Abstract This article aims to analyze the prevalence and associated factors of TMJ alterations in elderly institutionalized. An cross-sectional study of 1192 elderly institutionalized in Brazil was undertaken. Intra and extra-oral exams were performed and the TMJ was evaluated based on the Oral Health Assessment Form of the WHO (1997). Demographic data and elderly dependence were also collected. The self-perception of the elderly regarding oral health was measured using the Geriatric Oral Health Assessment Index - GOHAI. Data analysis was performed using the Chi-squared test and robust Poisson regression (level of significance of 5%). The prevalence of TMJ alteration was low compared to adults and was only associated with the state of dependence of the elderly individual (independent had 45.4% more alterations than dependent individuals), gender (women had 47.4% more alterations), self-perception of oral health (who evaluated negatively had 65.6% more alterations) and the need of upper dentures (who needed some kind of upper dentures had 45.8% more alterations than those who did not). Despite being low, the presence of alterations in the TMJ was more frequent in elderly independent, women, who evaluated negatively oral health and need some kind of upper dentures.