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Ramsey SE, Papachristou E, Watt RG et al. J Am Geriatr Soc 2018; 66: 473–479

Poor oral health has well recognised effects on eating, swallowing and nutrition as well as speech and smiling, and therefore has consequences for many aspects of health and well-being. Previous studies have suggested that poor oral health is also associated with a greater risk of frailty. With an increasing ageing population, frailty in older people has become a major healthcare challenge. Frailty in this paper is defined as 'a state of vulnerability in older age to adverse outcomes, including functional decline, hospitalisation, disability, long-term care and death'.

Using data from the British Regional Heart Study (7,735 men recruited age 40–59 from 1978–1980), survivors in 2010–2012 were called for re-examination. Measures of oral health included tooth number, pocket depth of six index teeth (three upper and three lower teeth), attachment loss and self reported oral health. Self reported measures included dry mouth, sensitivity and eating difficulties. Frailty measures included physical measurement of weight, height and girth, walking speed and grip strength. Medical history recorded included coronary heart disease, diabetes, and the regular use of medications with known xerostomic side effects. A smoking history and socio-economic status were also recorded.

Edentulousness, dry mouth and cumulative self reported oral health problems were associated with the incidence of frailty. These findings were independent of other general health issues and socio-economic factors. The relationship between poor oral health and frailty is not well established. However, dry mouth, often a side effect of polypharmacy, affects oral health-related quality of life and may influence the comfort of the mouth and of dentures in particular. There may then be a consequent effect on nutritional status, although self reported eating difficulties were not found to be a significant factor.

The authors conclude that oral health problems may be powerful markers and predictors of frailty in older people. Unsurprisingly, they state that 'oral health is under recognised in the assessment and care of older people' and it is encouraging that this study has been published in a journal of geriatrics and not a dental journal. Further research is needed to investigate the links between oral health and frailty, and whether they are associated through nutrition or inflammation. The authors also recognise that poor oral health may be a modifiable risk factor for frailty. Sadly, it is not suggested that a dental care professional is routinely involved in the assessment and care of older people.