Purpose: It is well-recognized that many institutionalized elderly persons with dementia do not wear dentures. The objective of this study was to evaluate the current status of denture use among elderly patients with dementia, in association with degree of mental impairment, to provide information relating to a decision-making process for optimal denture treatment. Materials and Methods: From August 2001 to December 2002, 101 hospitalized elderly persons in a geriatric hospital dental clinic received removable denture treatment by two certified prosthodontists. Prior to denture treatment, patient mental status was evaluated using the Mini Mental Status Examination (MMSE). Basic activities of daily living, including mobility, feeding, toilet use, dressing, and bathing, were also evaluated. Denture acceptance was determined 6 months after denture delivery. Results: Eight patients were excluded; 73 patients had accepted their dentures and 20 had not 6 months after denture delivery. The mean MMSE score for patients who did not accept denture delivery (11.7 ± 7.0) was significantly lower than that of those who did accept and wear their dentures (16.0 ± 6.8). Conclusion: The cognitive status of institutionalized elderly persons with dementia should be a criterion for clinical decision making relating to denture treatment.