Clinical takeaways
- Oral microbiota transplantation (OMT) may be a future option for refractory halitosis. For patients who haven't responded to conventional care, this emerging approach targets the underlying microbial imbalance rather than just reducing bacterial load.
- Donor periodontal health matters. The protocol requires a healthy donor (ideally someone close to the patient) to pass a full periodontal evaluation -- a a healthy periodontium reflects a healthy oral microbiome.
- Biofilm disruption via prophylaxis is a key first step. The recipient undergoes thorough prophylaxis before receiving donor bacteria, reinforcing that scaling and prophy are therapeutically meaningful, not just preparatory.
Researchers at the University of Washington (UW) School of Dentistry are conducting what they believe to be the first clinical trial of oral microbiota transplantation to treat chronic halitosis, according to a UW news article.
The unconventional treatment could offer a potential new option for patients who have not responded to conventional care.
Halitosis is caused by anaerobic bacteria that accumulate on the tongue and in the periodontal sulcus, where they break down organic matter and release sulfur compounds. It's these microbial imbalances, researchers believe, that are the cause of chronic bad breath.
"We know the oral microbiome can get out of whack. The question is, can you rebalance it? That is the hypothesis we're proposing," said Dr. Alvin Wee, MS, PhD, a professor of restorative dentistry and co-lead of the project.
Modeled on fecal microbiota transplantation
Researchers drew inspiration from studies using fecal microbiota transplantation (FMT), which has become a standard intervention for recurrent Clostridioides difficile infection and other gut dysbioses. The application follows a similar logic: Introduce a healthier microbial community to displace the pathogenic one.
The oral transplant procedure begins with a full periodontal evaluation of the donor -- ideally an intimate partner, family member, or trusted friend of the patient -- to confirm a healthy oral microbiome. Bacteria are then collected from the donor and suspended in saline. Meanwhile, the recipient undergoes a thorough prophylaxis to disrupt the existing biofilm. The patient rinses with the donor solution and receives a concentrated injection of the preparation along the gumline. At 90 days, participants self-report changes in breath quality.
"What we're trying to do is severely disrupt the original bacteria, and then we bring in the new guys to take hold and establish a new biofilm," co-investigator Alex Pozhitkov, PhD, a research scientist and affiliate faculty member in the UW School of Dentistry, said in the article. "If we bring enough of the new bacteria and they outcompete the ones that we disrupted, the healthy ones will take over. It's a numbers game."
Early stages, ongoing enrollment
The team has completed four transplants to date. The investigators are actively recruiting donor-recipient pairs. To learn more, clinicians can contact Alex Pozhitkov at [email protected] or Alvin Wee at [email protected].
