This 'In my opinion' paper has been written by a general dental practitioner who, prior to his recent retirement, had a particular interest in the provision of domiciliary oral healthcare. The paper describes the rapid rise in the number of elderly people with mental illness and the increasingly dentate older population who pose new challenges for dentists and carers. It considers the different types of care homes for the elderly, challenges, barriers to care and the provision of care in homes for the elderly and those with dementia. It goes on to reflect on the need for training carers, the role of technicians, and costs. It suggests that there is a need to review treatment planning for those in the early stages of mental illness and improve the availability of domiciliary care. There is a need also to review training and support for carers in the maintenance of oral health. Its final suggestion is that all of these issues are pressing and will become more so over the next 20 years as the population ages.