Development and validation of risk-predicting model for oral frailty in older patients with chronic pulpitis

Objective This study aimed to analyze the influencing factors of oral frailty in older adults with chronic pulpitis, and to construct and validate a predictive model for oral frailty. Methods From June to August 2025, 300 older adults with chronic pulpitis were selected from Nantong Stomatological Hospital using convenient sampling. They were randomly divided into a model training set (n=210) and a validation set (n=90) at a ratio of 7:3. Data were collected using a general information questionnaire, the Oral Frailty Index-8 (OHI-8), the Dental Anxiety Scale (DAS), the Fried Frailty Phenotype (FP), the Numerical Rating Scale (NRS), and the Oral Health Literacy Scale. Logistic regression was used to identify the influencing factors of oral frailty. R software was applied to construct an oral frailty risk prediction model and draw a nomogram. Bootstrap method was used for internal validation, and the predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis (DCA), and Hosmer-Lemeshow test. Findings The incidence of oral frailty in older adults with chronic pulpitis was 57.0%. Age (OR=2.368, P<0.001), pain intensity (OR=1.733, P=0.013), number of natural teeth (OR=1.918, P=0.006), course of chronic pulpitis (OR=3.008, P<0.001), frailty (OR=0.475, P=0.036), Dental Anxiety Scale score (OR=1.200, P<0.001), and oral health literacy (OR=0.959, P=0.006) were independent predictive factors for oral frailty. For the training set, the AUC was 0.836 (95%CI: 0.782-0.866) with a cut-off value of 0.531. The accuracy, sensitivity, and specificity were 78.1%, 79.3%, and 76.4%, respectively. The Hosmer-Lemeshow goodness-of-fit test (χ²=4.198, P =0.521) indicated good model fit. Conclusion The constructed oral frailty risk prediction model exhibits good discrimination, calibration, and clinical utility. It can provide a reference for the prevention and early screening of oral frailty in older adults with chronic pulpitis. Clinical medical and nursing staff can develop targeted nursing strategies based on the model's prediction results, strengthen comprehensive interventions, promote oral health, and prevent the progression of oral frailty.