The Impact of Periodontitis on Oral Health Outcomes in Older Adults: A Systematic Review

Objective: To systematically review the impact of periodontitis on clinical oral health outcomes and oral health-related quality of life (OHRQoL) in older adults (≥ 60 years). 

Background: Global evidence shows that severe periodontitis prevalence peaks in the 60s, yet how periodontitis relates specifically to oral health outcomes in older adults has not been comprehensively synthesised. Prior reviews in mixed-age populations demonstrate strong links with tooth loss but less consistent associations with OHRQoL. 

Methods: This systematic review followed PRISMA guidelines and was registered on PROSPERO (CRD420251010568). Searches of PubMed, MEDLINE, Embase, Scopus, and Cochrane Library (to May 2025) identified studies of adults ≥ 60 years with periodontitis reporting oral health outcomes or OHRQoL. Two reviewers independently screened studies, extracted data, and assessed risk of bias. 

Results: Forty-three studies met inclusion criteria: 18 longitudinal studies on clinical outcomes and 25 cross-sectional studies on OHRQoL. Clinical studies consistently demonstrated that deeper baseline periodontal pockets, greater clinical attachment loss, and higher CPI/CPITN scores predicted adverse outcomes over 18 months to 12 years follow-up, including tooth loss, further attachment loss, and functional decline. OHRQoL studies showed inconsistent findings, with roughly equal numbers reporting significant associations versus no relationship. 

Conclusions: In adults ≥ 60 years, periodontitis consistently predicts tooth loss and continued periodontal breakdown, whereas OHRQoL associations are inconsistent and appear mediated primarily through downstream consequences such as tooth loss and functional impairment, though direct effects may occur in advanced disease. These findings emphasise the importance of periodontal prevention and management in older adults.