Tobacco-associated oral potentially malignant disorders (OPMDs)-including leukoplakia, erythroplakia, proliferative verrucous leukoplakia (PVL), and oral submucous fibrosis (OSMF)-remain a major concern in oral healthcare due to their risk of malignant transformation. Despite numerous treatment modalities, no universally accepted approach exists, emphasizing the need for a multidisciplinary strategy. Early detection, intervention, and tobacco cessation are critical components of management. Pharmacological treatments such as retinoids, beta-carotene, and antifibrotic agents have shown variable success, with no definitive evidence of preventing malignancy. Long-term surveillance, regular follow-ups, and clinical documentation are essential for monitoring disease progression. Challenges include inconsistent diagnostic criteria, lack of high-quality RCTs, and limited treatment efficacy. Future directions should focus on personalized therapies based on genetic markers, regenerative medicine, and public health initiatives targeting tobacco and areca nut use.