It is widely known that tobacco use significantly contributes to a variety of health problems, including mouth cancer. The proteins P16 and Ki-67 have a role in regulating the cell cycle and promoting cell growth. Analyzing the levels of these proteins can give us valuable information about the overall health of cells. This study aims to assess the cellular alterations and immunohistochemical expression of P16 and Ki-67 in the oral mucosa of Saudi smokers. From March to December 2023, a cross-sectional study scraped 500 samples from the buccal mucosa. Participants in the study were Saudi citizens of both genders. We selected a total of 300 individuals who smoked cigarettes and 200 individuals who did not smoke tobacco as the control group. The selection process involved two sample techniques: initially purposive sampling and subsequently snowball sampling. The samples underwent an immunohistochemical examination to determine the presence of P16 and Ki-67 protein overexpression. We evaluated the samples by assessing the proportion of cells that exhibited positive staining and the intensity of the staining. The data were examined utilizing SPSS. We identified categorical variables by calculating frequencies and percentages using the chi-squared test. A significance level of p < 0.05 was used to determine statistical significance. A total of 48% of cigarette users had abnormal results, compared to 20% of nonsmokers. These abnormalities included cytological atypia, inflammation, reverse cytological infection, and binucleated or multinucleated cells (p = 0.015). People who smoked had higher levels of P16 and Ki-67 expressions than people who did not smoke, 12% and 5%, respectively (p = 0.042). There were no important changes in P16/Ki-67 expression between participants of different ages (p = 0.68) or between men and women (p = 0.27). These results demonstrate the detrimental effects of smoking on cell health, underscoring the importance of quitting to reduce the risk of cytological abnormalities and related diseases. Smokers have higher levels of the proteins P16 and Ki-67, which shows how important these biomarkers are for understanding the risks to oral health.