Original Study| Volume 22, ISSUE 3, P559-563.e2, March 2021

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Association Between Oral Health and Frailty Among American Older Adults

  • Faisal F. Hakeem
    Address correspondence to Faisal F. Hakeem, MSc, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London SE5 9RS, UK.
    Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom

    College of Dentistry, Department of Preventive Dental Sciences, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
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  • Eduardo Bernabé
    Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
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  • Wael Sabbah
    Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
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Published:August 25, 2020DOI:



      We examined the association between tooth loss, periodontal diseases, and frailty among older American adults.

      Designs, Settings, and Participants

      Data from the National Health and Nutrition Examination Surveys (NHANES) 2011–2014 was used. We included 2368 community-dwelling adults aged 60 years and older. Frailty was measured with the 49-item frailty index. Oral health indicators included number of teeth and periodontal disease. A composite nutritional intake variable based on 13 micronutrients from the dietary assessment was created. Negative binomial regression was used to test the association between oral health and frailty. The first model was adjusted for age and gender, the second model was additionally adjusted for nutritional intake, and the third model was additionally adjusted for other covariates.


      For each additional tooth, the rate ratio (RR) for frailty was 0.99 [95% confidence interval (CI) 0.98–0.99] in the fully adjusted model. Similarly, participants with moderate-severe periodontitis had 1.08 RR (95% CI 1.02–1.14) for frailty index compared with participants with no periodontitis after adjusting for age, gender, and poor nutritional intake. The association lost significance in the fully adjusted model.

      Conclusions and Implications

      Oral health is associated with the frailty index, and nutritional intake appears to have a modest effect on the association. Periodontal disease has a weaker association with frailty compared with number of teeth. The findings highlight the importance of maintaining good oral health at older age and incorporating oral health indicators in routine geriatric assessments. Future research should investigate the role of potential mediating factors in this association.


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