Rituximab is a biologic anti-CD20 monoclonal antibody that targets B lymphocytes, decreasing antibody production.  Consequently, it is widely used to treat lymphomas, leukemia, and autoimmune diseases. The literature supports its effectiveness in managing oral lesions linked to autoimmune conditions, such as pemphigus vulgaris, mucous membrane pemphigoid, paraneoplastic pemphigus, lupus erythematosus, Behçet’s disease, and Sjögren’s syndrome. Clinical reports have demonstrated its success in treating refractory cases of desquamative gingivitis, periodontitis, oral lichen planus, and vasculitis. However, oral adverse effects have been reported, with medication-related osteonecrosis of the jaws (MRONJ) being the most serious. Other side effects include oral lichenoid reactions and infections caused by fungi, viruses, and bacteria. This review discusses the applications of rituximab in treating oral diseases and highlights its potential oral side effects. It also outlines considerations for dental management of patients on rituximab therapy. A systematic search of PubMed, Medline, Web of Science, Scopus, and Google Scholar was conducted using terms such as rituximab, oral manifestations, adverse effects, periodontitis, gingivitis, autoimmune disease, and dental considerations. For patient safety, patients receiving rituximab should be under the care of a dentist or oral medicine specialist experienced in managing biologic therapies, both before and after treatment. Nonetheless, there is no universally accepted protocol for managing patients undergoing oral surgery or those who develop MRONJ, which requires further investigation.