Introduction: Oral frailty, characterized by tooth loss, chewing difficulty, and swallowing problems, has been associated with adverse health outcomes in older adults. However, longitudinal evidence on community-level inequalities and determinants of incident oral frailty remains limited. Objectives: This cohort study aimed to examine community-level inequalities in the incidence of oral frailty and identify individual- and municipality-level factors associated with its onset among older adults in Japan. Methods: We analyzed data from 42,987 participants aged ≥65 y who completed the Japan Gerontological Evaluation Study surveys in 2019 and 2022. Oral frailty was determined using a validated prediction model including age, number of teeth, chewing difficulty, and choking. Individual-level variables included sociodemographic, health status, and social capital indicators. Municipality-level variables included population density, aggregated social capital, and the presence of prefectural or municipal dental health ordinances. Modified multilevel Poisson regression was used to estimate incidence rate ratios. Results: The incidence of oral frailty varied across municipalities, ranging from 17.1% to 33.3%. In the fully adjusted multilevel model, individual-level factors significantly associated with a higher risk of incident oral frailty were male sex; being widowed, divorced, or never married; lower educational attainment; lower equivalent income; smoking history; current illness; and lack of social cohesion ( P < 0.05). At the municipality level, residing in urban, semi-urban, or rural-agricultural areas was associated with a lower risk of incident oral frailty compared with metropolitan area residency. Although not statistically significant in all models, higher municipality-level civic participation tended to be associated with a lower risk of incident oral frailty. Conclusion: Community-level inequalities in the incidence of oral frailty are driven by both individual vulnerabilities and municipality-level factors. Notably, higher municipality-level civic participation tended to be associated with a lower incidence of oral frailty. Effective prevention requires comprehensive strategies that address socioeconomic factors and promote community-level civic participation. Knowledge Transfer Statement: This nationwide cohort study demonstrates that community-level inequalities in the incidence of oral frailty are substantial. They are largely explained not only by modifiable individual socioeconomic factors but also by municipality-level civic participation. These findings highlight the importance of integrating individual risk-based prevention with community strategies that may contribute to reducing oral frailty and related oral health disparities in aging populations.
Introduction: As the clinical use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) continues to grow for the management of type 2 diabetes, cardiovascular and renal protection, noncirrhotic fatty liver disease, and weight management, their potential implications for oral health need to be considered. Objectives: This study examined oral health–related adverse events (AEs) associated with GLP-1 RAs using postmarketing data from the US Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: FAERS reports for available GLP-1 RAs, exenatide, liraglutide, semaglutide, dulaglutide, and tirzepatide, were screened from their initial market introduction through December 2025, identifying 364,274 total AE reports, of which 31,195 (8.6%) involved oral, craniofacial, or dental manifestations. Results: Tirzepatide, despite being one of the most recently approved GLP-1 RAs, accounted for the highest overall AE volume, and semaglutide demonstrated the largest proportion of oral health–related AEs. A disproportionality analysis revealed a significant drug-specific signal for dry mouth of semaglutide, while vomiting, regurgitation, and reflux-related events produced a significant signal across all 5 drugs. Sensory disorders, including dysgeusia and taste disturbances, also demonstrated significant proportional reporting ratios (PRRs) and reporting odds ratios (RORs) for several GLP-1 RAs. Association analysis of AEs showed significant associations between vomiting and taste disturbances, as well as between dry mouth and dysgeusia, particularly with semaglutide and dulaglutide. Conclusion: This analysis highlights emerging safety signals in oral health and underscores the need for heightened clinical awareness and prospective studies to characterize the incidence, timing, and mechanisms of oral AEs associated with GLP-1 RA therapy. Knowledge Transfer Statement: Understanding the oral adverse effects associated with GLP-1 receptor agonists allows clinicians and dental providers to more effectively counsel patients initiating or continuing these medications. By recognizing early symptoms such as dry mouth, dysgeusia, and reflux-related irritation, providers can implement targeted preventive strategies—including hydration guidance, salivary substitutes, dietary modifications, and closer oral health monitoring—to reduce complications and improve patient comfort, adherence, and overall treatment outcomes. This knowledge enhances interdisciplinary management of individuals using GLP-1 RAs.
