Biofilm battles: confronting stubborn resistance in dental healthcare by harnessing the antimicrobial potential of South African medicinal plants

Abstract Background Dental biofilms are complex microbial communities that play a pivotal role in the onset and progression of oral diseases such as dental caries and periodontal infections. Their inherent structural resilience and enhanced resistance to conventional antimicrobial agents pose significant challenges to effective treatment. This persistent nature of biofilms necessitates the exploration of innovative therapeutic strategies beyond traditional antibiotics and antiseptics. South Africa’s rich ethnobotanical heritage offers a valuable resource of medicinal plants historically used to treat infections, presenting potential alternatives for managing biofilm-related oral diseases. Methods A systematic search was performed across multiple scientific databases, including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar, covering publications from 2000 to 2024. The following keywords and combinations were used. Results This review investigates the role of South African medicinal plants in mitigating biofilm-associated infections within oral healthcare. Drawing from ethnobotanical traditions and current pharmacological research, the study highlights the therapeutic significance of indigenous flora such as Warburgia salutaris, Combretum molle, and Aloe ferox, among others. These plants exhibit broad-spectrum antimicrobial, anti-inflammatory, and anti-biofilm activities, targeting key mechanisms such as microbial adhesion, quorum sensing, and EPS matrix disruption. These activities are mediated through disruption of microbial adhesion, interference with quorum sensing signaling pathways, and degradation of the EPS matrix, which is essential for biofilm stability. Additionally, anti-inflammatory properties contribute to the reduction of host tissue damage. However, pharmacodynamic variability across extracts and the lack of standardized extraction protocols limit reproducibility and clinical translation. Furthermore, concerns about the sustainability of harvesting endangered species highlight the need for conservation efforts. Conclusion South African medicinal plants represent a promising natural arsenal for combating resilient oral biofilms and their associated infections. To fully realize their therapeutic potential, future research must focus on standardizing extraction methods, elucidating molecular mechanisms, and conducting rigorous clinical evaluations. Sustainable harvesting and benefit-sharing frameworks are essential to preserve indigenous biodiversity. Integrating these botanical resources into modern oral healthcare could significantly advance the management of biofilm-mediated diseases and address the growing threat of antimicrobial resistance globally.