Periodontal disease is an inflammatory condition characterized by progressive destruction of the tooth-supporting tissues and a shift from a symbiotic to a dysbiotic oral microbial community, rather than by a single pathogen. This review aimed to synthesize current evidence on how alterations in microbial composition, community structure, and functional activity contribute to periodontal disease severity and progression. A comprehensive literature search across four databases (PubMed, Web of Science, Google Scholar, and Embase) was conducted. Studies were included if they were peer-reviewed, human studies published between 2000 and 2026, and met the predefined inclusion and exclusion criteria. Twenty-two articles met these criteria and were analyzed for relationships between microbial patterns and clinical peritoneal outcomes. Across the studies reviewed, periodontal disease severity was consistently associated with compositional shifts in the oral microbiome rather than changes in overall microbial diversity or bacterial load. Increased prevalence and abundance of red-complex organisms, including Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were strongly associated with worsening clinical parameters, whereas Aggregatibacter actinomycetemcomitans showed a stronger association with aggressive disease phenotypes. Functional analyses further revealed enrichment of inflammatory and metabolic pathways, which support the concept of functional dysbiosis as a factor influencing tissue destruction. Interventions that modified local ecological conditions or host-microbe interactions demonstrated improved microbial profiles and clinical outcomes. These findings reinforce the idea that periodontal disease management is not just about targeting a single pathogen; it should focus on restoring microbial homeostasis and regulating the host's inflammatory response. Adopting this approach will help to create a more effective and personalized treatment strategy for the patient that will likely improve their symptoms, help prevent periodontal disease progression, and reduce their risk of developing complications associated with chronic oral inflammation.
Patel et al. (2026) studied this question.