This cross-sectional study aimed to evaluate the effect of waterpipe smoking on periodontal health in a sample of adult Egyptian patients. included 322 medically fit volunteers who were consecutively enrolled in the study at the diagnostic center at Cairo University's Faculty of Dentistry. A personal interview was conducted with the patient to complete a well-structured, translated questionnaire that investigated their age, gender, educational attainment, income, oral health behaviors, and tobacco habits, including waterpipe smoking duration (heads smoked per day), and extent of usage (age of initiation and number of sessions per week). A full-mouth plaque index (PI), bleeding on probing (BoP), pocket depth (PD), clinical attachment level (CAL), and gingival recession depth (RD) were measured. The prevalence of waterpipe smoking among the study sample was 17.7%. Most waterpipe smokers were males with good socioeconomic status and a daily frequency of tooth brushing. Waterpipe smokers showed significantly greater PI, PD, CAL, and RD than nonsmokers. Stage II periodontitis was the most prevalent periodontal disease among waterpipe smokers (46.2%), followed by stage I periodontitis (30.8%), gingivitis (15.4%), and stage III (7.7%). Smoking using a waterpipe may pose an equal risk for periodontal diseases as smoking cigarettes.