Introduction: Tobacco is the second major cause of death worldwide, and responsible for about 5 million deaths annually. Very few hospital based studies have been conducted to assess the prevalence of the tobacco use and their epidemiological and behavioural patterns among patients with dental needs. Therefore, the present study was conducted to evaluate the prevalence of tobacco use associated oral mucosal lesions among the patients in a rural set up and to elucidate the associated factors. Materials & Methods: The study protocol was analyzed and approved by the ethical review board. The present cross sectional study was conducted among 2835 subjects who consumption of tobacco. The subjects were selected based on the inclusion and exclusion criteria and those who were willing to participate in the study. The need and outcome of the study was explained to the subjects and an informed consent was obtained. Results: In smoking form tobacco users group most common individual lesion was Smokers palate 29% followed by Leukoplakia 23%, but Tobacco pouch keratosis and oral submucous keratois were absent. In smokeless form of tobacco users group most common individual lesion was Tobacco pouch keratosis in 45% subjects followed by oral submucous fibrosis in 12% subjects, but smokers palate and smokers melanosis were absent In both forms of tobacco users group most common individual lesion was Tobacco pouch keratosis in 51% subjects followed by Leukoplakia in 9% subjects Discussion & Conclusion: Tobacco use in different forms is one of the prime factors responsible for potentially malignant disorders and cancerous lesions. Lack of awareness regarding harmful effects is a major reason. There was strong association of these habits with respect to frequency and duration and occurrence of the oral lesions. The most common age of starting the tobacco habit was between 16-25 years, awareness should be focussed in this age group.