Background: Dutch dental hygienists are trained to indicate, take, and interpret intraoral radiographs to diagnose and treat primary caries. Therefore, the aim of this pilot study was to explore whether the profession (dentists or dental hygienists) influences caries detection based on intraoral radiographs and the subsequent treatment plan. Methods: A total of 60 oral health care professionals participated, comprising 39 dentists and 21 dental hygienists. They were recruited in their clinical practice to assess a selection of 28 radiographs for caries depth diagnosis and treatment option selection. Analyses included subanalyses based on gender and clinical experience. Statistical analyses were performed using linear mixed models, Bland–Altman plot, and intraclass correlation coefficient (ICC) analysis to test interexaminer reproducibility. Results: No significant differences were observed between dentists and dental hygienists in diagnostic ability or treatment decisions. Clinical experience had a significant effect on the caries depth score ( P = 0.004). Gender had a significant effect on the treatment decision ( P = 0.018). The ICC score for dentists assessing caries depth using the International Caries Detection and Assessment System was 0.782, and for dental hygienists, it was 0.758. For agreement on treatment options, dentists had an ICC of 0.708, while dental hygienists had 0.651. Conclusion and Clinical Relevance: In the relatively small group studied, no significant differences were observed between dentists and dental hygienists in diagnostic ability or treatment decisions. However, the study was not powered to demonstrate equivalence. The method proved feasible, and clinical experience and gender emerged as factors to include in future studies. Knowledge Transfer Statement: In this pilot study, dentists and dental hygienists showed comparable radiographic caries detection and treatment decisions in a relatively small group of practitioners. The findings demonstrate the feasibility of the assessment method and identify clinical experience and gender as factors that future research should take into account. For policymakers and researchers, the results provide preliminary evidence and a basis for the design of future studies on the redistribution of diagnostic tasks within oral health care.
Objectives: Oral frailty (OF) is increasingly recognized as a critical component of healthy aging, yet the lack of standardized assessment instruments hinders clinical implementation and comparative research. This systematic review summarizes existing oral frailty instruments and provides evidence-based recommendations for their clinical application. Methods: A systematic search of MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library was conducted from inception through July 24, 2025. Studies developing or validating oral frailty assessment instruments in older adults were included. Clinical measures were summarized descriptively. Patient-reported outcome measures (PROMs) were evaluated according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) 2.0 guidelines for methodological quality, measurement properties, and evidence levels. Results: From 6,208 records, 15 studies with 15 distinct instruments were included. Among them, 9 instruments (60.0%) were exclusively PROMs, 5 (33.3%) combined PROMs with clinical measures, and only 1 (OF signs) relied solely on clinical examination. Among clinical measures, Oral Frailty Index–6 (OF-6) was the most suitable reference standard for hospital-based objective assessment. Among PROMs, the Screening for Oral Frailty Tool (SOFT) showed the most comprehensive development and validation, with favorable measurement properties across multiple domains. However, most PROMs lacked sufficient evidence for responsiveness and longitudinal validity, and none reached the highest COSMIN recommendation category. Conclusions: This first COSMIN-based systematic review of oral frailty instruments demonstrates that none of the available PROMs satisfy the most rigorous psychometric criteria. Our analysis suggests stratified recommendations: SOFT appears most suitable for community nurses conducting broad screening, Oral Frailty 5-Item Questionnaire (OF-5) and OF signs may be preferable for general practitioners in primary care, and the OF-6 is currently the most appropriate reference standard for hospital dental specialists. Future research should focus on hospital-based validation, responsiveness assessment, and cross-cultural refinement of oral frailty instruments to improve generalizability and support a unified core outcome set. Knowledge Transfer Statement: By profiling the measurement properties, completion time, and population skew of existing oral frailty instruments, this study supports evidence-based selection by both clinicians and researchers.
Objectives: Although clinical practice guidelines (CPGs) aim to translate high-quality evidence into clinical practice, their use in Japanese dentistry remains limited. This study evaluated the methodological quality and credibility of Japanese dental CPGs. Methods: A cross-sectional assessment was conducted using 32 CPGs registered with the Japanese Association for Dental Science Guidelines Library. Methodological rigor and recommendation quality were independently appraised by 3 calibrated reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation–Recommendation Excellence (AGREE-REX). Domain scores were standardized and interpreted individually, without composite scoring, and the normality of each domain was assessed using the Shapiro–Wilk test. Interrater reliability was examined using intraclass correlation coefficients, and cross-instrument domain correlations and temporal trends were analyzed. Results: For AGREE II, Scope and Purpose and Clarity of Presentation scored the highest, whereas Applicability was consistently the lowest. For AGREE-REX, Values and Preferences scored the lowest, indicating limited incorporation of patient values and preferences into the development of recommendations. Rigor of Development (AGREE II) was correlated with Clinical Applicability (AGREE-REX), Stakeholder Involvement (AGREE II), and Values and Preferences (AGREE-REX). Among all domains, only Editorial Independence showed significant improvement over time, with no corresponding gains in the AGREE-REX domains. Conclusion: Japanese dental CPGs demonstrate strong methodological rigor across several domains but remain limited in translating evidence into patient-centered, implementable recommendations. Strengthening stakeholder involvement and evidence-to-decision processes may be essential to enhance guideline uptake in clinical practice. Knowledge Transfer Statement: This study evaluated the methodological quality and recommendation credibility of Japanese dental clinical practice guidelines using the AGREE II and AGREE-REX instruments. These findings highlight the gaps between guideline rigor and patient-centered implementability and provide clinicians, guideline developers, and policymakers with actionable insights to improve evidence-to-decision processes and guideline uptake in dental practice.
