•Non-smoking, non-drinking elderly females are a distinct subgroup of oral SCC patients.•Disease specific survival is up to 30% lower than all other oral SCC patients (P < 0.001)•Disease specific survival is up to 25% lower than age matched controls (P = 0.006)•NSND patients have higher rates of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005) Objectives To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma.Materials & methods Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded.Results Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. >50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was significantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort.ConclusionsThe results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.