Abstract
Objective
To investigate the status of oral frailty in elderly patients with periodontitis in Anhui province and analyze the influencing factors.
Method
Clinical data of elderly patients with periodontitis admitted to the Department of Periodontology and Oral Medicine, Stomatological Hospital Affiliated to Anhui Medical University from January 2024 to December 2024 were retrospectively analyzed. According to whether oral frailty occurred, the patients were divided into the non-oral frailty group (n = 193) and oral frailty group (n = 1113). Binary Logistic regression analysis was used to explore the related factors that may affect oral frailty.
Results
The incidence of oral frailty in elderly patients with periodontitis was 85.2%. Binary Logistic regression analysis showed that smoking and drinking; periodontitis, with 1, 2, 3 or more chronic diseases, 16–20 natural teeth and < 16 teeth, subjective masticatory difficulties, prefrail and frail were the risk factors for oral frailty in elderly patients with periodontitis (P < 0.05). Moderate level and high level of oral health-related quality of life were protective factors for oral frailty in elderly patients with periodontitis (P < 0.05).
Conclusion
Elderly patients with periodontitis demonstrating smoking habits, alcohol consumption, periodontitis, comorbidities, < 20 natural teeth, subjective masticatory difficulties, frailty and poor oral health-related quality of life show elevated risks of oral frailty. This study identifies critical risk factors warranting clinical attention, though therapeutic interventions require further investigation through interventional studies.
Keywords: The elderly, Periodontitis, Oral frailty, Frailty, Oral health related quality of life
Introduction
Periodontitis is currently the sixth most prevalent disease among adults worldwide, and its prevalence increases with age [1]. Severe periodontitis may lead to impaired masticatory function, tooth loss, and deterioration of oral health-related quality of life [2, 3]. Oral frailty refers to a series of phenomena and processes involving changes in oral status (number of teeth, oral hygiene, oral function, etc. ), accompanied by a decline in interest in oral health, reduced physical and mental reserve functions, and eating disorders, ultimately leading to the deterioration of physical and mental functions, with an incidence of oral frailty among people over 60 years old is 35.2%-60.9%(This data is derived from the results of 34 studies in five countries: China, Japan, Korea, Finland and India. ) [4]. Older adults with oral frailty demonstrate significantly higher risks of developing systemic frailty, with factors such as tooth loss, oral pain, periodontitis, and decreased chewing function being contributors to mortality in frail elderly individuals [5]. Frailty can also promote the occurrence and development of poor oral health, and the interaction between the two can accelerate physical disability in the elderly, placing a heavy burden on families and society in terms of medical care. Current research on oral frailty mainly focuses on community-dwelling elderly populations and hospitalized elderly patients, with limited studies on oral frailty in elderly patients with periodontitis. Building upon previous research on oral frailty [6–8], this study incorporated smoking status, alcohol consumption, periodontitis severity, number of chronic diseases, natural tooth count, frailty status, and oral health-related quality of life as independent variables. We aimed to investigate the current status and contributing factors of oral frailty in elderly periodontitis patients, thereby providing evidence-based references for developing targeted clinical interventions.
Methods
Participation and data collection
Convenience sampling was used to select elderly patients with periodontitis treated at the Department of Periodontology and Oral Medicine, Stomatological Hospital Affiliated to Anhui Medical University from January 2024 to December 2024. Inclusion criteria: (1) Diagnosed with periodontitis; (2) Age ≥ 60 years; (3) Willing to participate in the study; (4) Conscious and able to communicate normally. Exclusion criteria: (1) Suffering from malignant tumors; (2) Accompanied by severe systemic diseases; (3) Suffering from neurological diseases.
Based on the cross-sectional survey sample size calculation formula: Zα² * p(1-p) / d². The prevalence of oral frailty in China’s elderly population was 40.2% in epidemiological studies [4]. Previous research using the OFI-8 assessment tool reported a higher incidence of 51.7% [4]. Based on these findings, this study adopted a conservative estimated prevalence of 45% for sample size calculation. With a two-sided α level of 0.05 and permissible error of 3%, the initial sample size was determined to be 1056 participants. Accounting for a 20% buffer to compensate for response rate and data validity, the final required sample size was estimated at no fewer than 1267 cases.
This study actually included 1306 cases. The study was approved by the Ethics Committee of the Stomatological Hospital Affiliated to Anhui Medical University (HM2023002).
