Boosting the antibacterial potency of antimicrobial photodynamic therapy against oral pathogens through supplement agents: A narrative review

Abstract

Antimicrobial photodynamic therapy (aPDT) is a promising approach for managing oral infections; however, it faces several limitations, such as limited penetration depth, biofilm resistance, and photosensitizer dimerization or aggregation. To address these challenges, the current study reviews new techniques to enhance the antibacterial effectiveness of aPDT. Recent advances have pointed out the potential of novel supplement agents—including inorganic salts, antimicrobial peptides, surfactant media, and postbiotics—to overcome these limitations significantly. Inorganic salts like potassium iodide, potassium selenocyanate, and potassium thiocyanate can enhance aPDT by generating additional reactive species or increasing reactive oxygen species (ROS)-mediated cytotoxicity. Antimicrobial peptides disrupt membranes selectively and help penetrate deeper into biofilms, while surfactant media improve the solubility of photosensitizers and prevent their aggregation, thereby maximizing ROS production. Postbiotics not only lead to improved biofilm penetration but also cause increased oxidative stress on microbial cells. Therefore, these combined strategies have markedly improved microbial eradication, particularly against resilient biofilms and antibiotic-resistant strains. Although integrating these innovative supplement agents signals a new era for photodynamic therapy in oral healthcare—presenting renewed opportunities for practical, non-invasive, and resistance-free infection control—further studies are necessary to validate these findings, establish standardized protocols, and evaluate the long-term safety and clinical benefits of these combined strategies.