Introduction: Oral cancers contribute to over 30 % of all malignancies in India. Leukoplakia being one of the most common precancerous lesions can be detected clinically by in vivo staining procedures there by helping in early identification of this pre cancerous lesions and aid in early treatment initiation. Therefore the present study was conducted to compare the dysplastic expression in oral leukoplakia by toluidine blue staining, histopathology and immunohistochemistry (IHC) using CK 19 marker expression. Objectives: To compare dysplasia in oral premalignant lesion leukoplakia by clinical, histopathological and IHC using CK 19 marker. Materials and methods: Prospective comparative study was conducted on 15 patients who were found positive clinically with leukoplakia and there after comparing the dysplasia using toluidine blue staining, histopathology and Immunohistochemistry using CK 19 marker. Statistical analysis was done using SPSS version 16 Results: Of the 15 patients who were clinically suspected to have oral leukoplakia, 12 (80%), 10 (66.7%) and 8 (53.33%) cases were found to be positive on toluidine blue staining, histopathology and immunohistochemistry respectively. Conclusion: In the present study Toluidine blue was found to be sensitive in identifying precancerous lesions and can be used an adjunct to clinical diagnosis there by helping in early detection of oral cancer. This diagnosis can be confirmed using histopathology and IHC using CK 19 marker in detecting mild to moderate dysplasia at the early stages.