Fungi—A Component of the Oral Microbiome Involved in Periodontal Diseases

The human oral cavity is a diverse ecological niche favorable for colonization by hundreds of different species of microorganisms. They include not only bacteria but also numerous species of fungi, many of which are able to cause opportunistic infections when the host's immunity is impaired, predominantly by systemic and chronic diseases like diabetes, pulmonary diseases, renal disorders, or acquired immunodeficiency syndrome. Within the dental biofilm and subgingival sites, fungi of the genus Candida are often found, also in individuals affected with periodontitis. Moreover, fungal species of other genera, including Malassezia, Aspergillus, Penicillium, and Rhodotorula were identified in the oral cavity as well. The wide range of various virulence factors and mechanisms displayed by fungal pathogens allows them effectively invading host tissues during periodontal infections. These pathogenicity-related mechanisms include firstly the fungal ability to adhere successfully to the host tissues closely related to the formation of hyphae, the increase in the surface hydrophobicity, and the surface display of a wide variety of adhesins. Further mechanisms include biofilm formation and secretion of an armory of hydrolytic enzymes and toxins enabling the attack on host cells, modulation of the local inflammatory state, and evading the host immune system. In the pathogenesis of periodontitis, the significant role of fungal co-existence with key bacterial periodontopathogens has been demonstrated, and such interactions were primarily confirmed for Candida albicans and Porphyromonas gingivalis, where the presence of fungi ensured the survival of strictly anaerobic bacteria under unfavorable aerobic conditions. However, several other mechanisms, including those related to the production of quorum sensing molecules, might also be indicated as particularly important for synergistic or antagonistic interactions with a variety of bacterial species within mixed biofilms. These interactions constitute an extraordinary challenge for applying effective methods of combating biofilm-related infections in the periodontium without the risk of the development of drug resistance, the recurrence of disease symptoms, and the progress of life-threating systemic complications.