Objective: The incidence of major depressive disorder in the elderly ranges from 0.2 to 14.1/100 person-years, and the incidence of clinically relevant depressive symptoms is 6.8/100 person-years. This study aimed to assess the longitudinal relationship between chronic intra oral pain and depressive symptom in Japanese elderly. Basic research design: 3-year cohort study. Participants: 212 community-dwelling seniors (129 men, 83 women) aged 77 years residing in the city of Niigata, Japan in 2005. Interventions: At baseline, subjects were asked about chronic intra oral pain (tooth, gingival or denture pain), with response choices of “yes” or “no”. Any type of pain, was counted as chronic intra oral pain. Main outcome measures: The General Health Questionnaire 30 (GHQ-30) was used to assess depression at follow up. The Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence was used to assess activities of daily living. Results: In multivariate logistic regression, baseline intra oral pain predicted depressive symptoms at follow up (Odds Ratio = 3.2, 95% CI = 1.32-7.81) after adjusting for serum HbA1c, creatinine and working life. Conclusions: Chronic intra oral pain increased the risk for the development of depressive symptoms in the elderly. Key words: orofacial pain; depressive symptom; elderly