Fail Oral Health, Frail General Health

The link you cannot ignore

By Dr. Jessica Francis

Frailty, commonly associated with ageing, encompasses a multidimensional syndrome characterised by increased vulnerability to stressors, diminished physiological reserves, and heightened risk of adverse health outcomes. While mental and physical frailty has been extensively studied, the connection between oral frailty and overall frailty has gained significant attention in recent years.

What is oral frailty?

Oral frailty comprises various oral health-related factors such as tooth loss, periodontal disease, oral infections, xerostomia (dry mouth), and impaired masticatory function. These conditions can result from a
combination of factors, including age-related changes, chronic diseases, poor oral hygiene, and inadequate dental care. As individuals age, they are more likely to experience tooth loss, deterioration of oral tissues, and reduced saliva production, which can impact their overall oral health and well-being.

Emerging evidence suggests that poor oral health and dental conditions may contribute to the development of mental and physical frailty, forming a complex interrelationship that warrants further investigations. Studies have shown that oral frailty can contribute to mental frailty, including cognitive decline and mood disorders. Oral infections and chronic inflammation associated with periodontal disease have been linked to an increased risk of cognitive impairment, such as Alzheimer’s disease and dementia. Moreover, tooth loss and oral pain can significantly impact an individual’s nutritional intake, leading to malnutrition and subsequent frailty.

Oral frailty can also exacerbate physical frailty. Impaired masticatory function resulting from missing teeth or ill-fitting dentures can hinder adequate chewing, leading to difficulties in consuming a balanced diet. This nutritional deficiency can contribute to muscle weakness, reduced bone density, and frailty related complications.

Conversely, mental, and physical frailty can also contribute to the development of oral frailty. Individuals experiencing mental frailty may neglect their oral hygiene practices, leading to a higher risk of periodontal disease and oral infections. Additionally, physical frailty can limit an individual’s ability to access dental care, maintain regular dental visits, and perform proper oral self-care routines.

Several mechanisms underpin the relationship between oral frailty and mental and physical frailty.
Chronic inflammation, often observed in periodontal disease, has been associated with systemic inflammation and oxidative stress, contributing to cognitive decline and physical frailty. Moreover, the shared risk factors between oral frailty and mental and physical frailty, such as aging, chronic diseases, and poor nutrition, further reinforce their interconnection.

Addressing oral frailty

Recognising the complex interplay between oral frailty and mental and physical frailty has significant implications for healthcare professionals, policy makers, and individuals themselves. Integrated healthcare models that prioritize oral health as an essential component of overall health and well-being are crucial. Oral health assessments should be included as part of routine geriatric evaluations, and dental care should be readily accessible, particularly for vulnerable populations.

Further research is needed to explore the causal pathways linking oral frailty to mental and physical frailty, as well as to identify effective interventions. Implementing preventive measures, such as oral health education, regular dental check-ups, and early intervention for oral diseases, may help mitigate the impact of oral frailty on overall frailty.

In summary, oral frailty, encompassing various oral health-related factors, may contribute to the development of mental and physical frailty, and vice versa. Understanding the bidirectional relationship between oral frailty and overall frailty is essential for comprehensive healthcare approaches focused on
healthy ageing. By addressing oral health needs alongside mental and physical health, we can enhance the well-being and quality of life for older adults, ultimately promoting healthy ageing in our society.

“ORAL HEALTH ASSESSMENTS SHOULD BE INCLUDED AS PART OF ROUTINE GERIATRIC EVALUATIONS, AND DENTAL CARE SHOULD BE READILY ACCESSIBLE, PARTICULARLY FOR VULNERABLE POPULATIONS.”

Dr. Jessica is a Dental lecturer and Specialist in Special Care Dentistry, Faculty of Dentistry, Universiti Malaya. She completed her Bachelor of Dental Surgery (Malaya) in 2007, and Doctor of Clinical Dentistry (Special Needs Dentistry) (Melbourne) in 2016. She served the Ministry of Health from 2007 to 2021.