# The Potential of Cannabidiol in the Management of Oral Infections
## 1 Introduction  
### Oral Infections  
Oral infections encompass a range of diseases primarily caused by bacterial, fungal, and viral pathogens affecting the hard and soft tissues of the oral cavity. These infections are not only a major cause of dental morbidity but also serve as potential sources of systemic complications, particularly in immunocompromised individuals. The most prevalent oral infections include dental caries, periodontal disease, oral candidiasis, and herpetic lesions. Each condition presents distinct pathophysiological mechanisms, microbial profiles, and clinical manifestations [1, 2]. Dental caries is a chronic, multifactorial disease characterized by the demineralization of tooth enamel due to acid production by cariogenic bacteria. _Streptococcus mutans_ is the principal pathogen, capable of metabolizing dietary sugars to produce lactic acid, leading to localized pH reduction and enamel breakdown. If untreated, caries can progress to involve dentin and pulp tissues, causing pulpitis and periapical infections [3]. Periodontal disease encompasses gingivitis and periodontitis, which involve inflammation and destruction of the supporting structures of teeth [4]. Gingivitis, the milder form, is reversible andprimarily associated with plaque accumulation. Periodontitis is a more severe condition characterized by periodontal pocket formation, alveolar bone loss, and eventual tooth mobility or loss. The disease is driven by dysbiosisic oral microbiota, including _Porphyomonas gingivalis, Tannerella forysthia_, and _Treponema denticola_, along with a heightened host immune response that contributes to tissue damage [5]. Oral candidiasis, commonly known as oral brush, is a fungal infection predominantly caused by _Candida albicans_. This opportunistic pathogen can shift from a commensal to a pathogenic state under certain conditions, such as immunosuppression, xerostomia, antibiotic use, or poor oral hygiene. Clinically, it presents in various forms, including pseudomembranous (white plaques), erythematous (red, inflamed areas), and hyperplastic lesions. Denture-related stomatitis is a frequent manifestation in elderly populations [6]. Herpes simplex virus type 1 (HSV-1) is responsible for primary herpetic gingivostomatitis and recurrent herpes labialis (cold sores). Primary infection often occurs in childhood and may be asymptomatic or present with painful ulcers, fever, and lymphadenopathy. After primary infection, HSV-1 remains latent in the trigeminal ganglion and may reactivate under stress, illness, or immune suppression. Herpetic lesions are highly contagious and can complicate oral health, especially in immunocompromised patients [7]. In immunocompromised individuals, such as those with HIV/AIDS, undergoing chemotherapy, or post-transplant patients, other pathogens, including _Aspergillus_, _Histoplasma_, _cytomegalovirusovirus_, and Epstein-Barr virus, may cause oral lesions. Additionally, necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis (NUP) are aggressive infections linked to anaerobic bacteria and immune dysfunction [8]. Oral infections, particularly those of odontogenic origin, have the potential to extend beyond the local site and disseminate through the complex network of fascial planes in the head and neck region. In severe cases, these infections can spread from the skull base down to the mediastum, leading to deep neck space infections and life-threatening complications such as descending necrotizing mediastinitis. This progression is often facilitated by anatomical continuity between fascial spaces and can be exacerbated by delayed diagnosis, inappropriate treatment, or host factors such as immunosuppression. Immunocompromised patients are especially vulnerable, as their reduced ability to contain infection increases the risk of systemic spread, sepsis, and mortality.