Oral cancer is a global health burden with high mortality and morbidity. Advances in treatment have failed to improve the relatively poor survival rate due to late-stage diagnosis. Early detection and screening have been shown to be effective in reducing mortality and morbidity of most common cancers. Several studies have evaluated the effectiveness of oral cancer screening programs but clear results were not obtained. This narrative commentary aimed to give a critical insight into the dilemma of oral cancer screening and to suggest recommendations for future trends. Conventional oral examination still constitutes the gold standard screening tool for potentially malignant oral lesions and cancer. Interestingly, the findings of the most lasting (15-year) randomized controlled trial on oral cancer screening using visual examination (Kerala) supported the introduction of a screening program in high-risk individuals. Several screening adjuncts exist but are still not at the introduction stage. Further research to find an appropriate adjunct reliable tool for oral cancer screening is needed. In conclusion, oral cancer fulfills most of the essential principles of cancer screening but still many points need to be clarified. Therefore, there is a striking need to establish a global consortium on oral cancer screening that will oversee research and provide recommendations for health authorities at regular intervals.