Conflicting evidence exists regarding prognosis in younger patients with oral cavity squamous cell carcinoma (OSCC) compared to older counterparts. We compared the outcomes of OSCC patients <40 year-old (yo) to those between 40-70 yo treated at our institution. All OSCC treated between 2005 and 2017 were reviewed. Clinical characteristics and outcomes of a younger cohort (age <40 yo) were compared to the all the older (40-70 yo) patients, and then to a 1:1 matched propensity score matched older cohort. The cohorts were matched including: gender, ECOG performance status (PS), pT- and pN-categories, primary tumor subsite (oral tongue vs other subsites), resection margin status, and presence of extranodal extension (ENE). The primary endpoint was 5-yr overall survival (OS, measured by Kaplan-Meier method), and secondary endpoints were 5-yr locoregional failure (LRF, analyzed by competing risk method), and disease-free survival (DFS, evaluated by Kaplan-Meier method). A total of 57 patients were identified in the younger (< 40) cohort which had a median follow up of 4.3 (0.1-13.6) years, and 441 in the older (40-70) cohort who had a median follow up of 2.7 (0.2-9.4) years. Among the younger (< 40 yo) cohort: median age was 33 yo, 24 (42%) females, 35 (61%) non-smokers, and 25 (44%) non-drinkers; bilateral and ipsilateral neck dissection was performed in 12 (21%) and in 30 (53%), respectively. Postoperative radiation therapy was given in 23 (40%), and concurrent chemotherapy in 15 (26%). Before applying the propensity score matching, a comparison of the younger cohort (n=57) and entire older cohort (n=441) showed that younger patients, had better ECOG PS (PS 0-1 98% vs 94%, p=0.022), less smoking history (37% vs 67% p=<0.01), had more oral tongue primary tumor site (81% vs 46%, p<0.001), fewer pT3-4 (18% vs 45%, p<0.001), less frequent pN+ (42% vs 65%, p<0.001), and less pENE+ (17% vs 34%, p=0.01), a similar proportion received chemotherapy (28% v 26%, p=0.76). The young patients had better 5 year OS (82% [95% CI 71%-93%] vs (66% [60-71%] p=0.008), better 5 year DFS (66% [54%-81%] vs 54% [49%-60%] p=0.031), and less LRF (26% [16%-43%]) vs 31% [27%-37%] p=0.18). Following propensity score matching (50 patients in each matched cohort); there was no significant difference between the younger and older cohort in 5-yr OS (81% [70%-94%] vs. 71% [59%-85%], p=0.18), 5-yr DFS (63% [49%-80%] vs. 64% [52%-79%], p=0.49), and 5-yr LRF (28% [17%-47 %] vs. 32% [21%-48%], p=0.29). OSCC patients under 40 yo have better ECOG PS and pathologic features compared to the 40-70 yo counterparts. With propensity score matching, younger and older cohorts have comparable survival and tumor control. The clinical impression of poor outcomes for patients aged less than 40yrs may represent recall bias.