Objective—To evaluate the relationship between arsenic exposure and oral cavity lesions among an arsenic-exposed population in Bangladesh. Methods—We carried out an analysis utilizing the baseline data of the Health Effects of Arsenic Exposure Longitudinal Study (HEALS). HEALS is an ongoing population-based cohort study to investigate health outcomes associated with arsenic exposure via drinking water in Araihazar, Bangladesh. We used multinomial regression models to estimate the risk of oral cavity lesions. Results—Participants with high urinary arsenic levels (286.1–5000.0μg/g) were more likely to develop arsenical lesions of the gums [multinomial odds ratio (M-OR 2.90; 95% CI= 1.11–7.54)], and tongue (M-OR 2.79; 95% CI= 1.51– 5.15), compared with those of urinary arsenic levels of 7.0–134.0μg/g. Conclusions—Higher level of arsenic exposure was positively associated with increased arsenical lesions of the gums and tongue.