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Background: Tobacco use remains a significant global public health concern and is strongly associated with numerous oral diseases, including periodontal disease and oral cancer. Despite growing public awareness regarding the harmful effects of smoking on oral health, preventive oral hygiene practices remain inconsistent in many populations, particularly in low- and middle-income countries. Objective: This study aimed to evaluate smoking habits, oral health awareness, and oral hygiene practices among adults and to examine the relationship between tobacco use, knowledge of smoking-related oral diseases, and preventive dental behaviors. Methods: A cross-sectional observational study was conducted among 173 adults residing in Sindh, Pakistan. Data were collected using a structured 23-item questionnaire assessing oral health awareness, hygiene behaviors, and behavioral triggers influencing oral health practices. Descriptive statistics were used to summarize participant characteristics and behavioral patterns. Associations between demographic variables and oral health practices were analyzed using chi-square tests, and logistic regression analysis was applied to evaluate the relationship between smoking status and oral health awareness. Statistical significance was set at P < 0.001. Results: Among participants, 66.5% reported high awareness of oral diseases and smoking-related risks. However, preventive behaviors were limited: only 12.7% attended biannual dental visits, and 54.3% reported not using supplementary hygiene tools such as floss or mouthwash. Social media was the most common source of oral health information (36.4%). Stress emerged as the most frequently reported behavioral trigger influencing oral health practices. Significant associations were observed between gender and several oral hygiene behaviors (P < 0.001). Conclusion: Although awareness of smoking-related oral health risks was relatively high, preventive oral hygiene practices remained limited, indicating a substantial knowledge–behavior gap. Targeted behavioral interventions and improved preventive dental health programs are needed to translate awareness into consistent oral health practices