Recurrent aphthous ulcer (RAU) is one of the most common diseases of the oral mucosa. At present, no effective method is available for RAU treatment, especially for refractory RAU, which significantly affects patients’ oral health and quality of life. Research shows that combination with systemic diseases greatly increases the difficulty of curing refractory RAU, making conventional oral ulcer treatment harder to perform effectively. This is probably because dentists commonly only focus on handling oral ulcers but neglect to think about the etiology of oral ulcers from a holistic perspective. Thus, we summarized some conditions of refractory RAU accompanied by systemic diseases, including inflammatory bowel disease, iron deficiency anemia, diabetes mellitus, Behçet’s disease, Reiter’s syndrome, sprue syndrome, Sutton syndrome, and acquired immunodeficiency syndrome. We also outlined the treatment principles of these patients. To be specific, on the one hand, dentists should cooperate with the relevant specialists to treat the systemic diseases, while on the other hand they should take measures including topical/general use of medicine, local physical therapy, Traditional Chinese medicine treatment, and psychotherapy for RAU management. This paper aims to provide clinicians with a more comprehensive understanding of the diagnosis and treatment of refractory RAU, in order to make personalized treatment plans for patients and improve the clinical efficacy of refractory RAU.

Oral submucous fibrosis (OSF) is a chronic disease that produces scars, tissue fibrosis, and precancerous lesions. Epidemiological studies have shown that chewing betel nut is the most significant risk factor for OSF. Many studies have also indicated that habits such as chewing and smoking tobacco and drinking alcohol increase the risk of OSF, which is widely recognized as an oral precancerous lesion or a potentially malignant oral disorder. Pathological characteristics include chronic inflammation, excessive collagen deposition in the connective tissues below the oral mucous epithelium and local inflammation in the lamina propria or deep connective tissues. OSF patients have a 7%~30% chance of developing oral cancer. Submucosal local injection of triamcinolone and tanshinone was mainly used for the treatment of oral submucosal fibrosis. This treatment improves mouth opening and alleviates the burning sensation in OSF, and the treatment efficacy was as high as 93%. The article will discuss the occurrence, development, diagnosis and treatment of oral submucous fibrosis for clinical management by the medical community.

Oral lichen planus (OLP), a common and chronic disorder, has no effective treatment or cure because its etiology is complicated and has until now remained unclear. Therefore, effectively controlling the activity of the disease and preventing its recurrence are two primary purposes of clinical treatment for OLP. The available evidence supports the notion that topical steroids are the preferred drug for treating this disease. However, some cases have poor clinical curative responses to steroids or other medicines, mainly because of drug resistance and other factors. Therefore, scholars have explored new drugs and methods with the aim of achieving more effective and safe treatment effects. The current research evidence indicates that glucocorticoid remains the front-line drug for OLP treatment. Topical tacrolimus, pimecrolimus and retinoic acid combined with glucocorticoid can be used as alternative therapies, especially in cases with glucocorticoid drug resistance. The systemic application of glucocorticoid or immunosuppressive agents, such as methotrexate, mycophenolate mofetil, and sulfoxide, should be limited to extensive, refractory cases or those with lesions involving regions outside the oral cavity. Surgery and cryotherapy can be applied in a specific, limited range of lesions. Some previous randomized controlled clinical studies have had limitations, including a small sample size, short treatment and clinical follow-up periods, a lack of reliable questionnaires and differences in evaluation standards. Therefore, future studies should include the following: randomized controlled clinical studies with large sample sizes that offer reliable evidence of a curative effect; assessments of treatment outcomes should be extended as long as possible; the follow-up period should be long enough to assess the recurrence rate; and the methods and standards used to evaluate treatment effects should be standardized.