Similar to cigarettes, hookah smoking delivers the addictive drug nicotine and it is as toxic as cigarette smoking. While many hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes. This article identifies the negative impact of hookah smoking on overall as well as periodontal health and provides further evidence that this is an avoidable risk factor for periodontal disease. The purpose of this review article is to inform healthcare professionals about hookah smoking, and to introduce perspectives for dental patient management and future research