BACKGROUND: In view of the gradual rise in oral malignancy in Europe, there is an increased need for undergraduate dental students to have some appropriate training in the recognition of the signs and symptoms of oral Premalignancy and malignancy, and be aware of the appropriate early management of patients with such oral lesions. The present study outlines the results of a pilot study to determine the knowledge and awareness of a cohort of undergraduate dental students in Spain regarding the management of oral premalignancy and malignancy. METHOD: In March 1997 a self-administered questionnaire (SAQ) addressing student's knowledge, opinions, and related aspects of screening and detection of oral malignancy and premalignancy, was mailed to 200 undergraduate dental students in two Spanish Universities. The present report details the responses of this cohort of undergraduates. Statistical analysis of the data was performed using the chi(2) test and the results were considered significant when P < 0.05. RESULTS: 37.0% of the respondents were male and 63.0% female. Almost all of the respondents (99.0%) had attended general dental congresses and 81.5% had attended specific courses on oral malignancy and premalignancy. Only 20% of undergraduate students had witnessed at least one patient with oral malignancy. Squamous cell carcinoma (SCC) was the most frequently observed (94.4%) oral tumour. 79% of the respondents had examined or witnessed at least one patient with a potentially malignant lesion. Leukoplakias were the most commonly observed (80.0%) premalignant lesions. 5th year students were more likely to have performed a biopsy than 4th year students (P < 0.05), particularly male students (P < 0.005). 40.0% of respondents believed that the lower lip was the most common site of an oral cancer; almost half realised that a tumour could have a speckled appearance. 79% to 82% of the respondents indicated that tobacco and alcohol were the principal causes of oral SCC, but 34.6% suggested that HIV disease was a risk factor for oral SCC. Almost all respondents routinely recorded the tobacco or alcohol consumption of patients and would offer advice to patients regarding modification of these habits. 64.0% of undergraduates suggested that clinical screening at intervals of 6 to 12 months was an effective means of diagnosing oral premalignant and malignant lesions, and almost all considered oral health promotion to be an effective means of reducing oral cancer mortality. CONCLUSIONS: Undergraduate dental students in Spain have limited clinical experience or knowledge of related aspects of oral premalignant and malignant lesions, and they may fail to recognise appropriate signs and symptoms and aetiological factors of such disease.