The role of microbiota and epithelial barrier interaction in the pathogenesis of periodontal diseases: a systematic review

Relevance. Periodontitis and gingivitis are a significant concern in modern dentistry due to the persistently high global prevalence of gingivitis and periodontitis. This study aims to review and systematize current scientific knowledge regarding the role of increased epithelial permeability in the gingival sulcus in the pathogenesis of these diseases. It also explores key aspects of the interaction between the oral microbiota and the epithelial barrier.

Materials and Methods. A systematic analysis of scientific articles and original research was conducted using the PubMed, Google Scholar, and eLIBRARY databases. From an initial pool of 1,536 publications spanning 2004 to 2024, 53 articles were selected, comprising in vivo and in vitro studies as well as review articles. The findings from these studies are summarized in this review.

Results. Emerging evidence indicates that disturbances in the mucosal microbiota can modulate both innate and adaptive immune responses. Beneficial bacteria may trigger antimicrobial defense mechanisms through host immune responses or directly counteract periodontopathogens that compromise the epithelial barrier. Epithelialmesenchymal transition (EMT) is a critical mechanism through which epithelial cells lose their characteristic properties, altering their phenotype. These changes can result in basement membrane degradation and a loss of epithelial barrier integrity, ultimately contributing to periodontal pocket formation and the infiltration of pathogenic microorganisms into oral tissues. Intercellular junctions, particularly tight junctions, are vital for maintaining the stability and functionality of epithelial cells, playing a crucial role in these processes.

Conclusion. Impairment of the epithelial barrier, particularly increased permeability, facilitates the infiltration of microbial pathogens and may lead to dysbiosis, exacerbating epithelial damage in the gingival sulcus and contributing to the progression of periodontal diseases. When evaluating increased epithelial permeability in the gingival sulcus, it is essential to consider factors such as the presence of periodontopathogens, their metabolites, the expression of tight junction proteins, and genetic predispositions.

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