Microbial analytical methods have been instrumental in elucidating the complex microbial etiology of periodontal diseases, by shaping our understanding of subgingival community dynamics. Certain pathobionts can orchestrate the establishment of dysbiotic communities that can subvert the host immune system, triggering inflammation and tissue destruction. Yet, diagnosis and management of periodontal conditions still rely on clinical and radiographic examinations, overlooking the well‐established microbial etiology. This review summarizes the chronological emergence of periodontal etiological models and the co‐evolution with technological advances in microbial detection. We additionally review the microbial analytical approaches currently accessible to clinicians, highlighting their value in broadening the periodontal assessment. The epidemiological importance of obtaining culture‐based antimicrobial susceptibility profiles of periodontal taxa for antibiotic resistance surveillance is also underscored, together with clinically relevant analytical approaches to guide antibiotherapy choices, when necessary. Furthermore, the importance of 16S‐based community and shotgun metagenomic profiling is discussed in outlining dysbiotic microbial signatures. Because dysbiosis precedes periodontal damage, biomarker identification offers early diagnostic possibilities to forestall disease relapses during maintenance. Altogether, this review highlights the underutilized potential of clinical microbiology in periodontology, spotlighting the clinical areas most conductive to its diagnostic implementation for enhancing prevention, treatment predictability, and addressing global antibiotic resistance.

中文翻译：

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牙周病的微生物诊断


微生物分析方法通过塑造我们对龈下群落动态的理解，有助于阐明牙周病复杂的微生物病因学。某些病原体可以协调建立失调的群落，从而破坏宿主的免疫系统，引发炎症和组织破坏。然而，牙周疾病的诊断和治疗仍然依赖于临床和放射学检查，忽视了已明确的微生物病因学。这篇综述总结了牙周病原学模型的出现时间以及与微生物检测技术进步的共同进化。我们还回顾了临床医生目前可以使用的微生物分析方法，强调了它们在扩大牙周评估方面的价值。还强调了获得基于培养的牙周类群抗菌药物敏感性特征对抗生素耐药性监测的流行病学重要性，并在必要时结合临床相关的分析方法来指导抗生素治疗的选择。此外，在概述失调微生物特征时讨论了基于 16S 的群落和鸟枪法宏基因组分析的重要性。由于生态失调先于牙周损伤，因此生物标志物识别提供了早期诊断的可能性，以防止维护期间疾病复发。总而言之，这篇综述强调了临床微生物学在牙周病学中未充分利用的潜力，重点关注最有利于其诊断实施的临床领域，以增强预防、治疗可预测性和解决全球抗生素耐药性。