Background: Oral cancer is considered as a major health problem in most part of the world. Many factors have been identified as important causative agents responsible for the development of oral cancerous and precancerous lesions. In Sudan, smoking of tobacco has been identified as major cause. Aim: The study aimed to evaluate the value of PAP (Papanicolaou stain) and Silver stained Nucleolar Organizer Regions  (AgNOR) techniques in    identification of bacterial infections and changes in cells of buccal cavity among Sudanese hookah users. Methods: In the current study hundred apparently healthy people were included, Pap and AgNORs stains was used for the staining of buccal smears. Results: A total of hundred samples of buccal smears were included in this study. The age of participant ranged from 20 - 70 years. Thirty three samples (33%) had bacterial infection, one sample (1%) had Actinomyces infection, and 66 samples (66%) showed normal cells. Twelve samples (12%) had acute inflammation, 30 samples (30%) had chronic inflammation, and 58 samples showed normal cells. Samples stained with Pap stain, seven smears (7%) had inflammatory changes and 93 samples (93%) were negative. p < /em> value, and standard deviation, mean AgNORs showed 1.920_+4.50 in cases and 0.682_+1.420 in control. Conclusions: Analysis of AgNORs and Pap stain suggest that, use of hookah influences prolifrative activity in cells and also play a role in transmission of different types of microorganisms due to smoking it in the form of groups.