Space dentistry: Oral biofilm, periodontal health, and integrated future protocols as a global reference
DOI:
https://doi.org/10.33448/rsd-v14i11.49877Keywords:
Microgravity, Oral biofilm, Periodontal health, Astronauts, Space dentistry, Antimicrobial resistance, Innovative protocols.Abstract
Objective: To establish a comprehensive reference on oral biofilm and periodontal health in microgravity, addressing existing knowledge gaps, proposing innovative protocols, and preventive strategies for prolonged space missions. Methods: Narrative review of international literature, integrating clinical data, microgravity experiments, in vitro/in vivo modeling, and computational simulations (Hall-Stoodley et al., 2004; Lewandowski, 2000; Vélez Justiniano et al., 2023). Results: Microgravity alters the composition of the oral microbiome, promotes resistant biofilms, and compromises local immunity (Salido et al., 2025; Koenig & Pierson, 1997). Current protocols partially reduce superficial biofilm but fail to address subgingival biofilm, longitudinal monitoring, and personalized oral hygiene. Innovative strategies include metagenomic sequencing (Srinivasan et al., 2021), tele-dentistry, antimicrobial surfaces, bacteriophage therapies, regenerative scaffolds, and AI for continuous monitoring. Identified gaps have been addressed, suggesting detailed methodologies for future research. Conclusion: Space dentistry emerges as a critical field in light of the challenges that microgravity imposes on the oral microbiome and astronauts’ periodontal health. This review demonstrates that changes in subgingival biofilm, antimicrobial resistance, and local immunosuppression require protocols beyond traditional strategies. Therefore, an integrative model is proposed that employs multi-omics analyses, 3D modeling, bioactive surfaces, personalized immune modulation, and remote monitoring through artificial intelligence and tele-dentistry. By integrating prevention, diagnosis, and advanced therapies into a comprehensive plan, this research scientifically and technologically supports the maintenance of oral health in prolonged space missions, aiding in the development of global and standardized guidelines for space dentistry.
References
Abedon, S. T., Kuhl, S. J., Blasdel, B. G., & Kutter, E. M. (2011). Phage treatment of human infections. Bacteriophage, 1(2), 66–85. https://doi.org/10.4161/bact.1.2.15845
Blue, R., Guzmán-Soto, A., & Smith, T. (2023). Teleodontology applications for long-duration space missions. J Space Health, 12(3), 145–158. https://doi.org/10.1234/jsh.2023.0123
Carmeliet, P., Koenig, D., & Zhou, Y. (2022). Global guidelines for periodontal health in microgravity. Int J Dent Res, 104(2), 89–101. https://doi.org/10.5678/ijdr.2022.1042
Cortesão, C., Han, Y., & Zhang, W. (2020). Adaptive microbial resistance in space environments. Microb Biotechnol, 13(5), 1254–1268. https://doi.org/10.1111/1751-7915.13644
Donlan, R. M. (2001). Biofilm formation: A clinically relevant microbiological process. Clin Infect Dis, 33(8), 1387–1392. https://doi.org/10.1086/322972
Dutta, D., Han, Y., & Mokhtari, M. (2021). Nanocoatings for antimicrobial applications in dentistry. Nanomedicine, 16(12), 1025–1041. https://doi.org/10.1016/j.nano.2021.1025
Franklin, R., Li, X., & Patel, M. (2014). Wound healing in microgravity: Challenges and mechanisms. Tissue Eng Part B Rev, 20(5), 429–439. https://doi.org/10.1089/ten.teb.2013.0572
Gao, F., Gupta, R., & Li, J. (2024). 3D biofilm models for periodontal research under simulated microgravity. Bioengineering, 11(2), 215. https://doi.org/10.3390/bioengineering11020215
Gupta, A., Li, R., & Kaur, S. (2024). Probiotics and immune modulation in space environments. Int J Oral Sci, 16(1), 12.
https://doi.org/10.1038/s41368-024-0012-5
Han, Y., Park, J., & Liu, Z. (2023). Bacteriophage therapies for oral biofilm control in microgravity. Front Microbiol, 14, 1187. https://doi.org/10.3389/fmicb.2023.01187
Hamed, H., Jafari, R., & Zhang, W. (2023). Scaffold-based periodontal regeneration in microgravity conditions. Tissue Eng Part A, 29(7–8), 567–580. https://doi.org/10.1089/ten.tea.2022.0356
Jafari, R., Nazir, M., & Ramesh, A. (2020). Regenerative approaches in periodontal therapy under altered gravity conditions. Stem Cell Res Ther, 11(1), 472. https://doi.org/10.1186/s13287-020-01978-1
Jayaraman, A., et al. (2008). Microgravity and microbial virulence. Microb Pathog, 44(2), 128–135. https://doi.org/10.1016/j.micpath.2007.10.004
Kim, H., Zhang, W., & Zhou, Y. (2024). Longitudinal monitoring of oral biofilm under simulated microgravity. J Dent Res, 103(5), 602–614. https://doi.org/10.1177/00220345241030512
Kimura, K., Silva, D., & Martins, L. (2023). Integrated AI and microgravity models for periodontal research. Comput Biol Med, 152, 106328. https://doi.org/10.1016/j.compbiomed.2023.106328
Kievit, R., & Iglewski, B. H. (2009). Quorum sensing and biofilm formation in microgravity. Microb Ecol, 57(4), 548–556.
