Naswar is a widely consumed form of smokeless tobacco (ST) prevalent in South and Central Asia, particularly in Pakistan and Afghanistan. It is commonly placed in the lower labial sulcus, allowing prolonged exposure of oral tissues to a mixture of nicotine, slaked lime, ash, heavy metals, and other cytotoxic agents. This chapter comprehensively reviews clinical and laboratory-based studies assessing the impact of naswar on periodontal health. Evidence from cross-sectional studies reveals that naswar users consistently exhibit higher scores of plaque index, bleeding on probing, probing depth, clinical attachment loss, and marginal bone loss compared to non-users. These clinical findings are supported by laboratory investigations showing significantly elevated levels of proinflammatory cytokines including interleukin (IL) IL-1β, IL-8, and tumour necrosis factor-alpha, oxidative stress biomarkers, and collagen degradation products in naswar users. Furthermore, socio-behavioural factors such as poor oral hygiene, low education, and economic hardship contribute to increased disease susceptibility among naswar users compared with non-users. Although direct evidence is lacking, hypothetical extrapolations suggest that naswar use may also pose risks to peri-implant tissues due to similar inflammatory mechanisms. This chapter also addresses regulatory gaps, highlighting poor compliance with tobacco control policies and the need for stronger enforcement, taxation, and public awareness. This chapter emphasizes naswar as a modifiable risk factor for periodontal and potentially peri-implant diseases, calling for multifaceted interventions including clinical screening, patient education, and policy-level action to mitigate its public health impact.