Functional Teeth and Frailty in Older Adults

Imagine a 68-year-old grandmother in Sleman who has lost most of her teeth. She gets by on soft rice and easily chewable side dishes, while rarely eating meat or fibrous vegetables. Gradually, her body becomes weaker. She tires easily, her grip becomes weaker, and her walking slows down. Is this simply a normal part of aging? Or is there something that could have been prevented earlier?

Recent research from the Faculty of Dentistry, Universitas Gadjah Mada, offers a surprising answer: dental condition and oral function are closely associated with frailty, a syndrome of physical vulnerability that can often precede serious health decline among older adults.

What Was Studied, Who Participated, and Why Does It Matter?

The study, led by drg. Elastria Widita, MSc, PhD, from the Department of Oral Medicine, FKG UGM, involved 405 adults aged 60 years and older living in five subdistricts in Sleman Regency, Yogyakarta. The research used a community-based cross-sectional design and multistage cluster random sampling through local Elderly Integrated Service Posts (Posyandu Lansia).

Participants underwent direct dental examinations conducted by two trained and calibrated dentists and were interviewed using structured questionnaires. The researchers measured not only the number of teeth but also functional tooth units (FTUs)—a measurement that counts pairs of upper and lower teeth that can actually function for chewing, including natural teeth, fixed dental prostheses, implants, and removable dentures. The maximum score was 12 FTUs, representing complete functional dentition.

The researchers also assessed dental caries, dysphagia (difficulty swallowing), xerostomia (dry mouth), and oral health behaviors such as tooth-brushing frequency and dental visits. These factors were analyzed in relation to frailty status, which was assessed based on five criteria: unintentional weight loss, muscle weakness, exhaustion, slowness, and low physical activity.

The results? Of the 405 participants, 16 percent were classified as frail, 75 percent as pre-frail, and only 9 percent as robust.

The Fewer Functional Teeth, the More Vulnerable the Body

The strongest finding from this study was the association between the number of FTUs and frailty status. Even after adjusting for potential confounding factors such as age, sex, education level, nutritional status, chronic diseases, and medication use, the association remained significant.

Older adults with a greater number of FTUs had lower odds of being classified as frail (OR: 0.78; 95% CI: 0.66–0.92) or pre-frail (OR: 0.85; 95% CI: 0.75–0.96). Conversely, a lower number of FTUs was associated with a higher risk of exhaustion and muscle weakness—two of the five major components of frailty.

“These findings strengthen the growing body of evidence that oral health is associated with declining physical function in later life.” — drg. Elastria Widita, MSc, PhD, principal investigator, FKG UGM

The biological mechanism is plausible. When a person loses functional teeth, their ability to chew decreases. As a result, their food choices become more limited, and animal protein, hard vegetables, and other nutrient-dense foods may increasingly be avoided. Intake of branched-chain amino acids decreases, which is directly associated with reduced handgrip strength. Muscles weaken, and the body becomes increasingly frail.

Dysphagia and xerostomia can further exacerbate this condition. Dysphagia was associated with exhaustion (OR: 1.69; 95% CI: 1.09–2.62), while xerostomia was also significantly associated with exhaustion (OR: 0.91; 95% CI: 0.85–0.97). Dry mouth interferes with food bolus formation and swallowing, ultimately worsening nutritional status and accelerating physical exhaustion.

Who Is Most at Risk and Where Are the Opportunities for Intervention?

The participants' sociodemographic characteristics provided a picture that was unsurprising but still important. Frail older adults tended to be older, had lower educational attainment, and had poorer nutritional status. Almost all participants across the frail, pre-frail, and robust groups did not visit the dentist regularly. Notably, none of the participants in the frail group were recorded as making regular dental visits.

This is more than just a statistic. It reflects the reality of access to dental healthcare among older adults in Indonesia, where dental visits are still often viewed as a tertiary need rather than an integral part of routine healthcare.

The study was published in the international journal BMC Geriatrics in 2026 and is among the first studies to comprehensively map the relationship between oral health and frailty in the Indonesian context—a developing country characterized by limited access to healthcare services, varying nutritional quality, and oral health behaviors that still need improvement.

drg. Elastria Widita, MSc, PhD, and her team recommend integrating dental health examinations—including screening for dysphagia, xerostomia, and functional dentition—into comprehensive geriatric assessments. Posyandu Lansia, which served as the primary community setting for this study, could provide a realistic entry point for such interventions.

The major question that remains concerns causality: can improving oral health among older adults actually slow down or prevent frailty? With its cross-sectional design, this study cannot answer that question. However, it provides a strong foundation for future longitudinal research.

In the meantime, there is one thing that can already be done: stop treating dental health in older adults as a minor issue. Because behind functional teeth is a body that may still be capable of standing strong.

Source DOI: https://doi.org/10.1186/s12877-026-07167-6

Authors: Anny Anggraini; drg. Achmad Zam Zam Aghasy, M.Kes.

Photo: Freepik