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Oral lichenoid lesions (OLL) could be premalignant lesions. Hence, it is critical to investigate the epidemiologic aspects of oral lichenoid lesions. This cross-sectional study evaluated the prevalence of oral lichenoid reaction in patients attending the Department of Oral Medicine, School of Dentistry, during 2007-2018. All clinically and histopathologically documented files of oral lichen planus (OLP)- like lesions were evaluated, and oral lichenoid reactions were identified. The site of oral involvement, potential causes of OLL, and medications accompanied with OLL were all documented. The data were analyzed using SPSS version 18. Of the 191 patients with OLL, 137 (71.7%) were females, and 54 (28.3%) were males, with a mean age of 46.242 ± 13.77. In contrast, the control group consisted of 190 patients with OLP. The control group included 112 women (58.9%) and 78 (41.5%) men. The mean age of patients with OLP was 45.4 ± 11.16 years old, which matched the OLL group. Medications (48.2%) and amalgam restorations (52%) were the two most common causes of lichenoid reaction. While levothyroxine was used more frequently (17.8%) in patients with OLP, anti-hypertensive (30.4%) medications were used more predominantly in patients with OLL. In the present research, 8.23% of lichenoid lesions and 4.2% of OLP exhibited dysplastic change. The prevalence of OLL was 15.8% in patients who were referred to the Department of Oral Medicine, School of Dentistry. The prevalence of dysplasia was statistically higher in OLL patients (P < 0.0001). The odds ratio was 4.6, 95% CI: 2.06-10.28. This study showed that the prevalence of dysplasia was statistically higher in OLL patients.