Evaluation of phage therapy in odontogenic infections: systematic review

Abstract

Introduction: Phages are natural viruses that their hosts are bacteria. the method uses phages to treat bacterial infections called "phage therapy". Phage therapy was be mentioned by d'herelle in 1919 for the first time. Gradually by appearance of antibiotics and their extensive uses, importance of phage therapy was faded. Nowadays studies around phage therapy have been resumed. in dentistry it has applications in different fields such as dental caries, periodontitis, endodontics,… . In this article we specially reviewed the effect of phage therapy in dental root canal infections specially in recurrent and resistant cases and evaluate phages infecting pathogens which induced RCT failure such as Enterococcus faecalis. Materials and methods: In this systematic review, articles in the databases of Google Scholar, PubMed and SCOPUs were searched within 2000-2020. All information are classified into a table. results: In searching the aforementioned databases and considering the given time interval, 85 articles were found in connection to the searched keywords and abstracts. Once the repeated titles and articles were deleted, 40 studies were selected which were decreased to 19 by the meticulous review by the assessment team. The full text of these 19 articles were reviewed. To make the final choice, 9 articles had the inclusion criteria which included the objectives of this study. conclusion: Phage therapy has been proven to be more effective , in some cases , than conventional antibiotics , especially regarding multidrug-resistant biofilm infections.one of the rich sources of bacteriophages is oral cavity where phages appear as virions and prophages in lysogenic bacteria. As well they play an important role in oral ecological equilibrium. Concerning advantages of phage therapy and priority to antibiotics, this treatment as an alternative therapeutic method was found to be highly effective against biofilm and MDR bacteria. The potential of phage therapy in dentistry, in particular againt E. faecalis biofilms in root canals has studied in this review. Enterococci specially E. faecalis have been isolated from cases with root canal treatment failure and persistant infections of root canals as dominant culture. Isolated anti E. faecalis phages can be efficacious to prevent E. faecalis infection after root canal treatment. As example phage EFDG1 is a highly effective bacteriophage against pathogenic E. faecalis in the treatment of root canal infection refractory to conventional endodontic therapy. In addition, there are many anti E. faecalis phages that isolated and recognized. We therefore propose that phage therapy could be used to treat not only antibiotic-resistant E. faecalis infections in dental root canals but other aspects of dentistry such as periodontic infection, periimplantitis , oral ulcers , … .