Neurocognitive decline and delirium, frailty, incontinence, falls, hearing and vision impairment, medication compliance and pharmacokinetics, skin breakdown, impaired sleep and rest are regarded as geriatric giants by gerontologists, geriatricians and nursing home staff. As these are all interrelated in the elderly failure to act on one can impact on the others; however, the implications of poor oral health have for too long been ignored and deserve equal status. Mouth pain and discomfort can be devastating for the elderly, compound psychosocial problems, frustrate carers and nursing home staff and disrupt family dynamics. As appearance, function and comfort suffer, so may a person’s self-esteem and confidence. The contributing reasons for poor oral health such as rapid dental decay, acute and chronic periodontal infections, compromised systemic health on a background of hyposalivation, coupled with xerostomia-inducing medications, reduced fine motor function, declining cognition and motivation will not only lead to an increase in both morbidity and mortality but also impact on quality of life in one of the most vulnerable groups in the community.