The aim of this study was to evaluate the relationship between cigarette smoking and the condition of the teeth and periodontium and the oral health behavior of 18-year-olds. Cross-sectional studies on 1,611 18-year-olds from Poland were conducted in 2017. The questionnaire provided socio-economic data, information about health-related behavior (cigarette smoking and oral health behavior), and absence from school due to oral pain. The dentition status (DMFT and DMFS), periodontal status (gingival bleeding, depth of periodontal pockets, loss of attachment), and need for endodontic treatment or tooth extraction were clinically assessed. Cigarette smoking was reported by 25% of participants (15% reported every day smoking). Adolescents who smoked cigarettes regularly had a higher mean number of decayed teeth (2.40±3.21 vs. 1.95±2.66) and similar periodontal status. Cigarette smoking increased the risk of oral hygiene neglect (63% vs. 69%), dietary mistakes (25% vs. 13%), failure to make dental appointments (32% vs. 43%), occurrence of oral pain (28% vs. 27%), absence from school due to pain (13% vs. 6%), and the need for endodontic treatment or tooth extraction (11% vs. 5%). The socio-economic factors and sex of the subjects decreased the influence of smoking only on oral hygiene neglect. Cigarette smoking by adolescents seems to be an independent risk factor for serious dietary mistakes, failure to benefit from oral healthcare, and more dynamic damage of teeth, which lead to pain and even tooth loss. Therefore, these aspects should be included in the risk assessment of oral disease and incorporated into educational programs promoting a healthy lifestyle.