Patient-derived organoids (PDOs) have emerged as advanced bioengineered platforms for modeling oral mucosal tissues, offering unprecedented opportunities to interrogate disease mechanisms and evaluate therapeutic responses in a clinically relevant context. This article provides a critical and integrative assessment of recent advances in organoid technologies applied to oral mucosal disorders, with particular emphasis on oral squamous cell carcinoma (OSCC), oral lichen planus, and oral mucositis. Despite significant progress in therapeutic development, the clinical management of OSCC remains challenging due to pronounced inter- and intratumoral heterogeneity and unpredictable treatment responses. Conventional two-dimensional (2D) culture systems and traditional animal models often fail to recapitulate the complex cellular architecture, stromal interactions, and microenvironmental cues that govern oral mucosal pathophysiology, thereby limiting their translational predictive value. In contrast, organoid systems preserve key genetic, epigenetic, and phenotypic features of patient tissues, enabling more faithful ex vivo modeling of disease progression and therapeutic sensitivity. This article critically evaluates the engineering principles underlying oral organoid generation, including stem cell sources, extracellular matrix scaffolds, and microenvironmental modulation, and discusses their implications for disease modeling, drug screening, and personalized therapeutic stratification. Furthermore, current limitations, such as variability in culture conditions, incomplete immune and vascular components, and challenges in standardization, are examined alongside emerging strategies to enhance organoid complexity and translational relevance. Collectively, this article positions organoid-based platforms as a pivotal component of next-generation tissue engineering approaches for oral health research. By bridging fundamental biological insights with clinically actionable applications, organoid technologies hold substantial promise for advancing precision medicine and improving outcomes in patients with complex oral mucosal disorders.