Neutrophil equanimity: Function in health and diseases in periodontium

The oral cavity is a distinct space where the microbiota is continually changing from the mechanical effort of eating and the incursion of foreign microorganisms such as bacteria, fungi, and viruses. There is a balance between symbiotic bacteria and the innate immune system in healthy gingival tissues, which is mainly maintained by neutrophils. Neutrophils are the essential killers of the body and have been recognized for a long time. However, rather than accurate snipers, neutrophils are often seen as crude and unrefined legionnaires, whose successful missions are usually liable for significant collateral damage. The excess of microorganisms in the biofilm creates an inflammatory state that leads to the recruitment of more immune cells, in which mainly neutrophils can be detected. However, the microbial pathogens within the gingival crevice cannot be abolished or controlled by neutrophils. Sometimes, neutrophil accumulation, rather than protecting and favoring periodontal tissue, can lead to a chronic inflammatory disease that can destroy the tooth-supporting tissues or the periodontium. Thus, it is imperative to maintain homeostasis between neutrophil function and microbe challenge to ensure periodontal health. This critical review article aims to discuss and outline the morphology of neutrophil function in periodontal inflammation, including neutrophils' action on biofilm and neutrophil dysfunction to prevent various syndromes related to it and its myriad potential novel therapeutic measures.