# The Potential of Cannabidiol in the Management of Oral Infections
## 1 Introduction
### Management of Oral Infections  
Despite the pivotal role of antimicrobial agents in the management of infectious diseases, including those of the oral cavity, several significant limitations undermine their long-term effectiveness and clinical utility. These challenges span from microbial resistance and limited spectrum of action to adverse effects and impacts on host microbiota. Understanding these limitations is crucial for the development of novel therapeutic approaches, including alternative and adjunctive treatments such as plant-derived compounds and cannabinoids. The most pressing limitation of conventional antimicrobial therapies is the global rise in antimicrobial resistance (AMR) [10]. The overuse and misuse of antibiotics in both medical and dental settings have accelerated the evolution of resistant strains of pathogenic bacteria [11]. In oral health, resistance among organisms such as _Streptococcus mutans_, _Porphyomonas gingivalis_, and _Aggregatibacter actinomycetemcomitans_ has been increasingly reported. The emergence of biofilm-associated resistance further complicates treatment, as microorganisms within biofilms exhibit up to 1000-fold greater resistance to antibiotics compared to their planktonic counterparts. This makes standard doses ineffective, necessitating higher concentrations that may not be clinically feasible or safe [12; 13; 14]. Moreover, many antimicrobial agents exhibit a narrow spectrum of activity, which may not be adequate for polymicrobial infections commonly seen in periodontal disease and other oral conditions. This often leads to incomplete eradication of pathogens, contributing to recurrent infections and chronic inflammation. Furthermore, some antimicrobials may not effectively penetrate infected tissues or biofilms, reducing their therapeutic efficacy [12; 13; 14]. Systemic antimicrobial therapies can be associated with a range of adverse effects, from mild gastrointestinal disturbances to severe allergic reactions and organ toxicity. Topical agents, while often better tolerated, may still cause local irritation, mucosal desquamation, or alterations in taste. The risk-to-benefit ratio becomes particularly unfavorable in cases where antimicrobial use is prolonged or prophylactic [10; 15]. Antimicrobial agents, especially broad-spectrum antibiotics and antiseptics, can disrupt the balance of the commensal oral microbiota. This dysbiosis may predispose patients to opportunistic infections, such as oral candidiasis, and may impair the natural protective functions of the native microbial community. Maintaining microbial homeostasis is essential for oral and systemic health, and indiscriminate antimicrobial use poses a significant threat to this equilibrium. Poor adherence to prescribed antimicrobial regimens, whether due to complex dosing schedules, side effects, or misunderstanding of instructions, can contribute to subtherapeutic drug levels and the selection of resistant strains. This is particularly relevant in dentistry, where short-term prescriptions are common and often inadequately supervised [16]. Also, the pharmaceutical pipeline for new antimicrobial agents has slowed considerably in recent decades. Most new drugs are modifications of existing compounds rather than new classes, offering limited advantages in circumventing existing resistance mechanisms. As a result, clinicians often rely on a shrinking pool of effective therapies, increasing the urgency for alternative strategies. In summary, while antimicrobial therapies remain a cornerstone in the treatment of oral and systemic infections, their growing limitations highlight the need for novel, more targeted, and safer therapeutic options [10]. Adjunctive therapies, including phytochemicals, probiotics, and cannabinoids such as CBD, are under increasing investigation for their potential to address these gaps in treatment [17].