Oral Frailty: Current Concepts, Assessment, Systemic Implications, and Future Perspectives

Oral frailty is an emerging geriatric syndrome characterized by subtle and multifactorial declines in oral function that may precede clinically apparent oral dysfunction. Increasing evidence suggests that oral frailty is closely associated with physical frailty, sarcopenia, malnutrition, and other indicators of systemic vulnerability, highlighting its potential role in the early detection of functional decline. However, practical approaches to early detection and intervention remain challenging because conventional assessments of oral function often require specialized equipment and professional expertise. This review summarizes recent advances in the assessment, clinical significance, and management of oral frailty, with particular emphasis on practical screening and its implications for early intervention. We discuss the utility and limitations of questionnaire-based screening tools, including the Oral Frailty Index-8 (OFI-8) and Oral frailty five-item checklist (OF-5), which enable simple identification of individuals at increased risk in community and clinical settings. We also introduce findings from the FESTA study indicating that cystatin C-related indices, including the creatinine-to-cystatin C ratio and the eGFRcys/eGFRcre ratio, may reflect skeletal muscle mass and are associated with oral functional decline, particularly reduced tongue pressure. Comparative and longitudinal evidence further suggests an association between oral frailty and subsequent physical frailty, while OF-5 may help identify individuals at risk of functional decline. Because oral and physical frailty may influence each other bidirectionally, management should extend beyond screening to include appropriate oral care, nutritional support, physical exercise, and medical evaluation. Integrating simple oral frailty screening with objective systemic indicators may facilitate earlier identification of vulnerable individuals and strengthen medical–dental collaboration aimed at preventing frailty progression.