The study aimed to describe and compare the psychosocial and functional impact of oral disease on the quality of life of the institutionalized and non-institutionalized elderly in Hong Kong. A total of 268 institutionalized and 318 non-institutionalized elderly aged 60-80 years took part. The 49-statement Oral Health Impact Profile (OHIP) was administered in a structured interview format and sociodemographic information collected prior to a clinical, oral examination. A greater number of the institutionalized were edentulous (19%); they also had more untreated dental disease. The number of elderly reporting negative impacts was generally low. The percentage of institutionalized elderly reporting a negative impact was significantly lower in one of the OHIP subscales (handicap, P < 0.001) and similar in the other six. The main factors affecting the OHIP score were living location, socio-economic status, dental disease and treatment seeking behaviour. In conclusion, the psychosocial and functional impact of oral conditions was low and similar in the institutionalized and non-institutionalized elderly although the pattern of oral disease was different. Life events and socially and culturally derived values appeared to affect the elderly perception of the impact of oral disease.