MEDLINE contains well over 14,000 papers revealed by a search using keywords 'oral squamous cell cancer' or 'oral squamous cell carcinoma', over 27,000 using 'oral carcinoma' and over 48,000 using the keywords 'oral cancer'. It is difficult to see how clinicians could keep abreast of such a subject. This paper attempts to help by providing an overview of the aetiopathogenesis of oral squamous cell carcinoma (OSCC), discussing changes in epidemiology and increasing awareness of the wide range of risk factors, emphasising the genetic background to cancer susceptibility and the genetic changes associated with progression to OSCC and highlighting clinical implications.