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treatment. Evidence Acquisition: A web-based search in PubMed and Google Scholar was performed to identify publications regarding the effects of smoking on various aspects of the periodontal disease process and to find an explanation for the possible association between smoking and the progression of periodontitis. We evaluated the articles published in English language between 1990 and 2013 with the search terms ‘‘periodontal health and smoking’’, ‘‘periodontal treatment and smoking’’, and ‘‘tobacco smokers and oral hygiene’’. Results: Of the total yield of 145 identified publications, 72 were selected for this literature review. The results of the selected papers reflect the effect of smoking on oral hygiene, gingival inflammation and vasculature, gingival crevicular fluid, subgingival microflora in periodontitis, fibroblast function, genetic polymorphism, initiation and progression of periodontal disease and its effect on passive smokers, and host response to periodontal treatment. Conclusions: Smoking is a significant risk factor for impaired periodontal health and treatment.