# The Potential of Cannabidiol in the Management of Oral Infections
## 7 Challenges and Future Perspectives  
Several scientific, clinical, and regulatory hurdles limit the translation of CBD into routine dental practice. This section addresses the major challenges impeding clinical adoption and highlights key future research directions for integrating CBD into evidence-based oral infection management.  
While _in vitro_ and preclinical studies have consistently demonstrated CBD's antimicrobial and anti-inflammatory effects against common oral pathogens and inflammatory mediators, robust clinical evidence remains scarce [19]. Only a few human studies have explored CBD's effects on oral health outcomes, and most are small-scale, lack placebo controls, or have short follow-up periods [17; 61].  
Key gaps include the following: (i) the absence of large randomized controlled trials (RCTs) assessing efficacy in oral infections such as periodontitis or mucositis; (ii) limited data on long-term safety and tolerability of topical or localized CBD use in the oral cavity; and (iii) insufficient evidence on patient-centered outcomes, such as pain reduction, quality of life, and adherence. These limitations hamper the ability to draw firm conclusions on optimal use, safety, and clinical benefit.  
Moreover, CBD's therapeutic effects are highly dose- and formulation-dependent, yet there is no consensus on optimal dosing strategies for oral applications. The currently available products vary widely in CBD concentration and purity, the presence of other cannabinoids (e.g., THC, CBG), and delivery format (e.g., gels, rinses, patches, nanoparticles). This variability affects bioavailability, efficacy, and reproducibility. Moreover, the pharmacokinetics of CBD in oral tissues are not fully understood, complicating the selection of appropriate doses for clinical use. Establishing standardized, validated formulations with consistent pharmacological profiles is essential for advancing CBD as a reliable therapeutic agent in dentistry.  
Although CBD has demonstrated antimicrobial activity, particularly against Gram-positive bacteria and biofilm-forming oral pathogens, its spectrum is limited compared to conventional antibiotics. There is also a theoretical risk that indiscriminate or the subterapetic use of cannabinoid-based therapies could contribute to resistance development, although this remains to be empirically tested. To enhance efficacy and reduce resistance potential, future strategies may involve the following: (i) combination therapies pairing CBD with existing clinical antimicrobials or antiseptic (e.g., chlorhexidine, metronidazoleze); (ii) the use of CBD as an adjuvant to reduce inflammation and enhance clinical antimicrobial penetration; and (iii) synergistic formulations with other phytochemicals or probiotic agents to modulate the oral microbiome.  
Together, these strategies may enhance the therapeutic utility of CBD while mitigating potential limitations related to efficacy and microbial resistance. Overcoming these challenges through rigorous clinical research, standardized formulations, and integrated therapeutic strategies will be essential for establishing CBD as a safe, effective, and evidence-based adjunct in oral infection management.