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Mechanisms linking oral health and frailty in older adults: a narrative review

Background Frailty is a geriatric syndrome in which multiple systems lose their physiological reserves resulting in increased vulnerability to stressors and risk of adverse health-related outcomes. There is an increasing number of studies discussing the association of oral health with frailty through several pathways. Objective The aim of this review was to describe the possible mechanisms linking oral health and frailty. Data Sources A narrative review was performed with literature search in PubMed, Google Scholar and ScienceDirect electronic databases. Reference lists from relevant studies and cited papers were also investigated. Study Selection The review included full papers of any study design, published in peer-reviewed journals in English until July 2021. Data Extraction Current literature indicates four possible mechanisms linking oral health and frailty. Data Synthesis The first mechanism refers to the nutritional pathway. It is reported that poor oral health negatively affects protein and vitamins intake. Malnutrition and decreased energy intake have a dominant role in frailty onset. Inflammation is another mechanism. Periodontal disease causes a systemic increase of pro-inflammatory biomarkers which in turn may lead to muscle strength deterioration. Furthermore, oral health can be related to frailty through neural mechanisms. Specifically, occlusion and proprioception from the periodontal ligament contribute to the control of body balance. Finally, the mechanisms include the psychological pathway, since poor oral health may lead to social isolation and depression which increase the risk of negative general health outcomes. More studies are necessary to clarify the previous associations and reveal any causative effects.