Introduction: Periodontitis is a prevalent multifactorial inflammatory disease caused by lifestyle factors such as smoking and obesity. The erythrocyte sedimentation rate (ESR) is a systemic inflammatory marker, but its relationship with periodontitis, smoking status, and obesity remains underexplored.

Objective: This study evaluates the interrelationships among smoking status, anthropometric indices (body mass index [BMI] and waist circumference [WC]), hematological indices (ESR, hemoglobin [Hb], and total leukocyte count [TLC]), and periodontal indices.

Methods: This cross-sectional study included 45 healthy adults, divided into three groups (n=15 each): smokers with generalized moderate chronic periodontitis, non-smokers with chronic periodontitis, and periodontally healthy controls.  Clinical assessments included anthropometric indices, inflammatory hematological indices, and periodontal indices. Statistical analysis was conducted using the Statistical Package for Social Sciences software, with significance set at p<0.05.

Results: ESR levels were significantly higher in smokers with periodontitis (20 mm/hr) compared to non-smokers with periodontitis (14.33 mm/hr) and healthy controls (9.33 mm/hr), demonstrating a dose-dependent association with cigarette consumption. BMI was highest in smokers (29.47 kg/m²), followed by non-smokers (25.35 kg/m²) and controls (19.25 kg/m²). Reduced Hb levels were observed in smokers, while TLC showed no significant variation among groups.

Conclusion: In the presence of both periodontitis and obesity, smoking appears to exert a synergistic effect, resulting in heightened systemic inflammation and worsened periodontal tissue damage, as evidenced by elevated ESR and diminished Hb levels, independent of changes in TLC. These findings underscore the importance of incorporating lifestyle factors and systemic inflammatory markers into periodontal assessment to facilitate comprehensive patient management.