UK adult dental health surveys (ADHS) exclude care home residents from sampling. Aim To understand oral health status of care home residents in Wales using ADHS criteria. Cross sectional survey of care home residents in Wales using a questionnaire and oral examination contemporaneous with, and paralleling, the ADHS 2009. 708 randomly selected participants from 213 randomly selected care homes participated including individuals with and without capacity. 72.8% of residents had tooth decay. Compared to older adults examined in the ADHS, residents are less likely to brush teeth/dentures twice a day (37% vs 63%), more likely to only attend a dentist when they have a problem (63% vs 26%), have more teeth with active decay (3.1 vs 0.9), more have current dental pain (13% vs 5%) and other morbidity (open pulp, ulceration, fistulae, abscess 27% vs 10%). High decay is present in both recently admitted and longer term residents. There was some regional variation in levels of oral hygiene. Oral health status of older people resident in care homes in Wales is poor. Findings suggest more could be done to improve preventive care both before and after admission to the care home.