Non-Cochrane · intervention · PM41872864
Oral health care interventions on objective indicators of oral frailty in older adults: a systematic review and meta-analysis.
Luo Yuru, Ngoenwiwatkul Yaowaluk, Yadi Yang, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08145-5
Findings
Population Older adults aged 60 years or older
34 findings
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Dry mouth: unstimulated saliva secretion Community, nursing home and hospital settings · Overall of the analysis by intervention type (one study not estimable) | MD 0.12 [0.06, 0.19] GRADE not reported 5 studies · 396 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Measurement tool: Maximum tongue pressure (MTP) | SMD 0.41 [-0.05, 0.88] GRADE not reported 6 studies · 346 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Swallowing ability (objective swallowing physiology) Community, nursing home and hospital settings | SMD 0.51 [0.18, 0.84] GRADE not reported 3 studies · 151 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Dry mouth: unstimulated saliva secretion Community, nursing home and hospital settings · Intervention duration: 4 weeks or less | MD 0.11 [0.06, 0.16] GRADE not reported 2 studies · 209 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, no intervention or other care | Chewing ability: bite force Community, nursing home and hospital · Intervention-type subgroup analysis total (bite force studies) | MD 110.36 [54.85, 165.88] GRADE not reported 5 studies · 288 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability: masticatory performance Community, nursing home and hospital settings · Measurement tool: mixing ability index (MAI) | SMD 0.22 [-0.08, 0.52] GRADE not reported 1 study · 168 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Intervention duration: 5 to 8 weeks | SMD 0.74 [0.15, 1.32] GRADE not reported 7 studies · 272 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Intervention duration: more than 8 weeks | SMD 0.17 [-0.17, 0.52] GRADE not reported 2 studies · 136 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability: bite force Community, nursing home and hospital settings | SMD 0.4 [0.03, 0.77] Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 288 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Swallowing ability (objective swallowing physiology) Community, nursing home and hospital settings · Measurement tool: Regular Effort Saliva Swallowing (RESS) pressure | SMD 0.29 [-0.77, 1.34] GRADE not reported 1 study · 14 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Swallowing ability (objective swallowing physiology) Community, nursing home and hospital settings · Intervention duration: 5 to 8 weeks | SMD 0.29 [-0.77, 1.34] GRADE not reported 1 study · 14 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Measurement tool: Maximum Isometric Pressure (MIP) | SMD 0.84 [-0.16, 1.84] GRADE not reported 3 studies · 110 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Overall of the analysis by intervention type (mean difference scale) | MD 2.55 [-0.47, 5.58] GRADE not reported 6 studies · 346 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Intervention duration: 4 weeks or less | SMD 0.35 [0.02, 0.68] GRADE not reported 2 studies · 143 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings · Measurement tool: Anterior tongue strength (ATS) | SMD 0.43 [0.02, 0.84] Low Downgraded: risk of bias, imprecision 2 studies · 95 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability: masticatory performance Community, nursing home and hospital settings | SMD 0.61 [0.06, 1.16] GRADE not reported 5 studies · 447 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability: masticatory performance Community, nursing home and hospital settings · Measurement tool: chewing glucose-containing gum | SMD 0.61 [-0.23, 1.45] GRADE not reported 2 studies · 136 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings | SMD 0.54 [0.17, 0.91] GRADE not reported 11 studies · 551 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Dry mouth: unstimulated saliva secretion Community, nursing home and hospital settings · Intervention duration: more than 8 weeks | MD 0.13 [-0.18, 0.44] GRADE not reported 2 studies · 92 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability (bite force and mixing ability index) Community, nursing home and hospital settings · Overall of the analysis by intervention duration | SMD 0.32 [0.09, 0.55] GRADE not reported 7 studies · 539 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability (bite force and mixing ability index) Community, nursing home and hospital settings · Intervention duration: more than 8 weeks | SMD 0.51 [0.14, 0.88] GRADE not reported 4 studies · 228 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Dry mouth: unstimulated saliva secretion Community, nursing home and hospital settings · Intervention duration: 5 to 8 weeks | MD 0.2 [0.1, 0.29] GRADE not reported 2 studies · 95 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Swallowing ability (objective swallowing physiology) Community, nursing home and hospital settings · Measurement tool: Repetitive Saliva Swallowing Test (RSST) | SMD 0.53 [0.18, 0.88] Moderate Downgraded: risk of bias 2 studies · 137 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, no intervention or other care | Dry mouth (unstimulated saliva secretion) Community, nursing home and hospital | MD 0.13 [0.07, 0.19] Very low Downgraded: risk of bias, imprecision, inconsistency 6 studies · 396 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability: masticatory performance Community, nursing home and hospital settings · Measurement tool: Masticatory Performance Evaluating Gum (color-changing gum) | SMD 0.79 [-0.51, 2.1] GRADE not reported 2 studies · 143 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Chewing ability (bite force and mixing ability index) Community, nursing home and hospital settings · Intervention duration: 4 weeks or less | SMD 0.15 [-0.07, 0.37] GRADE not reported 3 studies · 311 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Swallowing ability (objective swallowing physiology) Community, nursing home and hospital settings · Intervention duration: more than 8 weeks | SMD 0.41 [0.12, 0.7] GRADE not reported 3 studies · 190 participants |
