Background Several recent reports suggest an increasing incidence of oral squamous cell carcinoma (OSCC) among young persons in many regions of the world-a trend which is particularly concerning given the overall stabilization or even decline in incidence rates for head and neck cancer in general. The aim of this study is to determine whether there has been an increase in the number of cases of OSCC diagnosed in patients \40 years old by our biopsy service from 1971 to 2006. Methods A retrospective review of all OSCC cases diagnosed from 1971 to 2006 by the Emory University Hospital Oral Pathology biopsy service was performed. A comparison of demographic information, frequency, location and histologic grade was made between these cases as a whole and those occurring in a subset of patients \40 years old. Statistical procedures included chi-square analyses. Results From 1971-2006, 1,919 cases of OSCC were diagnosed, and 95 (5.0%) occurred in patients \40 years old.