{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:24:21Z","timestamp":1791865461974,"version":"4.3.4"},"reference-count":9,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Gerodontology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Understanding and anticipating oral health deterioration in older adults requires more than describing their current oral and general health. Risk factors arising from oral, systemic and social domains strongly influence disease progression, care complexity and the ability to maintain function over time. We aimed to establish a framework for staging and grading oral health and disease in older adults, with grading systematically assessing and describing determinants of oral health deterioration. The developed framework is intended to support care planning, education, research and health\u2010service policy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Eight reviews examining oral, systemic and social risk factors for worsening oral health in older adults informed framework development. Additional existing reviews were also considered. A 2.5\u2010day international workshop involving 31 experts from 13 countries was conducted, during which structured subgroup discussions and Delphi\u2010style anonymous voting were used to refine and agree on the framework. Consensus was predefined at 75% agreement, and that was subsequently reached for all statements in a single voting round. The current paper presents the grading aspect of the developed framework; it should be used jointly with the paper on staging oral health in older adults.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Grading encompasses three levels of risk factors: (1) oral\u2010level factors such as dental caries risk, periodontitis risk and risks associated with the maintenance of existing dental prostheses; (2) systemic\u2010level factors including xerostomia, multimorbidity, polypharmacy and nutritional aspects and (3) social\u2010level factors such as social status and social support. Together, these domains reflect the likelihood of oral health deterioration, the intensity and frequency of required supportive care and the potential complexity of clinical management. Grading complements staging\u2014which describes the current oral health status\u2014by identifying the underlying risks shaping each older adult's oral health trajectory.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Grading provides a structured, evidence\u2010based method for assessing risk and care complexity in older adults. When combined with staging, it should enable clinicians, caregivers and policymakers to classify cases comprehensively, tailor preventive and supportive interventions, and inform resource planning, surveillance, research and education. Future work should focus on validating, disseminating and implementing the framework across diverse care settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ger.70051","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T06:10:32Z","timestamp":1779084632000},"page":"296-305","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Grading in Gerodontology: A Framework"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-1669","authenticated-orcid":false,"given":"Falk","family":"Schwendicke","sequence":"first","affiliation":[{"name":"Department of Conservative Dentistry, Periodontology and Digital Dentistry, LMU University Hospital LMU Munich Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-1673","authenticated-orcid":false,"given":"Gerry","family":"McKenna","sequence":"additional","affiliation":[{"name":"Centre for Public Health Queen's University Belfast Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3981-0134","authenticated-orcid":false,"given":"Frauke","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Center of Excellence in Precision Medicine and Digital Health, International Program in Geriatric Dentistry and Special Patients Care, Faculty of Dentistry Chulalongkorn University Bangkok Thailand"},{"name":"Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azize","family":"Bell","sequence":"additional","affiliation":[{"name":"Poliklinik f\u00fcr Zahn\u00e4rztliche Prothetik und Werkstoffkunde Universit\u00e4tsmedizin der Johannes Gutenberg\u2010Universit\u00e4t Mainz Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4094-6955","authenticated-orcid":false,"given":"Najla","family":"Chebib","sequence":"additional","affiliation":[{"name":"Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-0847","authenticated-orcid":false,"given":"Cristiane","family":"Da Mata","sequence":"additional","affiliation":[{"name":"Restorative Dentistry Cork University Dental School and Hospital, UCC Cork 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Health Sciences Ghent University Ghent Belgium"},{"name":"Department of Oral Health Ghent University Hospital Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M.","family":"Layton","sequence":"additional","affiliation":[{"name":"School of Dentistry, Faculty of Health and Behavioural Sciences University of Queensland, & Specialist Private Practice St Lucia Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Kanazawa","sequence":"additional","affiliation":[{"name":"Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences Institute of Science Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0610-6984","authenticated-orcid":false,"given":"Anastassia","family":"Kossioni","sequence":"additional","affiliation":[{"name":"Discipline of Gerodontology, Department of Prosthodontics, Dental School National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Maniewicz","sequence":"additional","affiliation":[{"name":"Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences Institute of Science Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5493-0295","authenticated-orcid":false,"given":"Pedro Molinero","family":"Mourelle","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine University of Bern Bern Switzerland"},{"name":"Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry Complutense University of Madrid Madrid Spain"},{"name":"Ramon y Cajal Research Institute (IRYCIS) Complutense University of Madrid Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Neri","sequence":"additional","affiliation":[{"name":"Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences Institute of Science Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Geriatric Dentistry Osaka Dental University Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungkrit","family":"Pojmonpiti","sequence":"additional","affiliation":[{"name":"ELOHA (Equal Lifelong Oral Health for All) Research Group, Department of Oral Health Sciences, Faculty of Medicine and Health Sciences Ghent University Ghent 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