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Background: patient experience is now a key parameter in health care. Yet, very little is known about the possible impact of dentist–patient relationships on patient-centred outcomes including older peoples' oral health-related quality of life (OHRQoL).Objective: this study assessed the relationship between OHRQoL and dentist–patient relationships related to perceived unmet dental needs; shared decision-making; time spent discussing oral health problems; respect and confidence and trust.Participants: older people aged 65 years and over living in East London, UK in 2011.Methods: a cross-sectional study using stratified random sampling recruited a representative sample of older people (n = 772). Participants completed an oral examination and a structured questionnaire including the Oral Health Impact Profile-14 (OHIP-14) measuring OHRQoL and five dentist–patient relationship questions taken from the UK 2009 Adult Dental Health Survey. Multivariate Poisson regressions modelled the association between OHRQoL and dentist–patient factors adjusting for socio-demographic factors, clinical oral indicators, and dental attendance.Results: having a perceived unmet need for dental treatment (PRR = 1.84; 95% CI: 1.32, 2.56) and expressing a lack of trust and confidence in one's dentist (PRR = 1.74; 95% CI: 1.01, 2.98) were significant predictors of poor OHRQoL among older people.Conclusions: these findings suggest that older people with unmet dental needs and those who expressed a lack of trust and confidence in their dentist were more likely to experience poor OHRQoL reinforcing the importance of the dental patient experience in healthy ageing and well-being. [ABSTRACT FROM AUTHOR]