Oral cancer is an aggressive disease with the propensity for local recurrence and distal metastasis in the head and neck region. Currently, cisplatin-based chemotherapy or concurrent radiochemotherapy is still the first choice to treat the advanced stage cancers, in particular, the unresectable tumours. Unfortunately, innate and acquired resistance to chemotherapy agent greatly limited its effectiveness and often led to treatment failure in these patients. Hence, it is urgent to clarify the mechanisms underlying the development of chemoresistance in patients with oral cancer. In this article, the current understandings on molecular mechanisms of chemoresistance in oral cancer were reviewed, including drug efflux, apoptosis, DNA damage and repair, epithelial mesenchymal transition, autophagy and miRNA. Keywords: chemoresistance, molecular mechanisms, oral cancer