Silent saboteurs: Unveiling the role of viruses in periodontal disease (Review)

Periodontal diseases have long been considered primarily bacterial infections driven by the complex interplay of microbial plaque and host immune responses. However, emerging research has highlighted the significant role of viruses, particularly those from the Herpesviridae and Retroviridae families, in the pathogenesis of periodontal conditions. These viruses are not merely passive inhabitants of the oral environment; rather, they actively modulate host immunity, disrupt periodontal homeostasis and increase the pathogenic potential of coexisting bacteria. Through various mechanisms, such as immune evasion, the induction of pro‑inflammatory cytokines and the impairment of local immune surveillance, viruses can facilitate tissue destruction and exacerbate periodontal breakdown. The present narrative review aimed to comprehensively summarize the involvement of viruses in periodontal disease by delving into their structural characteristics, classification, replication strategies and intricate interactions with host immune mechanisms. Special focus is placed on herpesviruses, including Epstein‑Barr virus and human cytomegalovirus, and human immunodeficiency virus, which have been implicated in both the aggressive and chronic forms of periodontitis. Diagnostic challenges and molecular approaches for detecting these viral agents in periodontal tissues are also discussed, along with the clinical implications of their presence. Understanding the viral dimension of periodontal disease not only broadens the current knowledge of its multifactorial etiology, but also opens new avenues for the development of diagnostic, preventive and therapeutic strategies. The present review underscores the need for a paradigm shift in both the research and clinical management of periodontal diseases. The emerging role of viral diagnostics, salivary biomarkers and immunologically targeted therapies highlights the potential for more precise risk assessment and personalized periodontal care.