Objectives:The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects. Setting and Subjects:302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist. Outcome Measures:The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders. Results:One third (33%) of the subjects had experienced at least one episode of RTI and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P=0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1–3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5–6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated. Conclusions:The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.