The role of the oral microorganism in health and disease has attracted increasing attention. As a key periodontal pathogen, Porphyromonas gingivalis plays a critical role in the development of oral squamous cell carcinoma by promoting tumor progression through multiple mechanisms, such as driving chronic inflammation, interfering with the cell cycle, and facilitating invasion. The harm of this bacterium persists throughout the course of the disease and severely restricts the prognosis of postoperative maxillofacial aesthetic reconstruction. Its colonization can interfere with wound healing, impair angiogenesis to jeopardize ffap survival, and possibly induce peri-implant inffammation, directly affecting the long-term stability and aesthetic effect of reconstruction. However, systematic understanding of the speciffc mechanistic network mediating the above dual effects and targeted intervention strategies remains insufffcient. This review aims to systematically summarize the dual roles of this bacterium in carcinogenesis and reconstruction interference, focusing on the clinical signiffcance of controlling its colonization during the perioperative period to ensure and improve the final aesthetic effect of facial aesthetic reconstruction, so as to provide a new perspective for integrating antimicrobial strategies and optimizing the aesthetic prognosis of patients with oral cancer.