Objectives: Tobacco use is a leading risk factor for oral potentially malignant and malignant lesions, particularly among low-income populations. Migrant construction workers represent a vulnerable group due to occupational stress, lack of healthcare access and socioeconomic challenges. This study examines the prevalence and patterns of tobacco-associated oral lesions in this demographic to inform targeted interventions and policy measures. Methods: A cross-sectional epidemiological study was conducted among 1,671 migrant construction workers in Chennai using a multi-stage cluster sampling technique. Data on demographic details, tobacco use (smoking and smokeless) and oral lesions were collected through questionnaires and clinical examinations, adhering to WHO guidelines. Statistical analysis, including logistic regression, was performed using SPSS version 22.0. Results: Among the participants, 84.8% used smokeless tobacco, while 15.2% were smokers. The prevalence of tobacco-associated oral lesions was 36.8%, with leukoplakia (8.6%) and oral submucous fibrosis (7.8%) being the most common. The buccal mucosa was the most affected site. Significant correlations were observed between tobacco use and lesion prevalence, with younger age groups (28–38 years) and males being the most affected. Conclusions: This study highlights the high prevalence of tobacco-associated oral lesions among migrant construction workers, emphasizing the need for targeted prevention programs. Recommendations include workplace-based tobacco cessation initiatives, regular oral health screenings and culturally sensitive awareness campaigns. Future studies should address long-term impacts, barriers to healthcare access and integration of findings into national oral health strategies.