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A single-center retrospective cohort study examined the association between molar malocclusion status at ICU admission and loss of activities of daily living (ADL) at hospital discharge among acutely ill patients. Patients were assigned to the bilateral occlusion group or malocclusion group (N = 227 and 93, respectively). The following data were collected from electronic medical records: age, sex, Clinical Frailty Scale (CFS) on admission, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, confirmed diagnosis (neurological disorders or others), CFS at hospital discharge, and occlusion condition. Patients who were frail at admission (CFS &gt, 5) were excluded from analysis, and ADL loss was defined as CFS &gt, 5 at hospital discharge. Multivariate analysis showed malocclusion was independently associated with ADL loss [OR, 2.03, 95% CI, 1.13–3.64, p = 0.02]. For those aged 65 and older, malocclusion was significantly associated with both ADL loss [OR, 3.25, 95% CI, 1.44–7.32, p &lt, 0.01] and the incidence of delirium [OR, 2.61, 95% CI, 1.14–5.95, p = 0.02]. Malocclusion on ICU admission was associated with ADL loss in critically ill patients, and was associated with ADL loss and the incidence of delirium in the elderly. Poor oral health was a poor prognostic factor among critically ill patients.