© 2015 Australian Dental Association. Abstract Background The aim of this study was to document the oral mucosal burden in an urban Indigenous community and to evaluate the efficacy of an adjunctive optical device (Identafi™) in a general dental practice. Methods Three hundred and forty-two patients who presented to an urban Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) were examined using conventional oral examination (COE) and with a multispectral device (Identafi™). Loss of autofluorescence (LAF) and the visibility of diffuse vasculature were noted. Results The urban Indigenous community assessed did not display significantly higher rates of smoking, alcohol consumption or lesion prevalence compared to non-Indigenous counterparts. The white and violet light functions of Identafi™ provided excellent lesion visibility in 84.5% and 77.9% of cases respectively compared to 75% with COE, and were capable of highlighting new lesions not seen during COE. Conclusions The urban Indigenous community does not appear to display a significantly higher prevalence of risk factors such as smoking and alcohol consumption compared to their non-Indigenous counterparts living in the same region, nor are they more likely to have oral mucosal lesions. The incidence of intraoral pigmentation has the potential to complicate use of autofluorescence screening devices, emphasizing the importance of skill and training when using this technology.