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Objectives The tea industry is one of India’s oldest and most significant sectors, employing over one million workers, predominantly from scheduled castes, tribes, and ethnic minorities. Major tea-producing states include Assam, West Bengal, Kerala, and Tamil Nadu, with notable plantations also in Tripura and Himachal Pradesh. Tea plantation workers often live in socioeconomically disadvantaged conditions, with overcrowding, poor hygiene, and low literacy levels, predisposing them to communicable diseases and lifestyle-related health issues, including tobacco use and oral malignancies. This study aimed to assess the pattern of tobacco use and the prevalence of premalignant oral lesions and oral cancer among tea plantation workers in the Nilgiri Hills, Tamil Nadu, India.Material and Methods A cross-sectional descriptive study was conducted among 400 tea plantation workers from five estates in the Nilgiri Hills. Data were collected using a pretested questionnaire covering demographic details, tobacco usage habits, frequency, and form. Oral examinations were conducted by a single trained examiner to identify premalignant and malignant lesions. The collected data were analyzed using SPSS version 15.Results Among the study population, 46% had no formal education, and 65% used indigenous methods for oral hygiene. Oral mucosal lesions were identified in 52% of participants. The most common findings included leukoplakia (34%), tobacco pouch keratosis (42%), and malignant oral tumors (6%). The prevalence of oral lesions was significantly associated with tobacco usage and limited awareness of its health risks.Conclusions Tobacco use remains a leading preventable cause of morbidity and mortality. The high prevalence of oral mucosal lesions among tea plantation workers highlights the urgent need for targeted health education, tobacco cessation programs, and routine oral screening in this vulnerable population. Health professionals have a critical role in raising awareness and implementing preventive strategies to mitigate the health burden from tobacco use.