Oral Health Determinants of Frailty in Older Adults: An Umbrella Review of Systematic Reviews and Meta-Analyses

Document Type

Review

Publication Date

2-1-2026

Abstract

Oral health is an important yet often overlooked determinant of healthy ageing, with growing evidence linking it to physical frailty in older adults. Findings from systematic reviews and meta-analyses on the associations between oral health indicators and physical frailty among older adults are evaluated and summarised. Systematic reviews, with or without meta-analyses, assessing oral health indicators (exposures) and physical frailty (outcomes) in adults with mean age ≥60 years were included. The methodologies of included reviews were appraised using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. The certainty of evidence associated with meta-analysis outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. PubMed (MEDLINE), Scopus, Web of Science and Cochrane Library, within the past 10 years, up to July 2025 were used. From the 654 records identified, 12 systematic reviews with 4 meta-analyses were included. All 12 reviews presented data from community-dwelling older adults, and 5 also included the institutionalised, hospitalised and home care populations. Findings suggested that physical frailty was significantly associated with (1) number of teeth, particularly ≤20 teeth and (2) impaired oral functions, including masticatory function assessed using various measures, tongue pressure, oral diadochokinesis and oral frailty. Evidence regarding the association between periodontal disease and physical frailty was insufficient and inconclusive. There is currently limited evidence on oral dryness, oral dysbiosis, oral pain and use/nonuse of denture. This umbrella review identified significant associations between poor oral health indicators and physical frailty, highlighting the importance of oral health in healthy ageing. Considerable heterogeneity in frailty definitions, oral health measures and study designs limits the ability to draw definitive conclusions or infer causality. Findings across systematic reviews are summarised, providing a comprehensive overview of associations between oral health and physical frailty. Research gaps and conflicting results were also identified to guide future studies.

Publication Title

International Dental Journal

ISSN

00206539

DOI

10.1016/j.identj.2025.109319

Volume

76

Issue

1

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