Southeast Asian nations, particularly India, report a substantial burden of oral cancer and oral potentially malignant disorders. This investigation evaluated how well screening findings align with histopathological outcomes and estimated the specificity and sensitivity of chair-side or field-level evaluations of oral lesions. In the first phase, 40,852 individuals aged 20–60 years were examined. Suspicious lesions were stained with toluidine blue (Otto Chemicals Pvt. Ltd., India) at two intervals; cases showing positive staining on both occasions proceeded to biopsy. The initial clinical impressions were subsequently compared with the histopathological results. The average age of patients who received biopsies was 49.01 ± 9.8 years. Among users of tobacco, leukoplakia (1.5%) emerged as the most frequent lesion, yet demonstrated the lowest diagnostic agreement (39.6%). Overall sensitivity reached 88%, while the positive predictive value was 80% for the clinical identification of OPMD. The concordance between clinical and histological diagnoses in this study indicates a higher proportion of true-positive findings during screening efforts in remote and underserved groups, ultimately supporting improved quality of life.
