The association between oral health and frailty in community-dwelling older adults: a systematic review

Frailty is an important geriatric syndrome characterized by decreased physiological reserves and increased vulnerability to adverse health outcomes among older adults. With the rapid growth of the aging population, identifying modifiable risk factors associated with frailty has become a major public health priority. Oral health is increasingly recognized as an essential component of healthy aging, as poor oral conditions may contribute to nutritional decline, systemic inflammation, impaired social participation, and functional deterioration. However, the relationship between oral health and frailty among community-dwelling older adults remains incompletely understood, and previous studies have reported heterogeneous findings due to variations in oral health indicators, frailty assessment tools, and study populations. The purpose of this systematic review is to comprehensively synthesize the current evidence regarding the association between oral health and frailty among community-dwelling older adults. Specifically, this review aims to identify oral health-related factors associated with frailty risk, summarize the consistency of reported associations across different oral health domains, and highlight potential gaps requiring further investigation. This systematic review will include observational studies involving community-dwelling older adults aged 50 years or older. Eligible studies will examine the association between oral health indicators and frailty outcomes assessed using validated frailty measurement tools. Oral health exposures will include subjective oral health measures, oral status indicators (e.g., number of teeth, dentition status, periodontal conditions), oral functional parameters (e.g., chewing ability and masticatory function), prosthetic factors (e.g., denture use), oral symptoms (e.g., xerostomia and oral pain), and oral health-related behaviors or dental service utilization. A comprehensive literature search will be conducted in PubMed, Embase, and Web of Science from database inception to September 13, 2024. Study selection, data extraction, and methodological quality assessment will be performed independently by two reviewers. The methodological quality of included studies will be evaluated using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Due to expected heterogeneity in oral health exposures, frailty assessment instruments, and reported outcomes, findings will be synthesized using a narrative approach rather than quantitative meta-analysis. This systematic review is expected to provide an updated and comprehensive overview of the relationship between oral health and frailty among community-dwelling older adults. The findings may contribute to identifying clinically relevant oral health indicators for early frailty risk assessment, informing community-based oral health promotion strategies, and supporting the integration of oral health evaluation into geriatric care. Furthermore, this review may help guide future longitudinal studies and the development of standardized definitions and assessment frameworks for oral frailty.