The most common oral infectious diseases are caries, endodontic infections, periodontitis and peri-implantitis. Early diagnosis and total control of these conditions remain a major challenge for clinicians. In this review, we describe infectious oral diseases and evaluate critically the current treatment strategies using a holistic aetiological approach. We draw attention to the local environment, the micro-ecology, where opportunistic pathogens may survive and thrive. We explain why elimination of bacteria from the disease site is probably not feasible and may not be critical; acceptance of this idea would represent a paradigm shift in understanding these conditions. We demonstrate that a crucial step for long-term success of treatment interventions and shift from disease to health involves a change in the local environment to create conditions in which pathogenic bacteria cannot survive and grow. We argue that measures that do not entail local micro-ecological change at affected sites will fail to prevent the recurrence of infectious oral diseases. Our further hope is that the idea of micro-ecology in dentistry will provide a model and pedagogical tool that will help clinicians, in their quest to counter oral diseases of infectious origin, to evaluate treatment approaches in dental care.
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