Efsun Somay¹*, Erkan Topkan², Sibel Bascil³ and Ugur Selek⁴

¹Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, Ankara, Turkey
²Department of Radiation Oncology, School of Medicine, Baskent University, Adana, Turkey
³Department of Periodontology, School of Dentistry, Baskent University, Ankara, Turkey
⁴Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey

*Corresponding Author:Efsun Somay, Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, Ankara, Turkey.

Received: April 16, 2025; Published: May 14, 2025

Abstract

Oral frailty (OF), which refers to a decline in oral functions, is an emerging concern in oncology, particularly among patients with head and neck cancer (HNC). Available evidence indicates that OF increases the risk of developing cancer and worsens the side effects of treatments, ultimately impacting survival rates and quality of life (QoL). OF is associated with various physiological changes, including reduced saliva production, impaired chewing ability, and poor oral hygiene, elevating the risk of developing HNC. A multidisciplinary approach is essential to address these challenges and improve patient outcomes.  Chronic inflammation and an imbalance in the oral microbiome are key factors linking OF to HNC development and an increased risk of severe treatment-related toxicities. Hence, recognizing the limited data available on this critical topic, this review compellingly seeks to elucidate the multifaceted and complex relationship between OF and HNC in an evidence-based manner.

 Keywords: Oral Frailty; Head and Neck Cancer; Survival

References

1. Johnson DE., et al. “Head and neck squamous cell carcinoma”. Nature Reviews Disease Primers1 (2020): 92.
2. Lechner M., et al. “HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management”. Nature Reviews Clinical Oncology5 (2022): 306-327.
3. Dewansingh P., et al. “Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions”. European Archives of Oto-Rhino-Laryngology 4 (2023): 1893-1902.
4. Moon S., et al. “Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in Korea”. PLoS One4 (2023): e0283596.
5. Tański W., et al. “Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis”. Nutrients4 (2021): 1259.
6. Parrettini S., et al. “Nutrition and Metabolic Adaptations in Physiological and Complicated Pregnancy: Focus on Obesity and Gestational Diabetes”. Frontiers in Endocrinology (Lausanne) 11 (2020): 611929.
7. Andres SF., et al. “Building better barriers: how nutrition and undernutrition impact pediatric intestinal health”. Frontiers in Immunology 14 (2023): 1192936.
8. Chen X., et al. “Frailty syndrome: an overview”. Clinical Interventions in Aging 9 (2014): 433-441.
9. Mendes ML., et al. “Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis”. Medicina Oral, Patologia Oral, Cirugia Bucal 5 (2021): e582-e589.
10. Zhao H., et al. “Oral frailty: a concept analysis”. BMC Oral Health1 (2021): 594.
11. Yan GLK., et al. “Functional Dentition, Chronic Periodontal Disease and Frailty in Older Adults-A Narrative Review”. International Journal of Environmental Research and Public Health1 (2022): 502.
12. Dibello V., et al. “Oral frailty and its determinants in older age: a systematic review”. Lancet Healthy Longevity 8 (2021): e507-e520.
13. Iwasaki M., et al. “The association of oral function with dietary intake and nutritional status among older adults: Latest evidence from epidemiological studies”. Japanese Dental Science Review 57 (2021): 128-137.
14. Shimizu A., et al. “Impact of Poor Oral Health Status on Swallowing Function Improvement in Older Dysphagic Patients”. Cureus12 (2023): e51249.
15. Ortíz-Barrios LB., et al. “The impact of poor oral health on the oral health-related quality of life (OHRQoL) in older adults: the oral health status through a latent class analysis”. BMC Oral Health1 (2023): 141.
16. Chen SC. “Oral Dysfunction in Patients With Head and Neck Cancer: A Systematic Review”. Journal of Nursing Research 6 (2019): e58.
17. Somay E., et al. “The impact of radiation-induced trismus on patients’ life quality”. Archives of Current Research International 5 (2022): 12-24.
18. De Cicco D., et al. “Health-Related Quality of Life in Oral Cancer Patients: Scoping Review and Critical Appraisal of Investigated Determinants”. Cancers (Basel)17 (2021): 4398.
19. Dzebo S., et al. “Quality of Life of Patients with Oral Cavity Cancer”. Material Sociomedicine1 (2017): 30-34.
20. In 't Veld M., et al. “Oral-Functioning Questionnaires in Patients with Head and Neck Cancer: A Scoping Review”. Journal of Clinical Medicine12 (2023): 3964.
