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Background: Oral premalignant and malignant lesions represent a significant public health concern, particularly in developing countries due to the high prevalence of tobacco, areca nut, and gutkha consumption. Early detection of oral potentially malignant disorders (OPMDs) is crucial for preventing progression to oral squamous cell carcinoma. Aim: To assess the prevalence of oral premalignant and malignant lesions and to evaluate their association with demographic variables and risk factors in the study population. Materials and Methods: A hospital-based observational study was conducted in the Department of Dentistry, Karwar Institute of Medical Sciences and Hospital, Karwar, Karnataka, over a period of six years (January 2020–December 2025). A total of 51,840 patients attending the dental outpatient department were screened clinically for oral premalignant and malignant lesions using WHO diagnostic criteria. Demographic data, oral habits, and clinical findings were recorded. Statistical analysis was performed using IBM SPSS version 27.0, and associations were assessed using the Chi-square or Fisher’s exact test, with p < 0.05 considered statistically significant. Results: Among the screened population, 85 patients (0.16%) were diagnosed with oral premalignant lesions and 97 patients (0.19%) with oral malignant lesions. The mean age of affected individuals was 50.1 ± 14 years, with the highest prevalence observed in the 50–60-year age group. A statistically significant association was found between age and lesion status (p < 0.001). Male predominance was observed (75.8%), and malignancy status showed a significant association with gender (p = 0.009). Oral submucous fibrosis was the most common premalignant lesion (69.4%). Buccal mucosa was the most frequently involved site for malignant lesions (52.5%). Smokeless tobacco use, gutka, and pan with tobacco showed a strong and statistically significant association with both premalignant and malignant lesions (p < 0.001). Conclusion: The prevalence of oral premalignant and malignant lesions in this study population was found to be 0.16% and 0.19%, respectively. The study highlights a low but notable prevalence of oral premalignant and malignant lesions, with significant associations with age, male gender, and smokeless tobacco and areca nut consumption. These findings emphasize the need for routine oral screening, early diagnosis, and targeted public health interventions aimed at reducing high-risk habits to prevent malignant transformation. Keywords: Premalignant, Malignant, leukoplakia, erythroplakia, lichen planus, OSMF and actinic cheilitis