Aim of the work The study has the dual aim of investigating health and oral hygiene of institutionalized elderly people in nursing homes (NH), assessing their impact on the quality of life, and to evaluate the knowledge and motivation of formal caregivers in oral hygiene in the geriatric care. Materials and methods The study was carried out in three NH enrolling two groups: the first consisting of 118 residents and the second of 51 formal caregivers. The tools used for the first sample were: survey questionnaire on geriatric dentistry, Geriatric Oral Health Assessment Index (GOHAI), clinical examination. The tool used for the second sample was a questionnaire designed to assess the knowledge and skills related to the management of oral hygiene and the degree of motivation of caregivers in relation to this practice. Results The results show disagreements between the statements of guests and healthcare professionals about oral hygiene habits and conditions assessed on clinical examination. Oral hygiene resulted to be poor (OHI-S 3.4), more than half of dentures (upper and lower) exhibited poor hygiene, with a prevalence of grades 3 and 4 of PHI. The staff showed a superficial motivation on this issue; 46.5% of the institutionalized elderly reported a score of <= 50 GOHAI, corresponding to a low degree of self-perception of oral health. Conclusion There is the need to motivate the staff through periodic programs of education and motivation to oral hygiene in elderly patients, even not self-sufficient ones, and enhance the activity of dentist and dental hygienist in nursing homes.