Aims: To comprehensively evaluate modifiable risk factors for oral cancer in India and generate evidence to guide targeted prevention strategies in a high burden population. Methodology: A systematic review was conducted in accordance with PRISMA guidelines. PubMed was searched for India-based primary studies assessing smokeless tobacco (SLT), smoking, areca nut/betel quid, oral hygiene, and human papillomavirus (HPV). Eligible study designs included case-control, cohort, cross-sectional, and molecular studies. Studies not specific to oral cavity cancers or lacking extractable data were excluded. Due to heterogeneity in exposure definitions, study populations, and methodologies, a qualitative narrative synthesis was performed. Results: Twelve studies met inclusion criteria. SLT emerged as the most consistent and strongest risk factor, with clear dose response relationships and prevalence exceeding 50 to 70% among cases. Areca nut was identified as an independent carcinogenic exposure, particularly among women and younger individuals. Smoking, predominantly bidi use, demonstrated a moderate increase in risk (odds ratio of 1.9) and frequently coexisted with other exposures. Poor oral hygiene and periodontitis were associated with increased risk (odds ratio of 2.25), with evidence of synergistic effects in combined exposures (odds ratio of 11.34). HPV prevalence showed marked variability (0-74%) with no consistent etiological role across studies. Conclusion: Smokeless tobacco and areca nut are the principal modifiable drivers of oral cancer in India. Smoking and poor oral hygiene contribute to additional risk, often in combination. HPV does not demonstrate a uniform association. Prevention strategies should prioritize stricter regulation of chewing products, integrated risk factor modification, and strengthening of oral health promotion and early detection programs. Conflict of Interest: The authors declare no conflict of interest.