The pediatric oral mycobiome: a comprehensive review of its role in health and disease.

The oral microbiome functions as an intricate and coordinated microbial network, residing throughout the oral cavity in both health and disease. Although most oral microbiome research has focused on bacteria, there is a growing interest in oral fungal communities, known as the oral mycobiome. The oral cavity hosts a complex and diverse mycobiome comprising of an estimated 100 fungal species; however, the roles of these fungi have been largely overlooked and remain insufficiently characterized, particularly in children. This represents a critical gap, as early life is a key window for establishing oral microbial communities that shape lifelong oral and systemic health and offer opportunities for early intervention. Recent technological advances, especially next-generation sequencing, have enabled the identification of new fungal species and deepened our understanding of the diversity, structure, and interactions among fungal, bacterial, and other components within the oral cavity. Yet, research on the pediatric oral mycobiome remains fragmented and limited in scope. Addressing this gap is important since the early-life oral mycobiome may play an underappreciated role in shaping immune development, influencing susceptibility to oral diseases, and potentially contributing to systemic conditions during childhood and beyond. In this review, we examine the oral mycobiome in children, focusing on its formation and dynamics in health and in disease, including dental caries, periodontal disease, endodontic infection, and cleft lip/palate, and exploring its connections to several systemic consequences. By synthesizing current findings on fungal-related biological risk factors, we aim to inform the development of improved diagnostic tools and to guide the advancement of preventive and therapeutic strategies from fungal perspective.