Background <p>The February 6, 2023 Kahramanmaraş earthquake sequence was associated with widespread disruption across eleven provinces in Turkey. Studies examining earthquake exposure, psychological responses, oral health behaviors, and oral health-related quality of life (OHRQoL) in adult survivors remain scarce. This study aimed to evaluate these associations.</p> Methods <p>A cross-sectional study was conducted among 284 adult patients attending Adıyaman University Faculty of Dentistry. Data collected via online questionnaire assessed earthquake exposure (EEI), retrospectively assessed pre- and post-earthquake anxiety (EA), clinical safety concerns (CSCS-3), oral health behaviors (HU-DBI), and OHRQoL (OHIP-14).</p> Results <p>Retrospectively reported post-earthquake anxiety scores were significantly different from retrospectively reported pre-earthquake scores (17.70 vs. 14.92; <i>p</i> &lt; 0.001). EEI, pre-earthquake anxiety, post-earthquake anxiety, and CSCS-3 were positively correlated with OHIP-14 (<i>r</i> = 0.283, 0.261, 0.159, and 0.276; all <i>p</i> ≤ 0.007). The HU-DBI showed low internal consistency (α = 0.544), limiting interpretability of oral health behavior findings. Chronic physical disease was associated with worse OHRQoL in both bivariate and multivariate analyses, whereas older age showed an association only in bivariate analyses. Although nominal sex differences were observed in post-earthquake anxiety and OHIP-14 scores, these differences did not retain statistical significance after false discovery rate correction.</p> Conclusions <p>In bivariate analyses, earthquake exposure, anxiety measures, and clinical safety concerns were each significantly correlated with worse OHRQoL. However, in hierarchical regression analysis, only chronic physical disease (β = 0.182, <i>p</i> = 0.006) and clinical safety concerns (CSCS-3, β = 0.165, <i>p</i> = 0.018) remained significant independent predictors. Pre-earthquake anxiety (β = 0.112, <i>p</i> = 0.081), post-earthquake anxiety (β = 0.045, <i>p</i> = 0.512), and earthquake exposure (β = 0.077, <i>p</i> = 0.227) were not independently associated with OHRQoL. Psychiatric disorder alone was not associated with OHRQoL (β = 0.034, <i>p</i> = 0.572). These findings suggest that integrating dental care with psychological support may improve oral health-related quality of life among disaster survivors, particularly those with chronic physical diseases. Because participants were recruited from a single dental clinic, the findings are most applicable to individuals who had already sought dental care, and the potential influence of clinical safety concerns on dental attendance in the wider survivor population cannot be determined. Furthermore, the findings related to the newly developed CSCS-3 should be regarded as preliminary and hypothesis-generating until confirmed through external validation.</p> Trial registration <p>Not applicable.</p>