{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:10:58Z","timestamp":1773058258755,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["UID\/4585\/2025"],"award-info":[{"award-number":["UID\/4585\/2025"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Oral frailty is an emerging determinant of late-life disability. While objective functional measures have been proposed as key indicators, their combined role in predicting frailty among physically active older adults remains unclear. Therefore, this study aimed to investigate the association between the presence of oral frailty and lip pressure, bite force, and denture use. Methods: This cross-sectional study included 192 participants aged 60 years or older from Brazil (n = 131) and Portugal (n = 61), all physically active and with \u226520 natural or rehabilitated teeth. Data were collected through a questionnaire on sociodemographic data and the Oral Frailty Index-8. The clinical assessment included lip pressure, bite force, and denture use. Multiple logistic regression identified independent predictors; model fit and discrimination were examined using the Hosmer\u2013Lemeshow test and ROC curve. Results: Participants were mainly female (83.3%), mean age \u224872 years; 76% used dentures and frailty prevalence was \u224849%. Higher lip pressure (OR = 0.986, 95% CI = [0.973\u20130.999]) and higher bite force (OR = 0.925, 95% CI = [0.885\u20130.967) were independently protective, whereas denture use (OR = 6.898, 95% CI = [2.994\u201315.895]) markedly increased oral frailty odds. The model showed good discrimination (AUC 0.779). Conclusions: Even small increases in lip pressure and bite force reduced the likelihood of frailty, while denture use identified individuals at substantially higher risk. These findings highlight orofacial muscle strength and masticatory capacity as core components of oral frailty and support incorporating lip pressure and bite force testing into multidimensional frailty assessment and targeted rehabilitation.<\/jats:p>","DOI":"10.3390\/dj14030152","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:58:45Z","timestamp":1773046725000},"page":"152","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lip Pressure, Bite Force and Denture Use as Predictors of Oral Frailty in Physically Active Older Adults: A Cross-Sectional Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1446-0036","authenticated-orcid":false,"given":"Catarina","family":"Cola\u00e7o","sequence":"first","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Neuromodulation and Pain Lab (NEUROPAIN), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8095-0107","authenticated-orcid":false,"given":"In\u00eas","family":"Caetano-Santos","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Neuromodulation and Pain Lab (NEUROPAIN), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8558-6754","authenticated-orcid":false,"given":"Jos\u00e9","family":"Brito","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Neuromodulation and Pain Lab (NEUROPAIN), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2503-260X","authenticated-orcid":false,"given":"Vanessa","family":"Machado","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Neuromodulation and Pain Lab (NEUROPAIN), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2666-6246","authenticated-orcid":false,"given":"Angel","family":"Lobito","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0167-4077","authenticated-orcid":false,"given":"Jos\u00e9 Jo\u00e3o","family":"Mendes","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Neuromodulation and Pain Lab (NEUROPAIN), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9756-3771","authenticated-orcid":false,"given":"Selma","family":"Siessere","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry of Ribeir\u00e3o Preto, University of S\u00e3o Paulo (FORP\/USP), 14040-904 S\u00e3o Paulo, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-8299","authenticated-orcid":false,"given":"Simone Cec\u00edlio Hallak","family":"Regalo","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry of Ribeir\u00e3o Preto, University of S\u00e3o Paulo (FORP\/USP), 14040-904 S\u00e3o Paulo, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7536-9193","authenticated-orcid":false,"given":"Luciano Maia Alves","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Neuromodulation and Pain Lab (NEUROPAIN), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal"},{"name":"Faculty of Dentistry of Ribeir\u00e3o Preto, University of S\u00e3o Paulo (FORP\/USP), 14040-904 S\u00e3o Paulo, Brazil"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","unstructured":"United Nations Population Fund (UNFPA), and HelpAge International (2012). Ageing in the Twenty-First Century: A Celebration and A Challenge, HelpAge International."},{"key":"ref_2","unstructured":"UN DESA (2024). World Population Prospects 2024: Summary of Results, United Nations Department of Economic and Social Affairs (UN DESA), Population Division."},{"key":"ref_3","unstructured":"UN DESA (2022). World Population Prospects 2022: Summary of Results, United Nations Department of Economic and Social Affairs (UN DESA), Population Division."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1159\/000528561","article-title":"Frailty: Pathophysiology, Theoretical and Operational Definition(s), Impact, Prevalence, Management and Prevention, in an Increasingly Economically Developed and Ageing World","volume":"69","author":"Doody","year":"2023","journal-title":"Gerontology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1056\/NEJMra2301292","article-title":"Frailty in Older Adults","volume":"391","author":"Kim","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20101058251355290","DOI":"10.1177\/20101058251355290","article-title":"Oral Frailty and Outcomes: A Scoping Review","volume":"34","author":"Foo","year":"2025","journal-title":"Proc. Singap. Healthc."