Therapeutic Strategies and Emerging Drug Delivery Systems for Oral Aphthous Ulcers

Aphthous ulcers, also known as canker sores, are painful mucosal lesions that occur on oral structures, including the cheeks, gums, lips, and tongue. Although their precise etiology remains unclear, contributing factors include nutritional deficiencies (vitamins B12, folate, C), stress, trauma, infections (viral, bacterial, fungal), chemical irritants like sodium lauryl sulfate, and heavy metal exposure. These ulcers significantly impair quality of life by causing pain during eating, brushing, and speaking. Treatment aims to manage pain, promote healing, and reduce the frequency of recurrence. Topical corticosteroids remain the mainstay of therapy, offering rapid resolution with minimal systemic effects. Adjunctive treatments include local analgesics, immunomodulators (e.g., thalidomide), NSAIDs (mesalazine), stem‑cell therapy, and various herbal remedies such as extracts from Psidium guajava, Curcuma longa, Glycyrrhiza glabra, and Punica granatum, which demonstrate anti-inflammatory, antimicrobial, and wound‑healing properties. Recent advances focus on novel mucoadhesive drug delivery systems—patches, gels, microneedles, nanosheets, hydrogels—to enhance drug residence time, bioavailability, and patient compliance. These innovative approaches target both symptomatic relief and accelerated healing, while minimizing systemic exposure and improving therapeutic outcomes. Moving forward, integrating molecular insights into disease mechanisms (microRNA dysregulation in OPMDs, microbial dysbiosis) with tailored delivery platforms may pave the way for precision interventions targeting recurrent aphthous ulcers.