Research tools
General information questionnaire
Self-designed, including two parts(The questionnaire is provided in Appendix 1). (1) Demographic data: including age, gender, marital status, residence, education level, body weight(Based on the Chinese classification standards, subjects were stratified into three Body Mass Index (BMI )categories: underweight BMI < 18.5, normal weight BMI 18.5–23.9, and overweight BMI ≥ 24.0(including obese individuals).), smoking status, alcohol consumption, and medical expense payment methods; (2) Disease-related information: Periodontitis staging: Clinical dentists performed full-mouth periodontal examinations (excluding third molars) using KangQiao periodontal probes, with each tooth examined at six points (mesial, middle, and distal on both buccal and lingual sides), including probing depth (PD), clinical attachment loss (CAL), gingival recession (GR), bleeding on probing (BOP), tooth mobility, and furcation involvement.
Periodontitis staging was determined based on radiographic assessment of alveolar bone loss and clinical examination findings, in strict accordance with the classification system for periodontal diseases and conditions in 2018 [9], with cases categorized into Stage I, II, III, or IV. Additional clinical parameters included: duration of periodontitis (years since initial diagnosis), number of chronic systemic comorbidities, count of remaining natural teeth, types and number of dental prostheses (fixed/removable), presence of xerostomia, and subjective chewing difficulty.
Oral frailty index-8 (OFI-8)
The scale was developed by Tanaka et al. [10, 11]It is used to assess oral frailty in the elderly, with a Cronbach’s α coefficient of 0.949. The scale includes five dimensions with a total of eight items: chewing ability (2 items), swallowing function (2 items), denture use (1 item), social participation (1 item), and oral health-related behaviors (2 items). The total score ranges from 0 to 11 (items 1–3: “yes” scores 2 points, “no” scores 0 points; items 4–5:“yes” scores 1 point, “no” scores 0 points; items 6–8:“yes” scores 0 points, “no” scores 1 point). A higher score indicates worse oral health, and a score ≥ 4 indicates oral frailty. The Cronbach’s α coefficient of this scale in the formal survey of this study was 0.902.
FRAIL scale
The original scale was proposed by the International Association of Nutrition, Health, and Aging in 2008 [12] and translated into Chinese by Jing Dongmei et al. [13] in 2021. It is used to assess frailty in the elderly, with a Cronbach’s α coefficient of 0.705. The scale includes five dimensions: fatigue, low resistance, slow walking speed, multiple comorbidities, and weight loss. Each item is scored 1 point, and the total score ranges from 0 to 5. A score of 0 indicates no frail, 1–2 indicates prefrail, and ≥ 3 indicates frail. The Cronbach’s α coefficient of this scale in the formal survey of this study was 0.843.
Oral health impact profile (OHIP-14)
The original scale was developed by Slade [14] in 1997 and translated and culturally adapted by Xin Weini et al. [15]in 2006. It is used to assess oral health-related quality of life in the Chinese population, with a Cronbach’s α coefficient of 0.930. The scale includes four dimensions with a total of 14 items: functional limitation (5 items), pain and discomfort (3 items), psychological disability (3 items), and social disability (3 items). A Likert 5-point scale is used, with scores ranging from 0 to 4 (never to very often). The total score ranges from 0 to 56, with higher scores indicating worse oral health-related quality of life;0–14 indicates a high level, 15–29 indicates a moderate level, and 30–56 indicates a low level. The Cronbach’s α coefficient of this scale in the formal survey of this study was 0.883.
Data collection methods
This study used a questionnaire survey method, with six oral medicine graduate students and two oral health professionals trained as investigators. The investigators first explained the purpose, significance, and questionnaire completion methods to the subjects using a standardized script, obtained their informed consent, and then had them complete the questionnaire independently. If subjects encountered difficulties during the completion process, such as lack of understanding or illiteracy, the investigators provided neutral explanations in simple language. After the survey was completed, the investigators repeated the selected options to the subjects to ensure that the recorded content matched their true intentions. The questionnaires were distributed on-site and collected immediately. A total of 1350 questionnaires were distributed, and 1306 valid questionnaires were collected, with an effective response rate of 96.70%.
Statistical methods
SPSS 23.0 was used for data analysis. The Kolmogorov-Smirnov test was used to test the normality of continuous variables. Normally distributed measurement data were described using mean ± standard deviation, and count data were described using frequency and percentage. The chi-square test or Fisher’s exact test was used for intergroup comparisons. Binary logistic regression analysis was used to analyze the influencing factors of oral frailty in elderly patients with periodontitis, with the occurrence of oral frailty as the dependent variable. P < 0.05 was used to indicate that the difference was statistically significant.
