Introduction: A method called sediment cytology includes the investigation of smears arranged from the sediment of the biopsy specimen fixatives. The sediment from this fixative is used to prepare smears and provides a potentially rich source for cytological material. Investigation of the fixative sediment and understanding of the cytological picture with pertinent clinical and radiological information permits diagnosis in a few hours. Aim: To evaluate the diagnostic efficacy of sediment cytology and oral brush cytology compared with histopathological findings in oral leukoplakia (OL) cases. Methods: Cytological smears were obtained from 30 clinically diagnosed OL lesions using 2 techniques: oral cytobrush and 10% formalin fixative sedimentation. Both smears were stained with Papanicolaou. Cytological smear evaluation was conducted with respect to cellularity, cell distribution, cellular clumping, and the presence of blood, debris, inflammatory cells, and microbial colonies. The cytopathological scores for all cases were compared between sediment and brush cytology and correlated with the histopathological diagnosis. For statistical analysis, the κ test and the Wilcoxon matched-pair test were used. Results: The cytobrush technique had a sensitivity of 83.3% for OL cases histopathologically diagnosed as severe dysplasia, while the sediment cytology technique had a sensitivity of 16.6%. For moderate/mild dysplasia cases, the cytobrush technique had a sensitivity of 7.7%, whereas the sediment technique showed no diagnostic sensitivity. Conclusion: Based on the results from the present study, sediment cytology, unlike oral brush cytology, is not a useful screening tool for the preliminary diagnosis of potentially malignant oral lesions.