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ferreira, L.M.A., Brito, J., Silva, J.R.T., Silva, M.L., Andrade, M.M.F., J\u00fadice, A., Mendes, J.J., Machado, V., Botelho, J.T., and Regalo, S.C.H. (2025). Assessing Frailty in the Older: The Role of Bite Force as an Independent Indicator. Geriatrics, 10.","DOI":"10.3390\/geriatrics10020040"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e507","DOI":"10.1016\/S2666-7568(21)00143-4","article-title":"Oral Frailty and Its Determinants in Older Age: A Systematic Review","volume":"2","author":"Dibello","year":"2021","journal-title":"Lancet Healthy Longev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/ger.12821","article-title":"The Impact of Dietary Intake and Nutritional Status on the Oral Health of Older Adults Living in Care Homes: A Scoping Review","volume":"42","author":"Sallam","year":"2025","journal-title":"Gerodontology"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wu, J., Lin, D., Chen, W., Zhang, L., Shen, X., Fu, D., Li, Y., Ma, X., and Cai, Z. (2025). Research Status and Hotspots of Oral Frailty in Older Adults: A Bibliometric Analysis from 2013 to 2024. Front. Oral Health, 6.","DOI":"10.3389\/froh.2025.1533159"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1111\/ggi.14980","article-title":"Consensus Statement on \u201cOral Frailty\u201d from the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty","volume":"24","author":"Tanaka","year":"2024","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1111\/ggi.13921","article-title":"Oral Health for Achieving Longevity","volume":"20","author":"Watanabe","year":"2020","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Dou, J., Liu, H., Mei, Y., Wang, S., Zhang, Y., Zhao, S., and Shi, X. (2025). Prevalence of Oral Frailty in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1423387"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Huang, J., Zhang, Y., Xv, M., Sun, L., and Wang, M. (2025). Association between Oral Health Status and Frailty in Older Adults: A Systematic Review and Meta-Analysis. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1514623"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/ger.12577","article-title":"A Systematic Review and Gap Analysis of Frailty and Oral Health Characteristics in Older Adults: A Call for Clinical Translation","volume":"38","author":"Slashcheva","year":"2021","journal-title":"Gerodontology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106059","DOI":"10.1016\/j.archger.2025.106059","article-title":"Association between Oral Health and Physical Frailty in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis","volume":"141","author":"Ko","year":"2026","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.2147\/CIA.S141148","article-title":"Relationship between Tongue Strength, Lip Strength, and Nutrition-Related Sarcopenia in Older Rehabilitation Inpatients: A Cross-Sectional Study","volume":"12","author":"Sakai","year":"2017","journal-title":"Clin. Interv. Aging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"294","DOI":"10.2186\/jpr.JPR_D_23_00282","article-title":"Masticatory Performance Indicates the Development of Psychological Frailty: A 6-Year Prospective Cohort Study by the SONIC Study Group","volume":"69","author":"Akema","year":"2025","journal-title":"J. Prosthodont. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s00784-024-05742-y","article-title":"Very Old Age Impacts Masticatory Performance: A Study among Sexagenarians to Centenarians","volume":"28","author":"Sekundo","year":"2024","journal-title":"Clin. Oral Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jdsr.2025.10.002","article-title":"Associations between Oral Health Parameters and Nutritional Status in Geriatric Populations: An Umbrella Review with Meta-Analysis","volume":"61","author":"Asaad","year":"2025","journal-title":"Jpn. Dent. Sci. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100210","DOI":"10.1016\/j.jnha.2024.100210","article-title":"The Predictive Value of Masticatory Function for Adverse Health Outcomes in Older Adults: A Systematic Review","volume":"28","author":"Smit","year":"2024","journal-title":"J. Nutr. Health Aging"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Okada, M., Hama, Y., Futatsuya, R., Sasaki, Y., Noritake, K., Yamaguchi, K., Matsuzaki, M., Kubota, C., Hosoda, A., and Minakuchi, S. (2023). Association between Masticatory Performance, Nutritional Intake, and Frailty in Japanese Older Adults. Nutrients, 15.","DOI":"10.3390\/nu15245075"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"72","DOI":"10.33879\/AMH.162.2023.09102","article-title":"Oral Frailty Interventions in Older Population: A Systematic Review Study","volume":"16","author":"Lee","year":"2025","journal-title":"Aging Med. Healthc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International Physical Activity Questionnaire: 12-Country Reliability and Validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 Guidelines on Physical Activity and Sedentary Behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"335","author":"Elm","year":"2007","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"104340","DOI":"10.1016\/j.archger.2021.104340","article-title":"Oral Frailty Index-8 in the Risk Assessment of New-Onset Oral Frailty and Functional Disability among Community-Dwelling Older