Tobacco has been linked with several pain conditions that include musculoskeletal pain, rheumatoid arthritis, and fibromyalgia. This study documented associations between smoking and smokeless tobacco use and measures of orofacial pain and oral pain impacts (activity reduction and trouble with sleep) assessed during a 48-month time period. These data were collected as part of the Florida Dental Care Study, a longitudinal study of oral health among 873 adults aged 45 years and older at baseline. Twenty-five percent of the study participants were current users of some form of tobacco, and 34% were former users. Separate models were tested for smoking and smokeless tobacco. Current tobacco users were at increased risk of experiencing a range of painful oral symptoms. We also found that behavioral impacts associated with oral pain are sensitive to differences in tobacco use status. Our data also support the supposition that once tobacco cessation occurs, the risk for pain associated with oral disease decreases significantly. No differences were found between former users and those never having used tobacco across any of the pain measures. Strengths of the current study include the longitudinal methodology, assessment of different pain symptoms with potentially differing etiology, and that several markers of tobacco use were used (prevalence, consumption, and duration). Perspective This study considers the harmful effects of tobacco use on oral health. Smokers were at significantly increased risk for oral pain and related limitation of daily activities. The data also suggest that the risk for oral pain associated with tobacco use decreases significantly if tobacco cessation occurs. © 2004 by the American Pain Society.