Staging and grading in gerodontology: A consensus-based framework for comprehensive assessment of oral health and care complexity in older adults.

OBJECTIVES

This manuscript summarizes an international framework for staging and grading in gerodontology and introduces its clinical, research, and policy relevance.

METHODS

The framework was developed through an international consensus process. A steering committee initially scoped existing concepts and then commissioned systematic reviews addressing major oral, systemic, functional, nutritional, and social determinants of oral health in older adults. The reviews informed a 2.5-day consensus conference in Geneva in August 2025 involving stakeholders (clinicians, academics, researchers, policymakers, and representatives of dental and geriatric professional organizations), from 13 countries. Statements were refined through plenary and subgroup discussions and anonymously voted on using a predefined agreement threshold of 75%.

RESULTS

The resulting framework separated oral health assessment into staging and grading. Staging describes the status across three domains: person-level staging based on the Clinical Frailty Scale, function-level staging based on clinical and subjective oral function, and disease-level staging based on caries, periodontal conditions, and oral mucosal status. Grading captures risk of deterioration across oral, systemic, and social domains, including caries risk, periodontal progression risk, prosthetic maintenance demands, xerostomia/salivary hypofunction, multimorbidity/polypharmacy/care dependency, nutritional status, social status, and social support. Together, these components provide a structured multidimensional case complexity definition for older adults.

CONCLUSIONS

This framework provides a unified language for describing oral health and care complexity in older adults. By combining assessment of current condition with assessment of associated risk factors, it may support more individualized preventive, active, and supportive care, while also improving comparability in education, research, surveillance, and health policy making.

CLINICAL SIGNIFICANCE: This framework enables clinicians to comprehensively assess older adults by integrating frailty, oral function, disease burden, as well as systemic and social risks, thus facilitating individualized treatment planning, targeted prevention, and appropriate supportive care, while improving communication and decision-making in complex geriatric dental cases.