Introduction: The etiology of Oral Cancer (OC) is multifactorial, resulting from several factors that predispose to the development of this pathology, with a high incidence and mortality, and is among the 10 most common pathologies in the world. Objective: It was to carry out a retrospective longitudinal observational study on the incidence of oral cancer in patients treated at public health units in the municipalities of the State of Sao Paulo-Brazil, as well as to present the main clinical and demographic characteristics of these patients. Methods: This study followed a retrospective observational cross-sectional model (2018-2022), following the rules of clinical research of the STROBE. The present study used the database of the public health system in Brazil on the incidence and prevalence of oral cancer in health units in 467 municipalities in the State of São Paulo-Brazil, whose data are available for public consultation and do not require approval. by the research ethics committee. Participants with oral cancer records of different ethnicities, aged over 20 years, and of both genders were included. Participants who had missing registration data were excluded. For data analysis, the database was built in a Microsoft Excel spreadsheet, which was exported to the Minitab 18® statistical program. One-Way ANOVA with p>0.05 was applied without a statistical difference in the CI95%. Results: The total number of municipalities in the State of São Paulo-Brazil analyzed was 467. Suspected oral malignancy did not present a significant statistical difference between the years 2018 and 2019 (0.33% vs. 0.30%), with p>0.05 in CI95 %. The highest incidences of suspected oral malignancy occurred in 2018 and 2019. In addition, it was evidenced that the most frequent histological type was squamous cell carcinoma in all the years analyzed. Also, bad habits such as alcoholism, smoking, excessive exposure to the sun, and also genetic predisposition, the presence of HPV did not show to influence statistically the occurrences of oral neoplasms. Conclusion: Based on the objective of this study, the incidence of oral cancer in the municipalities of the state of São Paulo-Brazil was higher in the years 2018 and 2019, regardless of the action of predictors such as smoking, alcohol consumption, HPV, genetic predisposition and age. However, further studies need to be carried out in the periods from 2020 to 2022 to know the population that was absent due to the COVID-19 pandemic.