This retrospective descriptive, correlational study highlights the crucial contribution of laboratory diagnostics in Saudi Arabia's healthcare system in managing oral and maxillofacial lesions. The study examined 412 patient records from tertiary care centers to quantify test utilization, diagnostic concordance, and clinical impact. Histopathological biopsy was the mainstay of investigation in most cases (87.6%). A statistically significant difference was noted between clinical and histopathological diagnoses, with an overall discordance rate of 11.7%. The discordance rate for lesions considered high risk for malignancy increased markedly to 28.0%, which emphasizes the severe limitations of clinical examination alone. Logistic regression analysis showed that a discordant histopathological result was a factor that changed the treatment plan most strongly, leading to 22.65 times higher odds of this change. Additionally, diagnostic intervals differed significantly from test to test, with pathways involving molecular adjuncts being the longest. Therefore, the present study supports that laboratory tests are fundamental for accurate diagnosis and are the main guide for therapeutic decisions. This work is empirical evidence that can serve as a plea for a biopsy threshold to be lowered and to help oral medicine diagnostic protocols.