Results
General information
A total of 1306 elderly patients with periodontitis were included, aged 60–87 (66.69 ± 5.57) years, other general characteristics are presented in Table 1.
Table 1.
Comparison of oral frailty in elderly patients with periodontitis by different characteristics (n = 1306)
| Item | No oral frailty group(n = 193) | oral frailty group(n = 1113) | x² | P | |
|---|---|---|---|---|---|
| Age(Years) | 60 ~ 70 | 142 | 751 | 4.977 | 0.083 |
| 71 ~ 80 | 51 | 345 | |||
| > 80 | - | 17 | |||
| Gender | Male | 103 | 636 | 0.954 | 0.329 |
| Female | 90 | 477 | |||
| Marital status | Married | 193 | 13 | - | 0.236 |
| Single | - | 1100 | |||
| Residence | Urban | 142 | 794 | 0.405 | 0.524 |
| Rural | 51 | 319 | |||
| Education level | Uneducated | 8 | 51 | 2.073 | 0.722 |
| Primary school | 82 | 465 | |||
| Junior high school | 46 | 307 | |||
| Senior high school | 36 | 171 | |||
| College or above | 21 | 119 | |||
| BMI | < 18.5 | 22 | 123 | 2.606 | 0.272 |
| 18.5ཞ23.9 | 151 | 826 | |||
| ≥ 24.0 | 20 | 164 | |||
| Smoking Status | No(Including having quit smoking for 3 months or more) | 126 | 465 | 36.683 | < 0.001 |
| Yes | 67 | 648 | |||
| Alcohol Consumption | No(Including abstaining from alcohol for more than three months) | 122 | 524 | 17.125 | < 0.001 |
| Yes | 71 | 589 | |||
| Medical Expense Payment Methods | Self-payment | 10 | 205 | 21.476 | < 0.001 |
| Resident Medical Insurance | 102 | 481 | |||
| Employee Medical Insurance | 81 | 427 | |||
| Periodontitis staging | Ⅰ | 103 | 279 | 95.314 | < 0.001 |
| Ⅱ | 66 | 306 | |||
| Ⅲ and Ⅳ | 24 | 528 | |||
| Periodontitis duration | ≤ 6 months | 34 | 184 | 0.401 | 0.818 |
| 7–12 months | 85 | 517 | |||
| >12 months | 74 | 412 | |||
| Number of Chronic Diseases (types) | 0 | 83 | 231 | 56.979 | < 0.001 |
| 1 | 55 | 278 | |||
| 2 | 31 | 296 | |||
| ≥ 3 | 24 | 308 | |||
| Number of Natural Teeth | > 20 | 142 | 361 | 128.256 | < 0.001 |
| 16ཞ20 | 46 | 423 | |||
| < 16 | 5 | 329 | |||
| Number of Dentures | 0 | 148 | 346 | - | < 0.001 |
| 1ཞ2 | 40 | 378 | |||
| 3ཞ4 | 5 | 308 | |||
| > 5 | - | 81 | |||
| Whether experiencing dry mouth | No | 193 | 561 | - | < 0.001 |
| Yes | - | 552 | |||
| Subjective Chewing Difficulty | No | 193 | 577 | - | < 0.001 |
| Yes | - | 536 | |||
| Frailty Status | No Frail | 4 | 9 | - | 0.001 |
| Prefrail | 189 | 1023 | |||
| Frail | - | 81 | |||
| Oral Health-Related Quality of Life | Low Level | 98 | 611 | 6.514 | 0.039 |
| Medium Level | 91 | 390 | |||
| High Level | 4 | 12 |
Oral frailty, frailty, and oral health impact status in elderly patients with periodontitis
The total oral frailty score of this group of elderly patients with periodontitis was 5.07 ± 1.52. According to the Oral Frailty Index-8 evaluation criteria [11], 1113 cases (85.22%) had oral frailty, and 193 cases (14.78%) did not have oral frailty; the total frailty score was 1.27 ± 0.60. According to the FRAIL Scale evaluation criteria13, 13 cases (1.00%) had no frail, 1212 cases (92.80%) were prefrail, and 81 cases (6.20%) were frail; the total oral health impact score was 30.26 ± 7.28. According to the OHIP-14 evaluation criteria [15], 709 cases (54.29%) had a low level, 581 cases (44.49%) had a moderate level, and 16 cases (1.22%) had a high level.
