The prevalence of smokeless tobacco use has been increasing in the United States with concomitant social, medical, legal, and regulatory ramifications. This paper examines the association between the use of smokeless tobacco and the occurrence of periodontal disease and dental caries. Existing literature consists primarily of case reports and cross-sectional studies among teenagers. The limited evidence suggests an association between smokeless tobacco use and gingival recession. There is insufficient evidence to support any associations between smokeless tobacco use and gingivitis, periodontitis, or dental caries. Methods to improve future epidemiologic research to examine possible associations between smokeless tobacco use and periodontal effects or dental caries are discussed.