Oral squamous cell carcinoma (OSCC) is a lethal disease of global significance. Having previously demonstrated a rising incidence and worsening mortality in a retrospective analysis of 9,887 OSCC patients diagnosed in Queensland, Australia, the authors of this paper re-analysed patient cohort data to determine the cause of death. Overall, 5,859 patients died: 3,585 (61.2%) from a cancer related episode in the head and neck, 796 (13.6%) from cancer outside the head and neck region, and 1,478 (25.2%) from a non-cancer related cause. Improved understanding of the cause of death offers important opportunities to enhance contemporary care provision, including more accurate prediction of mortality outcomes, recognition of patients whose pre-existent comorbidities limit the efficacy of intensified treatment modalities, and the delivery of better post-treatment screening and tertiary preventive strategies.