Purpose of ReviewSmoking is a strong and modifiable risk factor for periodontitis. The adverse effects of smoking on oral health are at the center of long-term studies. The aim of this review is to assess these effects with new findings.Recent FindingsStudies in different populations have demonstrated strong associations between smoking and severity of periodontitis. Additionally, researchers have observed similar effects in various types of smoking such as water pipe smoking and smokeless tobacco. Microbiological analyses recently have shown increased early colonization of periodontal pathogens in smokers. Lower levels of immunoglobulins and impaired fibroblast attachment to matrix proteins are new observations. Smoking markedly influences response to treatment, and smokers are resistant to conventional periodontal therapy. Implant failure and risk of peri-implantitis are higher among smokers.SummaryLatest data supports that severity of periodontitis is higher in smokers. Smoking cessation is beneficial for improving periodontal status and periodontal therapy outcomes.