Background: Premalignant oral cavity lesions are potentially malignant diseases that include oral leukoplakia, erythroleuko place, oral submucous fibrosis (OSMF), and lichen planus. There are various etiological factors associated with premalignant lesions of the oral cavity. The most frequent etiological factors are tobacco use, consumption of alcohol, chewing of betel quid containing areca nut and solar rays. Objective: To study details of the premalignant lesions, including their incidence, etiological factors and management at a tertiary care teaching hospital. Materials and Methods: This is a retrospective observational study conducted between December 2018 to January 2021. There were 652 patients with oral cavity premalignant lesions enrolled in this study Result: There were 383 male and 275 females patients with a male to female ratio of 1.39:1. The majority of the patients with oral cavity premalignant lesions are in the age group 50 to 60 years. Out of 658 patients, 262 had oral leukoplakia, 149 had OSMF, 48 erythroplakia,52 oral candidiasis and 25 had oral erythroleukoplakia. Conclusion: Early diagnosis and prompt treatment are important steps for managing the premalignant lesions of the oral cavity as late stags may progress into severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma in the oral cavity.