Oral Health and Social Engagement of the Elderly

Background/Purpose

Although oral health is often regarded as a narrowly clinical issue, its consequences extend beyond physical discomfort, particularly for older adults. Impaired oral health can affect basic functions such as eating and speaking, but it also shapes self-expression and social interaction. For many older adults, missing teeth, chewing difficulties, or concerns about appearance can undermine confidence and contribute to social withdrawal. While gerontology and public health research consistently highlight the crucial role of social connectedness in well-being and healthy aging, the specific impact of oral health on social engagement remains underexplored.

In this study, we use nationally representative longitudinal data from older adults in South Korea to examine the relationship between oral health and social engagement. By focusing on within-individual variation over time, we aim to isolate the effect of oral health from unobserved characteristics such as personality traits and dietary habits. We also explore a potential mechanism underlying this link, recognizing that social engagement requires financial and time resources. Poor oral health may redirect these resources toward dental care instead of social activities. Lastly, we provide suggestive evidence that reduced social engagement resulting from deteriorating oral health is associated with an increased risk of depression.

Methods

We analyze data from the Korean Longitudinal Study of Ageing, a nationally representative panel survey tracking the well-being of older adults in South Korea. To exploit within-individual variation, we use fixed effects models that control for time-invariant unobserved heterogeneity. To strengthen our empirical model, we augment our approach using Double Machine Learning. Our main model applies boosting methods to debias both the outcome and the key explanatory variable, with robustness checks conducted using random forest.

Results

Our findings show that one standard deviation improvement in oral health is associated with about 1.8 percentage points higher likelihood of meeting close contacts and an additional 3 days per year of social contact. We confirm that socialization is resource-intensive: increased social contact correlates with higher monthly dining-out expenditures. Conversely, poor oral health is associated with greater monthly medical spending and more frequent dental visits. Furthermore, both reduced social engagement and poor oral health are linked to higher risks of depression diagnosis.

Conclusions and implications

Our research revisits the often-overlooked question of “the significance of the mouth in old age,” offering empirical evidence through a combination of econometric modeling and machine learning techniques. Despite the centrality of oral health in shaping daily life, many major survey studies on older populations provide only limited attention to this domain. Our findings suggest that oral health problems impose not only physical burdens but also significant social costs, potentially reducing opportunities for social engagement and well-being in later life. Our findings call on gerontological social workers to inquire about oral health and its impact on social engagement and well-being. We advocate for deeper inquiry into this relationship and urge the inclusion of comprehensive oral health measures in aging-focused survey research to better inform policy and intervention.