Association between oral health and frailty: results from the Korea National Health and Nutrition Examination Survey

Abstract

Background Previous research has suggested that poor oral health is positively associated with frailty. The objective of this study was to explore associations of key oral diseases (periodontal disease, tooth loss), and oral hygiene and management behaviors with the level of frailty in community-dwelling older Korean adults using national representative survey data. Methods This study used cross-sectional, 6th and 7th Korea National Health and Nutrition Examination Survey (KNHANES VI, VII) data. Adults aged 50+ years were included. Frailty was measured using frailty phenotype (FP) and frailty index (FI). FP was determined using five frailty criteria, i.e., weight loss, weakness, exhaustion, slowness, or low physical activity, and the level of frailty was classified with the number of criteria present (robust, none; pre-frail, 1–2; frail, 3+). FI was determined using a 44-item FI constructed according to a standard protocol, and the level of frailty was classified as robust (FI: ≤ 0.08), pre-frail (FI: 0.08–0.25), and frail (FI: ≥ 0.25). Multiple ordinal regression analyses were conducted with each type of frailty as the outcome variable. Independent variables of interest were the periodontal status, number of teeth, and practices on oral hygiene and management. Analyses were additionally adjusted for participants’ socioeconomic, diet, and behavioral characteristics. Results The prevalence of frailty was 4.38% according to the FP classification (n = 4156), 10.74% according to the FI classification (n = 15,073). In the final adjusted model, having more teeth and brushing after all three meals were significantly associated with lower odds of being more frail (in both frailty models); no significant association was observed between periodontal disease and frailty. Conclusions Findings from this study show having more teeth and practicing adequate brushing are significantly associated with frailty. Due to limitations of the study design, well-designed longitudinal studies are needed to confirm these findings.

Research hotspots and trends of oral health in older adults from 2013 to 2023: A bibliometric and visual analysis

“…Periodontal disease is an inflammatory process that can lead to elevated levels of gingival epithelial inflammatory markers interleukin, tumor necrosis factor-alpha, and histamine, which amplify inflammation and may lead to the progression of frailty [ 17 ]. Other oral health indicators, i.e., oral function, self-rated oral health, brushing habits, oral pain and masticatory dysfunction were significantly associated with frailty [ [47] , [48] , [49] , [50] ]. The intrinsic mechanisms by which oral health contributes to frailty in older adults include five main aspects: malnutrition, chronic inflammation, cognitive function, psychosocial factors, and neural pathways [ 51 ].…”

Oral Health and Its Related Factors among Institutionalised and Non-Institutionalised Elderly People in Xiamen, China—A Pilot Study

“…Second, systemic health plays a significant role in oral health-related practices. Older adults living in institutions often exhibit a greater burden of systemic health issues, including chronic diseases [25] and cognitive decline [20,26], which impede their ability and inclination to undertake appropriate self-care oral practices, consequently elevating the risk of dental caries. Third, mobility restrictions and financial constraints commonly encountered by institutionalised elderly people usually hinder their ability to obtain timely and suitable oral healthcare interventions, thereby leaving dental caries untreated or unaddressed.…”

Association of oral status with frailty among older adults in nursing homes: a cross-sectional study

“…For instance, Tuuliainen et al found that the brushing frequency among Finnish frail older inhabitants remained significantly lower than in the non-frail older adults, and positive changes in the prevalence of brushing teeth twice a day were observed [ 44 ]. In 2022, a study from communities in South Korea found that brushing after all three meals was negatively correlated with frailty among older adults aged 50 years or older [ 45 ]. Additionally, insufficient brushing has been shown to frailty-related enabling factors [ 46 ].…”