# The Potential of Cannabidiol in the Management of Oral Infections
## 4 Antimicrobial Properties of Cannabidiol
### Anti-Inflammatory Effects in Oral Infection Models  
Percinical evidence from _in vitro_ and _in vivo_ oral infection models supports its potential as an adjunctive treatment in managing inflammation-associated oral pathologies [51].  
CBD has been shown to significantly downregulate pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-\(\alpha\)), interleukin-1 beta (IL-1\(\beta\)), and interleukin-6 (IL-6) in human gingival fibroblasts (HGFs) and periodontal ligament (PDL) cells exposed to bacterial components like _Porphyromonas gingivalis_ lipopolysaccharide (LPS) [52]. The proposed mechanism is that CBD suppresses the nuclear translocation of nuclear factor-kappa B (NF-\(\kappa\)B), a key transcription factor in the inflammatory cascade, thereby reducing cytokine gene expression and inflammatory mediator release. In LPS-stimulated HGFs, CBD treatment led to a significant reduction in IL-6 and prostaglandin E2 (PGE2) levels, indicating a dampened inflammatory response [53].  
Reactive oxygen species (ROS) are key contributors to inflammation-induced tissue damage in oral infections. CBD has demonstrated antioxidant activity by reducing ROS production and enhancing the expression of endogenous antioxidant enzymes, such as superoxide dismutase (SOD) and glutathione peroxidase (GPx), in inflamed oral tissues [54]. _In vitro_ models of oxidative stress in oral epithelial cells show that CBD attenuates ROS levels following bacterial or inflammatory stimulation, suggesting a protective role in oral mucosal and periodontal health [38; 51].  
CBD exerts immunomodulatory effects by influencing the behavior of key immune cells involved in oral inflammation, including macrophages, neutrophils, and T cells. CBD reduces the expression of inducible nitric oxide synthase (iNOS) and the production of nitric oxide (NO) in activated macrophages, favoring a shift from the pro-inflammatory M1 to the anti-inflammatory M2 phenotype. CBD has been shown to decrease Th1/Th17-mediated responses while promoting regulatory T cell activity, which could contribute to immune homeostasis in chronic inflammatory settings such as periodontitis [55].  
Animal studies provide further evidence for CBD's anti-inflammatory role in oral tissues. In rat models of ligature-induced periodontitis, the topical or systemic administration of CBD reduced inflammatory infiltrates, lowered cytokine expression in gingival tissues, and preserved alveolar bone levels compared to untreated controls. Histological analysis of periodontal tissues revealed decreased inflammatory cell infiltration and collagen degradation in CBD-treated groups. Similar anti-inflammatory effects have been observed in peri-implant mucositis models, where CBD treatment reduced peri-implant inflammatory markers and improved soft tissue healing [38; 56].  
Given its non-psychoactive profile, minimal toxicity, and broad anti-inflammatory effects, CBD represents a promising adjunct in the treatment of oral inflammatory diseases. Delivery strategies currently under exploration include CBD-infused mouth rinses, topical gels, periodontal films, and biodegradable microspheres for targeted drug release into inflamed periodontal sites with potential for clinical translation.