While cigarette smoking is recognized as being detrimental to periodontal health, the effect of water pipe smoking on gingival health is not known. The present study was conducted to determine whether water pipe smoking has an influence on gingival health. A cross-sectional study was carried out in 244 individuals aged 25-70 years. The levels of plaque and gingivitis were recorded on four sites of all present teeth, using the plaque index (PI) and gingival index (GI). Information about oral hygiene practices, dental care and smoking habits was obtained at the time of the clinical examination in accordance with a predetermined questionnaire. The means of plaque index and gingival index values were 1.2 and 0.9, respectively. Similarly, the mean percentages of surfaces with plaque and gingival bleeding sites were 66.7% and 30.4%, respectively. There was an overall significant association between smoking and plaque index and gingival index (F = 22.9 and F = 10.8, respectively, p 0.001). Oral hygiene was inferior in water pipe smokers, cigarette smokers, and mixed smokers when compared to non-smokers. The correlation between plaque % and gingival bleeding % in cigarette smokers was significantly weaker than in non-smokers. It was also weaker in water pipe smokers, but the difference was not statistically significant. The gingival bleeding response to plaque was significantly suppressed in cigarette smokers. There was a tendency towards suppression also in water pipe smokers. Schlagwörter: cigarettes, gingival bleeding, Saudi Arabia, tobacco smoking, water pipe