To determine the effect of waterpipe smoking on periodontal health.The study included 190 participants who were categorised into four groups; cigarette smokers, waterpipe smokers, dual smokers and nonsmokers. Intraoral examination included plaque (PI), gingival (GI) and calculus (CI) indices, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP).The four groups differed significantly in the prevalence and extent of periodontal disease. Pairwise comparison tests showed that the means of percentages of sites with PPD > 3 mm, PPD > 4 mm, CAL > 1 mm and bleeding on probing were significantly higher among smoking groups compared to the nonsmoking group (p 0.05).Waterpipe tobacco smoking is not an alternative, safe way of smoking considering periodontal disease. Thus, global actions against waterpipe smoking are required.