March 2024

[Special issue of Community Dental Health, to be disseminated at the ‘The oral microbiome – from cells to populations’ International Association for Dental Research symposium, March 2024, New Orleans, USA] Chronic oral diseases, such as caries and periodontal disease, may, in future, be treated by oral microbiome transplant (OMT) technology. OMT therapy would involve collecting a donor oral microbiome and transplanting into a recipient to either prevent or treat oral diseases linked to a change (i.e., dysbiosis) in the oral microbiome. Given the great promise of this technology, we must consider the ethical and practical implications of how it is developed to maximise its accessibility and affordability. Here, we examine ways that OMT technology might be commercialized in the context of equity and accessibility in both clinical or do-it-yourself settings. We do this while assuming that the technology can be developed for humans in ways that are safe and effective at the individual and population-levels. We highlight the need for OMT therapy to be 1) cost-effective, 2) understood by end users and clinicians, 3) easy to access even in rural or remote communities, and 4) providing donors equitable compensation for their microbiomes. These key elements will only be achieved through partnerships between scientists, clinicians, investors and stakeholders throughout development. Therefore, proper acknowledgement and equitable evaluation of contributions in this team will also be critical to ensuring that this technology can be globally accessed. While OMT is likely to reshape how we prevent or treat oral disease, consciously guiding its development toward equity and accessibility to all people may significantly aid in improving health for those without access to dental care. Keywords: dental health services, oral microbiome transplant, business ethics, dental ethics, equity, health equity