Oral diseases akin to gingivitis, periodontitis, caries, pulpitis, and abscesses are common but treatable ailments that have plagued humanity for thousands of years. These diseases, yielding increased pain when chewing, tooth loss, and oral deformations, result from an imbalance in the local microbiota due to improper or inconsistent preventative maintenance. While many of these infections are specific to the surface and immediate subsurface gingival layer, more serious infections can fester deep within these tissues, causing periapical tissue inflammation and degradation Recent studies have demonstrated that around 59% of all root canal procedures result in some degree of periapical pathosis, deeply imbedded within the bone and difficult to access for treatment. Periapical lesions pose a high risk of morbidity, severe pain, systemic infection, and even severe loss of bone (i.e., periapical periodontitis) and/or facial structure. This risk is further exasperated in combat situations like those seen during Operation Iraqi Freedom and Operation Enduring Freedom, which saw 20-25% deployed soldiers experienced a dental emergency, with nearly half requiring endodontic intervention. To return our warfighters to combat, and ensure their long-term effectiveness, it is vital that we better understand this disease and how to most efficiently and effectively control it. Apical periodontitis related infections are commonly populated by specific genera of bacteria such as Actinomyces, Campylobacter, Dialister, Eubacterium, Enterococcus, Filifactor, Fusobacterium, Olsenella, Parvimonas, Peptostreptococcus, Porphyromonas, Propionibacterium, Pseudoramibacter, Streptococcus, Tannerella, Treponema, and Veillonella. Naturally occurring bacteriophages have been documented for few of these genera and there is still a pertinent knowledge gap present. Additionally, apical periodontal infections are traditionally treated with antibiotics. However, the total removal of both pathogenic and nonpathogenic bacteria potentially allows for the establishment and proliferation of harmful fungal populations in these deep tissue spaces. A treatment to target the pathogenic bacteria to control oral infections long-term is needed. Phage-derived proteins have potential to be used as a treatment method for infections stemming from apical periodontitis but must be further explored and refined. Our lab currently has plaque and saliva samples obtained from patients suffering from periapical lesions for further use in metagenomic analysis of both bacterial and fungal populations. Additionally, we have partnered with wastewater treatment facilities to obtain wastewater for the discovery of bacteriophages specific to the microbial populations associated with periapical lesions. The observed phages will be recorded and further analyzed for potential use in phage-therapy for the treatment of hard-to-reach periapical lesions, while maintaining a healthy population of beneficial microbes.

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