2025/10/14 by Ozge Unlu, Nil Yakar, Alpdogan Kantarci
paper · doi:10.1111/prd.70015
Abstract Background Antibiotics marked a pivotal turning point in human civilization, enhancing social interactions and extending human life expectancy. In addition to their success in treating systemic infectious diseases, they have significantly improved periodontal treatment outcomes as an adjunct therapy. The current status of systemic antibiotics in periodontal therapy is well established. However, antibiotic‐resistant bacteria emerged as a result of their overuse and misuse. It is estimated that by 2050, infections caused by multidrug‐resistant bacteria could result in the deaths of 10 million people annually. Beyond promoting the expansion of resistant species, broad‐spectrum antimicrobials also eliminate commensal microorganisms and disrupt the microbial balance in distant organs, both of which are essential for maintaining overall health. Aim This narrative review acknowledges how the use of systemic antibiotics has contributed to our understanding of the role of microbial factors as therapeutic targets, presents novel and emerging technologies that will advance the field, and highlights emerging strategies aimed at eliminating oral disease‐related microbial species without inducing antimicrobial resistance or causing dysbiosis in distant parts of the body. Materials and Methods A literature search of the National Library of Medicine ( MEDLINE / PubMed ) database was conducted to identify publications related to new and developing antimicrobial approaches for treating oral infections without triggering antibiotic resistance or creating dysbiosis in other parts of the body. Results Previous studies suggest that targeted antimicrobials directed against oral pathobionts and locally effective antibiotics applied at disease sites are potential strategies to reduce the large‐scale emergence of antimicrobial resistance and minimize microbiota disruption. Selective action is fundamental to the development of a targeted antimicrobial strategy: An ideal antimicrobial treatment should be highly specific to pathogenic microorganisms without harming the host or its commensal microbiota. In addition to targeted antibiotics and localized drug delivery systems, probiotics, antibodies, phage therapy, photodynamic therapy, and vaccination are promising approaches for addressing the issues associated with broad‐spectrum antibiotics. Future Directions The WHO has recommended a global action plan that calls for the development of novel antimicrobials or innovative therapeutic approaches for infectious diseases. New methods are required, extensive education programs should be offered worldwide, and stricter criteria for dental antibiotics should be developed using a comprehensive approach.