Univariate analysis of oral frailty in elderly patients with periodontitis
According to the Oral Frailty Index-8 evaluation criteria [11], the 1306 elderly patients with periodontitis were divided into a non-oral frailty group (n = 193) and an oral frailty group (n = 1113), and the differences between the groups were compared. The results showed that there were statistically significant differences in oral frailty among elderly patients with periodontitis with different smoking statuses, alcohol consumption, medical expense payment methods, periodontitis staging, number of chronic diseases(types), number of natural teeth, number of dentures, whether experiencing dry mouth, subjective chewing difficulties, frailty status and level of oral Health-Related Quality of Life (P < 0.05). See Table 1.
Binary logistic regression analysis of influencing factors of oral frailty in elderly patients with periodontitis
Using the occurrence of oral frailty (0 = no, 1 = yes) as the dependent variable and the 11 variables with statistical significance in the univariate analysis as independent variables, binary logistic regression analysis was performed (input,αentry = 0.05,αexit = 0.10). Stages III and IV periodontitis were combined into a single category for analysis due to the relatively low number of Stage IV cases (n = 4) and to enhance the statistical power of the regression model.The Omnibus test of model coefficients showed χ2 = 283.278, P < 0.001; the Hosmer-Lemeshow goodness-of-fit test showed χ2 = 3.410, P = 0.906. The results showed that smoking (OR = 3.553);alcohol consumption (OR = 4.441);Stage III and stage IV periodontitis (OR = 6.234);having 1, 2, or 3 or more chronic diseases (OR = 2.702, 3.610, 7.469);having 16–20 natural teeth or fewer than 16 (OR = 3.617, 25.883);subjective chewing difficulties (OR = 1.953);prefrail and frail (OR = 15.318, 63.063) were risk factors for oral frailty in elderly patients with periodontitis (P < 0.05). Moderate and high levels of oral health-related quality of life (OR = 0.300, 0.080) were protective factors against oral frailty (P < 0.05). See Table 2.
Table 2.
Binary logistic analysis of influencing factors for oral frailty in elderly patients with periodontitis (n = 1306)
| Item | β | SE | Waldχ2 | P | OR | OR 95%CI |
|---|---|---|---|---|---|---|
| Smoking | 1.268 | 0.462 | 7.533 | 0.006 | 3.553 | 1.437∼8.786 |
| Constant | 1.752 | 0.078 | 504.939 | < 0.001 | 5.767 | - |
| Alcohol Consumption | 1.491 | 0.433 | 11.861 | 0.001 | 4.441 | 1.901∼10.374 |
| Stage of Periodontitis (using stageⅠ as reference) | - | - | 6.399 | 0.041 | - | - |
| Stage Ⅱ | 0.128 | 0.149 | 0.735 | 0.391 | 1.136 | 0.849∼1.521 |
| Stage III and IV | 1.830 | 0.746 | 6.011 | 0.014 | 6.234 | 1.444∼26.926 |
| Number of Chronic Diseases (using 0 as reference) | - | - | 44.484 | < 0.001 | - | - |
| 1 | 0.994 | 0.400 | 6.174 | 0.013 | 2.702 | 1.234∼5.919 |
| 2 | 1.284 | 0.403 | 10.127 | 0.001 | 3.610 | 1.637∼7.958 |
| ≥ 3 | 2.011 | 0.396 | 25.784 | < 0.001 | 7.469 | 3.437∼16.230 |
| Number of Natural Teeth (using > 20 as reference) | - | - | 88.277 | < 0.001 | - | - |
| 16ཞ20 teeth | 1.286 | 0.184 | 48.738 | < 0.001 | 3.617 | 2.521∼5.189 |
| < 16teeth | 3.254 | 0.461 | 49.733 | < 0.001 | 25.883 | 10.478∼63.932 |
| Subjective Chewing Difficulty | 0.669 | 0.252 | 7.076 | 0.008 | 1.953 | 1.193∼3.197 |
| Frailty Status (using no frail as reference) | - | - | 106.999 | < 0.001 | - | - |
| Prefrail | 2.729 | 0.402 | 46.035 | < 0.001 | 15.318 | 6.963∼33.694 |
| Frail | 4.144 | 0.435 | 90.898 | < 0.001 | 63.063 | 26.902∼147.829 |
| Oral Health-Related Quality of Life (using low level as reference) | - | - | 79.232 | < 0.001 | - | - |
| Medium Level | -1.203 | 0.252 | 22.773 | < 0.001 | 0.300 | 0.183∼0.492 |
| High Level | -2.530 | 0.298 | 71.830 | < 0.001 | 0.080 | 0.044∼0.143 |
Discussion
Incidence of oral frailty in elderly patients with periodontitis
