The preservation of old book collections raises issues related, on the one hand, to the sensitivity and variety of materials in the structure of books and, on the other hand, to the diversity of the aggressors. Currently, the approach to these issues is different in Western countries compared to what is done in museums in countries with fewer resources allocated to the preservation of cultural heritage. If in Romania there are museums without a biologist or with a single biologist, in Western museums there are work teams dedicated to managing the biodeterioration problems, according to well-defined working protocols and standards. The conservators and restorers of old books in Romania still use, on a large scale, the chemical methods of disinfection of books and documents on paper support. Some physical treatments that have been constantly applied in the West for over 10–15 years (heat treatments, anoxia), entered later in the Eastern countries being accessible to a small number of museums. Financial and human resources dictate the degree of implementation of modern methods in preserving old book collections. Research for the development of methods that do not affect objects, people who come into contact with them and the environment, continues permanently, evaluating treatments by irradiation, microwave, laser, essential oils of plants, silver nanoparticles, and biological methods that use antagonists of pests.