Oral cancer is one of the major health problems in the Sudan, due to the habit of use of Toombak and cigarette smoking.Epithelial atypia (ET)was ascertained in 29 subjects and could not be ascertained in the remaining 271. Among the 29 subjects with ET, there were 11 (38%) toombak dippers, 14 (48%) cigarette smokers and 4 (14%) non-tobacco users. Among the 271 subjects without ET, there were 89 (33%) toombak dippers, 86 (32%) cigarette smokers and 96 (35%) non-tobacco users. ET was found in all the 5 control cases with OSCC. For the ET among toombak dippers and cigarette smokers, adjusted OR and the 95% CI were found to be 3 (0.91-9.7) and 4 (1.2-12.3), respectively.Exfoliative cytology is the most suitable method for implementation of oral screening program as it is both non-invasive and cheap.