Herbal medicine for oral ulcer treatment: Mechanisms, efficacy, and therapeutic potential

Oral ulcers are common inflammatory lesions of the oral mucosa that significantly affect patients' quality of life through pain, eating difficulties, and psychological stress. Their development is multifactorial, involving mechanical trauma, infection, nutritional deficiencies, immune dysregulation, and oxidative stress. Conventional treatments including antiseptics, corticosteroids, and immunomodulators, provide symptomatic relief but are often limited by side effects, recurrence, and poor patient adherence. Increasing interest has therefore focused on herbal medicines as complementary or alternative therapies. Numerous single herbs such as Aloe vera, licorice, curcumin, chamomile, berberine, neem, sage, myrrh, and guava and traditional formulations have demonstrated anti-inflammatory, antioxidant, immunomodulatory, antimicrobial, and wound-healing activities. These effects are mediated through key signaling pathways including nuclear factor kappa B, mitogen-activated protein kinases, Janus kinase/signal transducer and activator of transcription, nuclear factor erythroid 2-related factor 2/kelch-like ECH-associated protein 1, phosphoinositide 3-kinase/protein kinase B, and transforming Growth Factor-beta/Sma- and Mad-related protein, enabling multi-target regulation of cytokine balance, macrophage polarization, oxidative stress reduction, angiogenesis, and tissue regeneration. Collectively, current evidence supports the therapeutic potential of herbal medicines as effective and well-tolerated options for oral ulcer management. This review summarizes the impact, pathogenesis, mechanisms, and clinical applications of herbal agents, providing insights to guide future research and inform integrative clinical practice. Herbal medicine holds therapeutic potential for oral ulcer management, warranting further research and integration into clinical practice.