Microbial role in periodontitis: Have we reached the top? Some unsung bacteria other than red complex

The microbial etiology of periodontal disease has been the focus of researchers for a long time. The search for the pathogens of periodontal diseases has been underway for more than 100 years, and continues up today. Despite the increasing knowledge about oral microbiota, we are not able to implicate any one particular organism that can be considered as a candidate pathogen. In fact the term “candidate pathogen” has lost its steam with a myriad of microorganisms being incriminated from time to time. Most studies of the bacterial etiology of periodontitis have used either culture-based or targeted deoxyribonucleic acid approaches and so it is likely that pathogens remain undiscovered. The advent of 16S cloning and sequencing has facilitated identification of several uncultivable bacteria in the oral cavity. The concept that not one single organism, but several organisms contained in the biofilm orchestrating in a medley of the show appears to be more plausible. The present review highlights some lesser known bacteria associated with periodontal destruction.