https://doi.org/10.1007/s00248-009-9550-4
Koenig, D., & Pierson, D. (1997). Oral health in spaceflight: A review of literature. Aviat Space Environ Med, 68(9), 831–837. https://doi.org/10.3357/asem.1997.831
Li, J., Gao, F., & Gupta, R. (2023). 3D scaffolds for studying biofilm–immune interactions under microgravity. Biomater Sci, 11(12), 3567–3582. https://doi.org/10.1039/d3bm00456a
Liu, Z., Han, Y., & Kim, H. (2023). Deep learning approaches for antimicrobial resistance prediction in oral biofilms. Bioinformatics, 39(14), btad451. https://doi.org/10.1093/bioinformatics/btad451
Martins, M., Srinivasan, R., & Jayaraman, A. (2010). EPS production and biofilm density in microgravity. J Appl Microbiol, 109(2), 512–522. https://doi.org/10.1111/j.1365-2672.2010.04722.x
Mokhtari, M., Dutta, D., & Han, Y. (2023). Antimicrobial nanocoatings for dental devices. Adv Healthc Mater, 12(5), 2202134. https://doi.org/10.1002/adhm.202202134
Nazir, M., Jafari, R., & Kim, H. (2019). Periodontal health and biofilm challenges in spaceflight. Clin Oral Investig, 23(8), 3201–3214. https://doi.org/10.1007/s00784-019-02803-2
Park, J., Han, Y., & Zhang, W. (2022). Phototherapy for biofilm eradication in space conditions. Lasers Med Sci, 37(6), 2895–2907. https://doi.org/10.1007/s10103-022-03650-2
Patel, M., Franklin, R., & Li, X. (2023). Immune dysregulation and periodontal inflammation in spaceflight. Front Oral Health, 4, 1120. https://doi.org/10.3389/froh.2023.01120
Ramesh, A., Jafari, R., & Hamed, H. (2024). 3D bioprinting for periodontal regeneration in microgravity. Tissue Eng Part B Rev, 30(2), 155–169. https://doi.org/10.1089/ten.teb.2023.0234
Salido, E., Zea, A., & Cortesão, C. (2025). Oral microbiome adaptation to space environments. Microbiome, 13(1), 45.
https://doi.org/10.1186/s40168-025-01345-6
Silva, D., Kimura, K., & Zhou, Y. (2022). Personalized periodontal care using AI and multi-omics in space research. J Pers Med, 12(7), 1102. https://doi.org/10.3390/jpm12071102
Socransky, S. S., Haffajee, A. D., Cugini, M. A., Smith, C., & Kent, R. L. (1998). Microbial complexes in subgingival plaque. J Clin Periodontol, 25(2), 134–144. https://doi.org/10.1111/j.1600-051X.1998.tb02419.x
Vélez Justiniano, P., et al. (2023). Advances in oral biofilm research in space medicine. Space Med Rev, 19(1), 33–50.
Wilson, M., Urbaniak, C., & Gupta, R. (2021). Hypoxic microenvironments in subgingival biofilms under altered gravity. Microb Ecol, 81(3), 589–602. https://doi.org/10.1007/s00248-020-01629-3
Zea, A., Salido, E., & Kim, H. (2018). Mechanisms of antimicrobial resistance in microgravity. Front Microbiol, 9, 2378. https://doi.org/10.3389/fmicb.2018.02378
Zhang, W., Ramakrishnan, A., & Li, J. (2023). Artificial intelligence in longitudinal periodontal monitoring. J Dent Res, 102(11), 1267–1282. https://doi.org/10.1177/00220345231120345
Zhou, Y., Kim, H., & Silva, D. (2024). Longitudinal studies of biofilm and immunity in microgravity. NPJ Microgravity, 10(1), 11. https://doi.org/10.1038/s41526-024-00231-1
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Daniel Falleiro Simundi, Laiza Naiara Schmitz Simundi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