21. Patel V., et al. “Presenting pre-radiotherapy dental status of head and neck cancer patients in the novel radiation era”. British Dental Journal 228 (2020): 435-440.
22. Pan MY., et al. “Prevalence of and factors associated with fewer than 20 remaining teeth in Taiwanese adults with disabilities: a community-based cross-sectional study”. BMJ Open10 (2017): e016270.
23. Jansson L., et al. “Mortality rate and oral health - a cohort study over 44 years in the county of Stockholm”. Acta Odontologica Scandinavica 76 (2018): 299-304.
24. Polzer I., et al. “The association of tooth loss with all-cause and circulatory mortality. Is there a benefit of replaced teeth? A systematic review and meta-analysis”. Clinical Oral Investigation 16 (2012): 333-351.
25. Mattila KJ., et al. “Role of infection as a risk factor for atherosclerosis, myocardial infarction, and stroke. Clinical Infectious Disease 26 (1998): 719-734.
26. Soysal P., et al. “Inflammation and frailty in the elderly: a systematic review and meta-analysis”. Ageing Research Review 31 (2016): 1-8.
27. Ali S., et al. “Sarcopenia, cachexia and aging: diagnosis, mechanisms and therapeutic options - a mini-review”. Gerontology 60 (2014): 294-305.
28. Tanaka T., et al. “Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly”. Journals of Gerontology Series A 73 (2018): 1661-1667.
29. Watanabe Y., et al. “Oral health for achieving longevity”. Geriatrics and Gerontology International 20 (2020): 526-538.
30. Wakabayashi H. “Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders”. Journal of Frailty Aging 3 (2014): 97-103.
31. World Health Organization. “WHO global report on falls prevention in older age” (2014).
32. Leopardi A. “Complete Dentures: Achieving Superior Anterior Esthetics and Post‐Delivery Maintenance”. Inside Dentistry (2009).
33. Eisbruch A., et al. “Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?” International Journal of Radiation Oncology, Biology, Physics 5 (2004): 1425-1439.
34. Iwasaki M., et al. “A Two-Year Longitudinal Study of the Association between Oral Frailty and Deteriorating Nutritional Status among Community-Dwelling Older Adults”. International Journal of Environmental Research and Public Health1 (2021): 213.
35. Kusunoki H., et al. “Oral Frailty and Its Relationship with Physical Frailty in Older Adults: A Longitudinal Study Using the Oral Frailty Five-Item Checklist”. Nutrients1 (2024): 17.
36. Nishi H., et al. “Head and neck cancer patients show poor oral health as compared to those with other types of cancer”. BMC Oral Health1 (2023): 647.
37. Naidu MU., et al. “Chemotherapy-induced and/or radiation therapy-induced oral mucositis--complicating the treatment of cancer”. Neoplasia 5 (2004): 423-431.
38. Dewansingh P., et al. “Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions”. European Archives of Oto-Rhino-Laryngology 4 (2023): 1893-1902.
39. Miyasato K., et al. “Oral Frailty as a Risk Factor for Malnutrition and Sarcopenia in Patients on Hemodialysis: A Prospective Cohort Study”. Nutrients 20 (2024): 3467.
40. Minakuchi S., et al. “Oral hypofunction in the older population: position paper of the Japanese Society of Gerodontology in 2016”. Gerodontology 35 (2018): 317-324.
41. Report of the Conference on the Establishment of Definitions for “Oral Health Management” and “Oral Frailty”. (2023).
42. Tanaka T., et al. “Oral frailty five-item checklist to predict adverse health outcomes in community-dwelling older adults: A Kashiwa cohort study”. Geriatrics and Gerontology International 9 (2023): 651-659.
43. Tanaka T., et al. ‘Oral Frailty Index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwelling older adults”. Archives of Gerontology and Geriatrics 94 (2021): 104340.
44. Rajasekaran JJ., et al. “Oral Microbiome: A Review of Its Impact on Oral and Systemic Health”. Microorganisms9 (2024): 1797.
45. Mitus-Kenig M., et al. “Comparison of Oral Health Impact Profile (OHIP-14) Values in Cancer Survivor Patients Treated Orthodontically with Either Rapid or Standard Duration Protocols of Treatment-A Prospective Case-Control Study”. International Journal of Environmental Research and Public Health 23 (2020): 9068.

Citation

Citation: Efsun Somay., et al. “The Connection Between Oral Frailty and Head and Neck Cancer: A Concise Review”.Acta Scientific Medical Sciences 9.6 (2025): 47-56.

Copyright

Copyright: © 2025 Efsun Somay., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.