Among the 1,306 elderly periodontitis patients included in this study, 1,113 cases (85.2%) exhibited oral frailty (score ≥ 4). This prevalence markedly exceeds rates reported in recent studies of community-dwelling older adults (29.5%) [16, 17], hospitalized chronic disease patients (30.4%) [18], and hospitalized cancer patients (64.3%) [19]. While variations in assessment tools and geographic regions may contribute to these differences, the distinct study populations represent the primary explanatory factor. The pathogenesis involves several interrelated mechanisms: Periodontitis induces periodontal attachment loss and alveolar bone resorption, thereby compromising tooth-supporting structures [20]. Diminished natural dentition leads to significantly reduced masticatory efficiency compared to dentate healthy individuals [21]. Notably, diabetic patients demonstrate approximately threefold greater susceptibility to periodontitis, with glycemic levels showing a dose-dependent relationship with disease severity [22]. This elevated prevalence of oral frailty in elderly periodontitis patients emerges from the synergistic interplay of: Direct structural damage to periodontal tissues, Systemic consequences of chronic inflammation, Cumulative effects of tooth loss, Compounding impacts of comorbid conditions, Age-related decline in functional reserve capacity. These findings underscore the critical bidirectional relationship between oral health and systemic disease, emphasizing the imperative for enhanced preventive strategies and integrated care approaches in this vulnerable population.
Influencing factors of oral frailty in elderly patients with periodontitis
Periodontitis
Findings from this study identified stage III and IV periodontitis as significant contributing factors to the progression of oral frailty. As an inflammatory disease, periodontitis exerts multifaceted impacts on oral health. The condition promotes alveolar bone resorption, compromising tooth support and ultimately leading to tooth mobility or loss. These pathological changes directly impair masticatory function and nutritional intake-hallmark manifestations of oral frailty [23]. Concurrently, periodontal pain and discomfort may interfere with proper food mastication and create food aversion, thereby exacerbating frailty status. Without timely and effective intervention, the persistent inflammatory state further diminishes the regenerative capacity of gingival tissues, accelerating oral frailty progression. Emerging evidence has established associations between periodontitis and both cognitive impairment and depressive tendencies [24], with these factors demonstrating validated connections to oral frailty. Collectively, periodontitis exacerbates oral frailty through three primary pathways: (1) structural destruction of periodontal tissues (e.g., gingival recession, alveolar bone loss), (2) functional impairment of the masticatory system, and (3) psychological dysfunction. These mechanisms may potentially establish a vicious cycle of deterioration.
Clinical implications underscore the importance of regular dental examinations and enhanced personal oral hygiene practices as critical preventive measures against both periodontitis and oral frailty. Early implementation of aggressive periodontal therapy may not only arrest frailty progression but also contribute to improved systemic health outcomes.
Chronic diseases
This study found that suffering from chronic diseases is associated with the exacerbation of oral frailty. Existing evidence shows that compared with non-diabetic patients, diabetic patients have a threefold increased risk of developing periodontitis [25], and there is a bidirectional relationship between periodontitis and diabetes. Diabetes increases the risk of developing periodontitis, and periodontitis negatively affects blood sugar control [22]. The high inflammatory phenotype exhibited by diabetic patients has a stronger lipopolysaccharide-induced immune response, thereby altering TLR4 expression in gingival epithelium, leading to periodontal tissue destruction, and the severity of periodontitis can in turn affect blood sugar control and the progression of complications [26]. Commonly used hypertension medications, such as diuretics, may cause dry mouth, affecting the self-cleaning function and bacterial inhibition of the oral cavity, and easily leading to oral health problems. On the other hand, systemic inflammation plays a mediating role in the association between periodontitis and hypertension. Based on the above evidence, chronic diseases may indirectly or directly exacerbate oral health problems through systemic inflammatory responses and reduced immune function. In addition, chronic disease patients may further exacerbate the degree of oral frailty due to long-term medication and lifestyle changes. This suggests that in chronic disease management, more attention should be paid to the monitoring and intervention of oral health. Therefore, taking effective measures to control chronic diseases such as diabetes and hypertension can not only improve the overall health of elderly patients but also significantly reduce the risk of oral frailty and improve quality of life.
