Distant metastatic lesions in the oral and maxillofacial regions are rare in occurrence and are indications of an end-stage severe malignant process progressing in another part of the body. Lung, breast, kidney, bone, and colorectal regions have been reported as the most prevalent origins of the primary tumor metastasizing to the oral cavity; however, this prevalence rate may not necessarily align with the relative incidence of these primary tumors in the general population suggesting a selective pattern for the metastasis to the oral tissues. The organ selectivity in the whole process of metastasis may be determined by the characteristics of the distant site tissue microenvironment and the migrating tumor cells as explained in the seed and soil theory. The path of circulation is another determining factor for the tumor cells trapping in certain distant organs. Metastasis in the oral cavity mostly affects both soft and hard tissues of the mandible in comparison to the maxilla. Among oral soft tissues, the gingiva is a common site for oral cavity neoplasms secondary to a distant primary tumor due to the high susceptibility of the gingiva to inflammation. The traces of an undetected tumor may be found in the oral cavity for the first time. Therefore, this chapter aims to highlight the prevalence, origin, and appearance of the oral metastatic lesions reported in the current literature and propose possible mechanisms underlying the organ selectivity in the process of metastasis to the oral and maxillofacial regions.