OBJECTIVE The aim of the present study was to determine the association between dental anxiety and quality of life (QoL) and to test the hypothesis that treatment of highly anxious patients would significantly enhance QoL. METHODS Subjects were 35 highly anxious dental patients of a Dutch dental fear clinic who were assessed on dental trait anxiety (DAS and S-DAI) and QoL (oral health-related QoL with the use of OHIP-14, dental anxiety-related QoL with the SADAS, and general aspects of QoL using Global Assessment of Functioning, while five different aspects of life satisfaction were quantified on a VAS-scale) both prior to and after treatment (an average of six sessions of 45-60 minutes each). Also, both objective (DMFT and dentists' judgement) and subjective (patients' judgement) indices of oral health status were recorded. RESULTS Higher dental anxiety was significantly associated with lower OH-QoL as indexed by the OHIP-14 (r = 0.51-0.56, P < 0.01). Treatment was associated with marked improvement on oral health status, reduction of dental anxiety, and improvements regarding a variety of aspects of QoL (all Ps < 0.001). Reduction of dental anxiety, rather than improved oral health, was found to predict enhanced OH-QoL. CONCLUSIONS The results underline the importance of applying effective treatment methods for dentally anxious patients, not only with the purpose to alleviate their dental anxiety and to improve their oral health, but also because it contributes to an enhancement of their QoL.