Frailty status
The results of this study found that physical frailty is positively correlated with oral frailty. Frailty weakens the body’s immune system function, leading to decreased resistance, making the oral cavity more susceptible to bacterial and viral infections, increasing the risk of infection, leading to periodontitis and oral ulcers, and exacerbating oral frailty [27]. At the same time, physical frailty is usually accompanied by a decline in tissue repair and regeneration ability, weakening the self-repair ability of gingival and periodontal tissues, making oral wounds difficult to heal, thereby accelerating the progression of oral frailty. At the social relationship level, frailty may lead to poor treatment compliance in patients, lacking the motivation to actively participate in oral care and regular check-ups, resulting in oral diseases not being effectively controlled, further leading to the worsening of oral frailty. Based on the above evidence, physical frailty affects oral health by weakening immune function, slowing tissue repair ability, and reducing life ability, accelerating the process of oral frailty. Therefore, by developing a healthy lifestyle, maintaining good overall health, and relying on comprehensive health management, early identification and intervention of potential oral problems can effectively slow down oral function decline and improve quality of life.
Oral health-related quality of life
This study found that better oral health-related quality of life may be a factor in delaying oral frailty. A low level of oral health-related quality of life reflects the physiological discomfort and decline in quality of life caused by oral function decline in individuals. This functional impairment not only exacerbates oral frailty but may also lead to overall physical weakness. At the same time, poor oral health can have a negative impact on individuals’ mental health, weakening self-confidence and reducing social ability, thereby forming a vicious cycle and further exacerbating oral health problems. Low oral health-related quality of life may lead to oral frailty through functional malnutrition, physiological, and psychosocial aspects. This state not only affects oral health but also affects the function and metabolism of multiple organs throughout the body, thereby accelerating the process of oral frailty [28]. Therefore, in clinical practice, it is necessary to comprehensively assess the multifaceted impact of oral health on patients’ quality of life, fully consider the comprehensive effects of oral health problems on physiological, psychological, and social functions, and improve patients’ oral health-related quality of life through comprehensive treatment and personalized interventions, slowing down the progression of oral frailty, and ultimately improving patients’ overall health and quality of life.
Number of natural teeth and subjective chewing difficulties
This study found that the number of natural teeth and subjective chewing difficulties are important factors affecting oral frailty. Teeth are the foundation of oral function and structure, and the loss of natural teeth directly affects chewing function, pronunciation, facial aesthetics, and overall oral health. Existing studies have shown that as the number of natural teeth decreases, oral frailty tends to increase [29]. Tooth loss, especially the loss of posterior teeth, makes it difficult to chew and grind food, affecting nutritional intake. On the other hand, the negative perception of one’s own chewing ability may lead individuals to prefer soft or liquid foods, further exacerbating malnutrition and weakness. The oral environment after tooth loss is prone to the accumulation of food debris and bacteria, easily leading to oral diseases such as periodontitis and dental caries. These diseases not only lead to further gingival recession and alveolar bone resorption but may also cause systemic diseases, accelerating the process of frailty [30]. Based on the above evidence, the number of natural teeth and subjective chewing difficulties can lead to oral frailty by affecting nutritional intake and increasing the risk of oral diseases. Therefore, maintaining normal oral motor function, i.e., preserving as many natural teeth as possible and maintaining normal chewing function, is particularly important for reducing the incidence of oral frailty. The most important aspect is the active treatment of existing oral diseases, including oral hygiene and functional maintenance, and promoting oral function exercises, which are the foundation for maintaining overall oral health.
