and Host Response.” Trends in Immunology, vol. 35, no. 1,
2014, pp. 3–11., doi:10.1016/j.it.2013.09.001.

48. Proctor, Diana M., and David A. Relman. “The Landscape Ecology and
Microbiota of the Human Nose, Mouth, and Throat.” Cell Host & Microbe,
vol. 21, no. 4, 2017, pp. 421– 432., doi:10.1016/j.chom.2017.03.011.
Landscape ecology refers to the
relationships between spatial
arrangement and processes that give
rise to patterns in local community
structure. The mouth, nose, and throat
are all different landscapes that, when
analyzed spatially, can help us to further
understand the physiological factors that
govern microbial community composition,
function, and ecological traits that
underlie health and disease.

49. The Mouth-
Body
Connection

50. Rosier, B.t., et al. “Resilience of the Oral Microbiota in Health:
Mechanisms That Prevent Dysbiosis.” Journal of Dental Research,
vol. 97, no.4, 2017, pp 371380.,doi10.1177 /002203451774 2139.
Health-maintaining mechanisms that
limit the effect of disease drivers
involve interrelationships that
develop within dental biofilms and
between biofilms and the host.
Health maintaining mechanisms
include ammonia production, limiting
drops in pH that can lead to caries,
and denitrification.

51. Nikitakis, Ng, et al. “The Autoimmunity-Oral Microbiome Connection.”
Oral Diseases, vol. 23, no. 7, 2016, pp. 828–839., doi:10.1111/odi.12589.
Increasing evidence links dysbiosis of the oral microbiome to various autoimmune diseases
such as Sjögren’s Syndrome (SS), systemic lupus erythematous (SLE), Crohn’s disease
(CD), and rheumatoid arthritis (RA).
Babu, Nchaitanya, and Andreajoan Gomes. “Systemic Manifestations of
Oral Diseases.” Journal of Oral and Maxillofacial Pathology, vol. 15, no. 2,
2011, pp. 144–147., doi:10.4103/0973-029x.84477.
Periodontitis is a polymicrobial inflammatory disease that affects a large proportion of the world's
population and has been associated with a wide variety of systemic health conditions, such as
diabetes, cardiovascular and respiratory diseases. Levels of potassium in the periodontal
pocket could be an important element in of dysbiosis in the oral microbiome.

52. The link between oral health and systemic health may be explained by periodontal
pathogens. The periodontum presents a large, inflamed surface area that is rich in dysbiotic
microbes. Frequent transient bacteremia exposes the system to chronic, low-grade
inflammation.
Parashar, Amit, et al. “Interspecies Communication in Oral Biofilm: An Ocean of
Information.” Oral Science International, vol. 12, no. 2, 2015, pp. 37–42.,
doi:10.1016s1348-8643 (15)00016-6.
Within oral biofilms, resident bacterial cells interact with one another and exchange messages in
the form of signaling molecules and metabolites. Signaling between bacteria may have important
implications for the virulence of oral pathogens. When assessing the ability of oral bacteria to
cause disease, it is essential to consider the community in its entirety.
Nelson-Dooley, Cass. “The Mouth, the Oral Microbiome, and Systemic
Inflammation.” Health First Consulting, 27 Jan. 2018,
healthfirstconsulting.com/uncategorized/the-mouth-the-oral-microbiome-and-
systemic-inflammation/.

53. Moutsopoulos, Niki M., and Joanne E. Konkel. “Tissue-Specific Immunity at
the Oral Mucosal Barrier.”Trends in Immunology, vol. 39, no. 4, 2018, pp. 276–
287., doi:10.1016/j.it.2017.08.005.
The gingiva is a constantly stimulated dynamic environment where homeostasis is often
disrupted, resulting in the common inflammatory disease periodontitis. Unique signals tailor
immune functionality at the gingiva where a specialized network polices this oral barrier.
Rosier, B.t., et al. “Resilience of the Oral Microbiota in Health: Mechanisms
That Prevent Dysbiosis.” Journal of Dental Research, vol. 97, no. 4, 2017, pp.
371–380., doi10.1177/002203 4517742139.
The transition from periodontal health to disease is associated with a dramatic shift from a
symbiotic microbial community to a dysbiotic microbial community composed mainly of
anaerobic genera. Persistence of dysbiotic oral microbial communities can mediate
inflammatory pathology at local as well as distant sites outside of the oral cavity.

54. Lundgren, Jennifer D. “The Relationship of Night Eating to Oral Health and
Obesity in Community Dental Clinic Patients.” General Dentistry, vol. 58, no. 3,
May 2010.
Night eating can negatively effect your oral health. People who engage in night eating often do
not brush or floss afterwards, and less saliva is produced at night, both of which can contribute
to an increased risk of developing periodontal disease. Obesity and night eating are also
heavily correlated.
Omori, S et al. “Exercise habituation is effective for improvement of
periodontal disease status: a prospective intervention study.” Therapeutics
and Clinical Risk Management. 14: 565–574. 2018.
Exercise could be a possible therapeutic intervention for periodontal disease. The results
showed that there were significantly reduced probing pocket depth (PPD) and number of
teeth bleeding on probing (BOP), two commonly used measurements of periodontal disease
in the exercise intervention group.

