The study aims to elucidate salivary proteome alterations in medwakh smokers. Saliva samples from 33 medwakh smokers and 30 non-smokers were subjected to proteomic analysis using UHPLC-ESI-QTOF-MS. Saliva samples were analyzed for the production of 13 cytokines using LEGENDplex™ Human Essential Immune Response Panel. Statistical analysis revealed alterations in the abundance of 74 proteins including key immune mediators and inflammatory markers (Accession: PXD045901). Proteins involved in oxidative stress, cell anchorage, and cell metabolic processes were affected in medwakh smokers. Salivary immune response evaluation further validated proteome findings, revealing significantly higher levels of IL-1β, IL-12p70, IL-23, IFN-γ (Th1 cytokines), IL-6 (Th2 cytokine), and MCP-1 (chemokine) in medwakh smokers. The substantial increase in abundance of involucrin suggests stratified squamous cell differentiation and increased cell lysis in the oral cavity of medwakh smokers akin to chronic obstructive pulmonary diseases (COPD). The protein–metabolite joint pathway analysis further showed significantly enriched differentially expressed proteins and metabolites of glycolysis/gluconeogenesis, pentose phosphate, fructose and mannose, nicotinate and nicotinamide, and glutathione metabolism pathways in medwakh smokers. The findings underscore an urgent need for comprehensive public health interventions among youth, including awareness, cessation programs, and promoting healthier lifestyle choices to safeguard the well-being of individuals and communities worldwide.