Smoking status
This study found that smoking is a risk factor for oral frailty. Smoking weakens the oral immune system, reducing the oral environment’s resistance to infection, and accelerating the occurrence and development of oral diseases. At the same time, bacteria and dental plaque are more likely to deposit in the oral cavity of smokers, promoting the formation of dental calculus and plaque, further exacerbating oral inflammation and infection [31]. Smoking affects the balance of oral microorganisms, disrupts saliva, and has adverse effects on the gums [32].While smoking is a risk factor for periodontitis, it may reduce gingival bleeding due to vasoconstriction, it can also lead to periodontal diseases, manifested as tooth loosening, oral ulcers, and pigmentation, thereby increasing the risk of oral frailty. At the psychological level, smoking causes tooth staining, which not only affects aesthetics but may also affect patients’ self-confidence, leading to feelings of isolation and anxiety in social situations, further exacerbating oral health problems and frailty. Based on the above evidence, the impact of smoking on oral frailty is very extensive, involving multiple aspects of oral health, including direct physiological damage and indirect effects on oral function and mental health. Therefore, when paying attention to the impact of smoking on health, we should not only focus on lung or systemic diseases but also pay attention to its comprehensive threat to oral health. Medical institutions should strengthen oral health education and preventive care, and at the social level, policy guidance and public education should be used to help people stay away from the multiple harms of tobacco to oral health, thereby comprehensively improving quality of life and overall health.
Alcohol consumption
This study found that alcohol consumption is associated with the exacerbation of oral frailty. Alcohol consumption, especially excessive drinking, affects the immune system, reducing the body’s resistance to oral infections. At the same time, alcohol can irritate and damage the soft tissues in the oral cavity, leading to the occurrence of oral diseases such as gingivitis and periodontitis. When alcohol consumption and smoking act together, this risk increases significantly [33]. Studies have shown that alcohol consumption is a risk factor for tooth loosening and periodontitis in the elderly. Alcohol may increase the level of salivary acid in the oral cavity, lowering the pH of saliva, thereby increasing the risk of dental caries [34]. In addition, alcohol damages oral tissues, slows saliva flow, and the lack of saliva leads to the accumulation of acidic substances, increasing the risk of diseases such as dental caries and gingival recession [35]. Long-term alcohol consumption not only affects oral health but is also closely related to the occurrence of chronic diseases such as cardiovascular diseases, diabetes, and liver diseases. The presence of these chronic diseases may further exacerbate oral health problems, forming a vicious cycle of oral frailty and systemic frailty. Based on the above evidence, alcohol consumption can affect oral frailty by increasing the probability of pathogen infection, causing and exacerbating oral diseases, and altering the oral microenvironment. Therefore, in health education for the elderly population, the importance of abstaining from alcohol should be emphasized, helping them fully understand the negative impact of alcohol on oral health, which is crucial for preventing and slowing down the progression of oral frailty.
This study has limitations. Firstly, the convenience sampling method employed may introduce selection bias, thereby limiting the representativeness of the sample relative to the broader population. Secondly, as a single-center study conducted at the Stomatological Hospital of Anhui Medical University, the generalizability and external validity of the findings may be constrained. These factors should be carefully considered when interpreting and extrapolating the conclusions of this research. Future studies should focus on establishing standardized oral health record systems and conducting long-term, multi-center follow-up investigations to validate and refine multidisciplinary intervention models for periodontitis in the aging population.
Conclusion
The prevalence of oral frailty among elderly patients with periodontitis in Anhui Province reached 85.2%. Key risk factors included smoking, alcohol consumption, periodontitis (Stage III/IV), presence of one or more chronic comorbidities, chronic comorbidities, fewer than 20 natural teeth, subjective chewing difficulty, and prefrail/frail status. Conversely, moderate-to-high oral health-related quality of life served as a protective factor. Periodontitis and oral frailty may exacerbate each other through inflammatory pathways, functional decline, and psychosocial impacts. These findings highlight the need for integrated care models to improve both oral and systemic health in elderly periodontitis patients.
Acknowledgements
We are grateful to the patients who were willing to participate in the study.
Abbreviations
- BMI
Body mass index
- PD
Probing depth
- CAL
Clinical attachment loss
- GR
Gingival recession
- BOP
Bleeding on probing
- OFI-8
Oral frailty index-8
- OHIP-14
Oral health impact profile
Authors’ contributions
Xin Xia: Formal analysis, Data curation, Writing – Review & Editing.Haiyan Kong: Conceptualization, Methodology, Writing – Original Draft, Funding acquisition.Li Fan: Supervision, Project administration.Zhengyue Dai: Methodology, Software, Validation.Xueli Liu: Investigation.
Funding
This study was supported by the Clinical Science Foundation Project of Anhui Medical University (2023xkj175). The funder supported the study design, data collection, analysis, and manuscript preparation.
Data availability
The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Ethics Committee of the Stomatological Hospital of Anhui Medical University (Approval No: HM2023002). Informed consent was obtained from all individual participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Haiyan Kong, Email: 2504972724@qq.com.
Li Fan, Email: 421048505@qq.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.