Purpose: The objective of this study was to determine the oral health-related quality of life in state institutionalized older adults and correlate it to their oral health status. Materials and Methods: A group of 278 older adults (average age: 83.5 ± 6.5 years) from 9 state institutions in Malta was randomly selected. Participants were clinically examined and answered three questionnaires (Oral Health Impact Profile [OHIP-14], Geriatric Oral Health Assessment Index [GOHAI], and Denture Satisfaction). Results: Oral health-related quality of life measurements were significantly associated with pocket depth (OHIP-14 and GOHAI, P .05); decayed, missing, or filled teeth (OHIP‑14 and GOHAI, P .05); carious teeth (OHIP-14 and GOHAI, P .05); number of missing teeth (OHIP-14 and GOHAI, P .05); and maxillary and mandibular dentures (OHIP‑14 and GOHAI, P .0001). Denture satisfaction was associated with denture age (P = .010) and types of prostheses (P .05). Conclusion: Institutionalized older adults have high levels of oral disease. Although oral health-related quality of life is generally good, those participants with a poorer oral health-related quality of life had significant associations with poor oral health. However, the extent varies with the individual's perception of good health.