Only limited information on oral mucosal abnormalities in the rural or semi-urban population of India is available, however few isolated studies of prevalent lesions have been reported [6–11]. The prevalence of oral lesions in population has been documented in other parts of the world like Colombia , Mexico , Brazil , Chile , Spain , Argentina , USA, Israel  and Cambodia , mainly based on clinical evaluation of the lesions. In contrast, Correa et al  and Dehler et al  conducted prevalence studies based on the clinicopathological correlation, evaluating the biopsies of the observed lesions.
While emerging lifestyle and food habits have been contributing factors, the problem of bad oral health is compounded by a low dentist to population ratio. The World Health Organisation (WHO) recommends a 1: 7500 dentist to population ratio whereas the dentist to population ratio in India is as low as 1:22500 . In 2004, India had one dentist for 10,000 persons in urban areas and about 2.5 lakh persons in rural areas. Almost three-fourths of the total number of dentists were clustered in urban areas, which house only one-fourth of the country's population . This limits the curative approach to tackle dental problems in rural areas while it is widely acknowledged that oral cancer can best be prevented through early detection and primary prevention. Unfortunately, the awareness levels of lesions associated with usage of addictive agents continue to remain abysmally low.
This study was a community survey, in which the prevalence of clinically significant oral lesions was 8.4% - which was higher in comparison to a previous study from Chennai (4.1%). This could probably be due to higher prevalence of smoking and/or tobacco chewing (52%) in this study in comparison to 31% reported by Saraswathi et al . Vellappally et al found that in a survey of 805 subjects for dental caries, the highest prevalence of oral mucosal lesions were present in tobacco chewers (22.7%) followed by regular smokers (12.9%), occasional smokers (8.6%), ex-smokers (5.1%) and non tobacco users (2.8%) . The prevalence figure of oral lesions was 8.4% covering all age groups. On the other hand, Gonzalez et al  in Mexico, demonstrated a prevalence of 23.2% in the elderly. Sanchez reporting in Spain, documented 39% of aged patients had oral mucosa alterations .
Of the clinically significant lesions which were biopsied, the percentage of patients suffering from leukoplakia was 40.7%, oral submucous fibrosis 9.7% and lichen planus 2.7% which was higher to those found by Saraswathi et al (0.59%, 0.55% and 0.15% respectively) Prevalence of smoker's melanosis was 2.3% in this study while it was lesser in Chennai (1.14%) . Dysplasia was found in 17 patients out of which 6% was found with grade I, 1.4% with grade II and 0.5% with grade III while squamous cell carcinoma was found in 0.93% in this study. These findings reveal higher percentages than similar studies from India, [6–11] and this difference may probably be explained by the fact that, unlike most other clinical studies, in this report, histopathological confirmation was obtained in most of the cases.
Subjects who smoked or chewed tobacco in any form had a far higher incidence of oral lesions vis-à-vis non-users. On assessing the correlation of habits with incidence of leukoplakia, smokers were found to have an Odds ratio of 4.5 while chewers had 5.6 as compared to non-users. This was less than findings of Saraswathi et al who reported figures of 5.08 and 6.82, respectively. Subjects who chewed areca nut with or without tobacco had a higher prevalence of oral submucous fibrosis, similar to earlier findings.
Since the information on habits was garnered by the patients or attendants by a questionnaire, the possibility of an information bias should be considered while interpreting the results. Another limitation of the study was that due to the rather small sample size, inherent in a population survey vis-à-vis a hospital survey, there is a lack of generalizability and limited statistical significance.