Aim: The aim of this study was to evaluate the use of tobacco and its association with oral precancers and cancers. Materials and methods: Medical records of 1,007 individuals were assessed for the patterns of tobacco abuse and the presence of tobacco-related oral mucosal alterations. Results: This study comprised 1,007 individuals (M:F: 95.4%:4.6%). In the cohort, 60.1% had smoking habit and 56.1% had smokeless habit. Of the bidi smokers, 18.2% developed carcinoma, 14.3% developed leukoplakia, which is statistically significant (p < 0.001). A logistic regression analysis of the development of oral submucous fibrosis (OSMF) shows that habit of smokeless forms of tobacco has an odds ratio (OR) of 18+ when compared with smoking. Combination of bidi and gutkha had 12.3 times higher risk of developing oral cancer and 4.4 times risk of developing leukoplakia. A total of 33.3% betel quid and gutkha chewers presented with tobacco pouch keratosis, which is statistically significant. Conclusion: Smoked and smokeless forms of tobacco were equally popular among the study population. The packeted form of smokeless tobacco (gutkha) was more prevalent. Oral submucous fibrosis was more common than leukoplakia, and oral cancer developed more frequently in elderly men smoking bidis. Clinical significance: This study throws light on the fact that the use of both smoke and smokeless forms of tobacco is still prevalent, and the use of gutkha was most prevalent. These findings will help tobacco cessation and counseling centers to focus their effort in motivating people to stop gutkha chewing habit. This also brings to the forefront the need to create better treatment strategies to manage OSMF. Keywords: India, Oral cancer, Oral precancers, Prevalence, Tobacco. The Journal of Contemporary Dental Practice (2020): 10.5005/jp-journals-10024-2791