| Oral health care interventions (oral exercise, oral health education, professional oral care) | Routine care, other care or no intervention | Swallowing ability (objective swallowing physiology) Community, nursing home and hospital settings · Overall of the analysis by intervention duration | SMD 0.4 [0.12, 0.68] GRADE not reported 4 studies · 204 participants |
| Oral exercise | Routine care, other care or no intervention | Chewing ability: bite force Community, nursing home and hospital settings | MD 118.25 [54.4, 182.11] GRADE not reported 4 studies · 250 participants |
| Oral exercise | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings | MD 1.56 [0.17, 2.94] GRADE not reported 5 studies · 306 participants |
| Oral exercise | Routine care, other care or no intervention | Dry mouth: unstimulated saliva secretion Community, nursing home and hospital settings | MD 0.15 [0.08, 0.21] GRADE not reported 5 studies · 358 participants |
| Oral health education | Routine care, other care or no intervention | Chewing ability: bite force Community, nursing home and hospital settings | MD 47.4 [-110.5, 205.3] GRADE not reported 1 study · 38 participants |
| Oral health education | Routine care, other care or no intervention | Dry mouth: unstimulated saliva secretion Community, nursing home and hospital settings | MD -0.03 [-0.16, 0.1] GRADE not reported 1 study · 38 participants |
| Oral health education | Routine care, other care or no intervention | Tongue pressure Community, nursing home and hospital settings | MD 9.34 [6.35, 12.33] GRADE not reported 1 study · 40 participants |
Included primary studies 18
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Jung 2024 Smartphone-based combined oral and whole-body exercise programme aimed at improving oral functions: A randomized clinical trial. PMID:38606673 | 2024 | 2 other reviews | not stated | not extracted yet |
| Ki 2021 Effect of Oral Health Education Using a Mobile App (OHEMA) on the Oral Health and Swallowing-Related Quality of Life in Community-Based… PMID:34770193 | 2021 | 2 other reviews | not stated | not extracted yet |
| Ibayashi 2008 Intervention study of exercise program for oral function in healthy elderly people. PMID:18648184 | 2008 | 1 other review | not stated | not extracted yet |
| Kashiwazaki 2023 Effect of gum-chewing exercise on maintaining and improving oral function in older adults: A pilot randomized controlled trial. PMID:38618096 | 2024 | 1 other review | not stated | not extracted yet |
| Kim 2020 Simple oral exercise with chewing gum for improving oral function in older adults. PMID:32476089 | 2021 | 1 other review | not stated | not extracted yet |
| Lee 2020a Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial. PMID:32489001 | 2020 | 1 other review | not stated | not extracted yet |
| Ohara 2015 Effectiveness of an oral health educational program on community-dwelling older people with xerostomia. PMID:24796714 | 2015 | 1 other review | not stated | not extracted yet |
| Shirobe 2021 Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial. PMID:34247160 | 2022 | 1 other review | not stated | not extracted yet |
| Szynkiewicz 2020 A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults. PMID:32770381 | 2021 | 1 other review | not stated | not extracted yet |
| Tani 2023 The Impact of Nutrition and Oral Function Exercise on among Community-Dwelling Older People. PMID:37049448 | 2023 | 1 other review | not stated | not extracted yet |
| Chen 2021 Effects of a Multifaceted Intervention Program on the Eating Ability of Nursing Home Residents. PMID:34501540 | 2021 | this review only | not stated | not extracted yet |
| Hakuta 2008 Evaluation of an oral function promotion programme for the independent elderly in Japan. PMID:19555360 | 2009 | this review only | not stated | not extracted yet |
| Kim 2019 Improvements in oral functions of elderly after simple oral exercise. PMID:31190777 | 2019 | this review only | not stated | not extracted yet |
| Lee 2020b Effects of Professional Oral Health Care Programs for Elderly Residents of Nursing Facilities. PMID:33376120 | 2020 | this review only | not stated | not extracted yet |
| Matsuo 2021 Improvement of oral hypofunction by a comprehensive oral and physical exercise programme including textured lunch gatherings. PMID:33128790 | 2021 | this review only | not stated | not extracted yet |
| Nam 2016 A comparative study of the effects of intra and extra circumoral exercise for older people on oral health at nursing homes:… PMID:27102223 | 2016 | this review only | not stated | not extracted yet |
| Van den Steen 2018 Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial. PMID:30209561 | 2019 | this review only | not stated | not extracted yet |
| Yano 2020 Effects of Tongue-Strengthening Self-Exercises in Healthy Older Adults: A Non-Randomized Controlled Trial. PMID:33215265 | 2021 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Older adults aged 60 years or older; excluded people with specific diseases such as stroke, diabetes, dementia | Older adults aged 60 years or older in community (n=11), nursing home (n=4) and hospital (n=3) settings (18 studies, n=1133) |
| Intervention | Oral health care interventions (oral exercise, oral health education, professional oral care); excluded dental treatments (prosthetics, implants, restorative care) | Oral exercise (n=15), oral health education (n=2), professional oral care (n=1) |
| Comparison | Other types of care (e.g., routine care) or no intervention | No intervention, routine care, other exercise or alternative comparator (e.g., physical jaw exercise, lip-strengthening exercise, tablet or mailed information) |
| Outcomes | Oral frailty indicators: chewing ability, swallowing ability, tongue pressure, dry mouth, oral motor function | Tongue pressure (11 studies, n=551); chewing ability: bite force (5 studies, n=288) and masticatory performance (5 studies, n=447); swallowing ability (3 studies, n=151); dry mouth (6 studies, n=396). Oral motor function measured in some studies but not pooled |
| Study designs | RCTs and quasi-experimental studies in English | 8 RCTs and 10 quasi-experimental studies |
| Timing | Not specified | Intervention durations from 1 week to 6 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | Yes | no |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NRSI: Partial Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |