Antimicrobial photodynamic therapy (aPDT) represents a promising yet underexplored approach in oral health research, offering an alternative to conventional antimicrobial strategies within rising antibiotic resistance. While numerous studies have demonstrated its capacity to reduce microbial burden and modulate inflammation across various in vitro dental conditions, clinical reproducibility remains limited. This inconsistency largely reflects the absence of formulations and protocols specifically tailored to the complex biological and physicochemical characteristics of the oral cavity such as saliva dynamics, blood interference, acidic pH, and low oxygen tension. Evidence to date supports the therapeutic potential of aPDT in dentistry; however, its success depends on moving beyond the adaptation of photosensitizers originally designed for other medical fields. Progress in this area requires the development of oral-specific photosensitizers, controlled oxygenation strategies, and standardized dosimetric parameters. When these particularities are properly addressed, aPDT holds substantial promise as a precise, resistance-free, and biocompatible tool for managing infectious and inflammatory oral diseases.