Adults","volume":"94","author":"Tanaka","year":"2021","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Corr\u00eaa, L., J\u00fadice, A., Scoz, R., Machado, V., Mendes, J.J., Proen\u00e7a, L., Botelho, J., and Ferreira, L. (2024). Portuguese Version of the Oral Frailty Index-8: Instrument Validation Study. Interact. J. Med. Res., 13.","DOI":"10.2196\/49975"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/joor.13531","article-title":"Lip and Tongue Pressure and the Functionality of Oro-facial Structures in Healthy Individuals","volume":"50","author":"Ramos","year":"2023","journal-title":"J. Oral Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"621","DOI":"10.12965\/jer.1836284.142","article-title":"The Reproducibility and Validity Verification for Body Composition Measuring Devices Using Bioelectrical Impedance Analysis in Korean Adults","volume":"14","author":"Yang","year":"2018","journal-title":"J. Exerc. Rehabil."},{"key":"ref_31","unstructured":"Afifi, A.A., Clark, V., and May, S. (2004). Computer-Aided Multivariate Analysis, Chapman & Hall\/CRC. [4th ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Zhao, H., Wu, B., Zhou, Y., Yang, Z., Zhao, H., Tian, Z., Jiang, M., and Huang, D. (2024). Oral Frailty: A Concept Analysis. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04376-6"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/ger.12406","article-title":"Association between Oral Health and Frailty: A Systematic Review of Longitudinal Studies","volume":"36","author":"Hakeem","year":"2019","journal-title":"Gerodontology"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Cichero, J.A.Y. (2018). Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics, 3.","DOI":"10.3390\/geriatrics3040069"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Azzolino, D., Passarelli, P.C., De Angelis, P., Piccirillo, G.B., D\u2019Addona, A., and Cesari, M. (2019). Poor Oral Health as a Determinant of Malnutrition and Sarcopenia. Nutrients, 11.","DOI":"10.3390\/nu11122898"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1159\/000516968","article-title":"Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial","volume":"68","author":"Shirobe","year":"2022","journal-title":"Gerontology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"279","DOI":"10.17135\/jdhs.2019.19.4.279","article-title":"The Effects of Orofacial Myofunctional Training on the Changes of Lip and Tongue Strength in Elderly People","volume":"19","author":"Kim","year":"2019","journal-title":"J. Dent. Hyg. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/joor.12578","article-title":"A 5-year Longitudinal Study of Association of Maximum Bite Force with Development of Frailty in Community-dwelling Older Adults","volume":"45","author":"Iwasaki","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1177\/00220345211019018","article-title":"Dental Care Use, Edentulism, and Systemic Health among Older Adults","volume":"100","author":"Meyerhoefer","year":"2021","journal-title":"J. Dent. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2316","DOI":"10.1111\/joor.13815","article-title":"Influence of Denture-bearing Conditions on Masticatory Function and Patient-reported Outcomes Measures","volume":"51","author":"Girundi","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"105572","DOI":"10.1016\/j.archger.2024.105572","article-title":"Relationship between Tooth Loss and Progression of Frailty: Findings from the English Longitudinal Study of Aging","volume":"127","author":"Komiyama","year":"2024","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s40520-025-03053-0","article-title":"The Association between the Number of Teeth and Frailty among Older Adults: A Systematic Review and Meta-Analysis","volume":"37","author":"Zhang","year":"2025","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Huang, P., Wu, L., Zhang, R., Chen, S., Zhang, Y., and Chen, Y. (2025). Systematic Review and Meta-Analysis on the Prevalence and Risk Factors of Oral Frailty among Older Adults. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1512927"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Cruz-Moreira, K., Alvarez-Cordova, L., Gonz\u00e1lez-Palacios Torres, C., Chedraui, P., Jouvin, J., Jim\u00e9nez-Mole\u00f3n, J.J., and Barrios-Rodr\u00edguez, R. (2023). Prevalence of Frailty and Its Association with Oral Hypofunction in Older Adults: A Gender Perspective. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-02824-3"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1042\/CS20160004","article-title":"Gender, Aging and Longevity in Humans: An Update of an Intriguing\/Neglected Scenario Paving the Way to a Gender-Specific Medicine","volume":"130","author":"Ostan","year":"2016","journal-title":"Clin. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1016\/S2468-2667(24)00053-7","article-title":"Differences across the Lifespan between Females and Males in the Top 20 Causes of Disease Burden Globally: A Systematic Analysis of the Global Burden of Disease Study 2021","volume":"9","author":"Patwardhan","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/eos.12049","article-title":"Oral Health and Welfare State Regimes: A Cross-national Analysis of European Countries","volume":"121","author":"Tsakos","year":"2013","journal-title":"Eur. J. Oral Sci."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/3\/152\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T09:30:18Z","timestamp":1773048618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/3\/152"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["dj14030152"],"URL":"https:\/\/doi.org\/10.3390\/dj14030152","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]}}}