55. Beyond
Bacteria

56. Witherden, Elizabeth A., et al. “The Human Mucosal Mycobiome
and Fungal Community Interactions.” Journal of Fungi, vol. 3,
no. 4, July 2017, p. 56., doi:10.3390/jof3040056.
There are various fungal communities
within our mouths that engage with
bacterial communities. These fungal
communities show significant variation
between different body habitats and
with changes in disease status. Such
variations have a significant role in host
homeostatic responses and
pathologies.
Oral Microbiome
Gut Microbiome
Oral Mycobiome
Gut Mycobiome

57. Lof, Marloes, et al. “Metabolic Interactions between Bacteria and Fungi in
Commensal Oral Biofilms.” Journal of Fungi, vol. 3, no. 3, 2017, p. 40.,
doi:10.3390/jof3030040.
The healthy oral cavity is characterized by a great microbial diversity, including both bacteria
and fungi. In the oral cavity of healthy individuals, over 100 fungal species have been
identified, with Candida as the most prevalent species. Presence of C. albicans in biofilm
decreases cariogenic potential of plaque by decreasing acidity within the mouth.
Sultan, Ahmed S., et al. “The Oral Microbiome: A Lesson in
Coexistence.” PLOS Pathogens, vol. 14, no. 1, 2018,
doi:10.1371/journal.ppat.1006719.
The ecological balance in the oral cavity is maintained through antagonistic as well as
mutualistic interspecies interactions. Bacterial streptococci have been shown to provide C.
albicans with a carbon source for growth as well as adhesion sites for fungi to persist within
the oral cavity.

58. Ly, M., et al. “Altered Oral Viral Ecology in Association with Periodontal
Disease.” MBio, vol. 5, no. 3, 2014, doi:10.1128/mbio.01133-14.
The human oral cavity is home to a large and diverse community of viruses.
Most of the viruses that inhabit the saliva and the subgingival and supragingival biofilms are
predators of bacteria. Dental plaque viruses in periodontitis were predicted to be significantly
more likely to kill their bacterial hosts than those found in healthy mouths.
Baker, Jonathon L et al. “Ecology of the Oral Microbiome: Beyond Bacteria”
Trends in microbiology vol. 25,5 (2017): 362-374.
A comprehensive understanding of the oral microbiota and its influence on host health and
disease will require a holistic view that emphasizes interactions among different residents
within the oral community, as well as their interaction with the host.

59. Parmar, Krupa M., et al. “Intriguing Interaction of Bacteriophage-Host
Association: An Understanding in the Era of Omics.” Frontiers in
Microbiology, vol. 8, 2017, doi:10.3389/fmicb.2017.00559.
Innovations in next-generation sequencing and microbial studies through omics: genomics,
transcriptomics, proteomics, and metabolomics have allowed researchers to discover
phylogenetic affiliation and functions of bacteriophages and their impact on microbial
communities.
Szafrański, Szymon P., et al. “The Use of Bacteriophages to Biocontrol Oral
Biofilms.” Journal of Biotechnology, vol. 250, 10 Jan. 2017, pp. 29–44.,
doi:10.1016/j.jbiotec.2017.01.002.
Many oral infections such as caries, periodontal disease, and peri-implant disease are induced
by biofilm accumulation, influencing quality of life, systemic health, and expenditure. As bacterial
biofilms become increasingly resistant to antibacterial therapy, biocontrol of biofilms through
bacteriophage therapy may be the future of oral treatments.

60. Ly, Melissa, et al. “Altered Oral Viral Ecology in Association with Periodontal
Disease.” MBio, vol. 5, no. 3, 20 May 2014, doi:10.1128/mbio.01133-14.
This study compares oral microbial compositions between healthy individuals and individuals
with periodontal disease. Viruses inhaling dental plaque were significantly different on the
basis of oral health status, while those present in saliva were not. Dental plaque viruses in
periodontitis were predicted to be more likely to kill their bacterial hosts than those found in
health mouths.
Edlund, Anna, et al. “Bacteriophage and Their Potential Roles in the Human
Oral Cavity.” Journal of Oral Microbiology, vol. 7, no. 1, 2015, p. 27423.,
doi:10.3402/jom.v7.27423.
The oral cavity contains vast oral phage communities that have been implicated in the
acceleration of microbial diversity of their bacterial hosts. Both host and phage mutate to gain
evolutionary advantages through acquisition of new gene functions by lysogenic conversion.
Such evolutionary advantages include antibiotic resistance.

61. Silveira, Cynthia B. “Piggyback-the-Winner in Host-Associated Microbial
Communities.” Biofilms and Microbiomes, no. 2, 6 July 2016,
doi:10.1038/npjbiofilms.2016.10.
Piggyback the winner model suggests that switching to lysogenic life cycle reduces phage
predation control on bacterial abundance. The model predicts that lysogeny is favored at the
top of mucin concentration gradients (biofilms) and lytic predation predominates in the
bacteria-sparse intermediary layers .
Tetz, George, and Victor Tetz. “Bacteriophages as New Human Viral
Pathogens.” Microorganisms, vol. 6, no. 2, 16 June 2018, p. 54.,
doi:10.3390/microorganisms6020054.
Researchers suggest that bacteriophages have different ways to indirectly interact with
eukaryotic cells and proteins, leading to human diseases. Though the underlying mechanisms
are not completely understood, bacterial viruses should be further explored as diagnostic
treatment target for therapeutic intervention