Oral wound healing in the elderly: Mechanisms, challenges, and innovations

This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly.

Narrative review of preclinical and clinical studies addressing age-related changes in the four canonical wound-healing phases (hemostasis, inflammation, proliferation, remodeling), tissue-specific molecular pathways, systemic and local factors affecting repair, operative considerations, and emerging therapeutic modalities. Data sources included PubMed, Embase, and Cochrane databases through June 2025.

Aging compromises each repair phase. Hemostasis is prolonged by diminished platelet function and altered clot architecture. Inflammation is exacerbated by impaired neutrophil/phagocyte activity and persistent reactive oxygen species. Proliferation is slowed by reduced fibroblast proliferation and angiogenic signaling, while dysregulated matrix metalloproteinase activity impairs extracellular matrix remodeling. Tissue-specific cues in oral mucosa, periodontal ligament, cementum, and bone are also altered with age. Compounding factors-including "inflamm-aging," malnutrition, polypharmacy-induced xerostomia, cognitive decline, and frailty-further impede healing. Clinical optimization requires comprehensive preoperative risk and frailty assessments; medical/nutritional management; minimally invasive flap designs; tension-free primary closure; streamlined surgical protocols to limit operative time; and postoperative monitoring with tailored communication. Emerging regenerative strategies-growth factors (PDGF, FGF), platelet concentrates, gene and cell-based approaches (MSCs, exosomes), immunomodulatory scaffolds/agents, photobiomodulation, and AI-driven risk dashboards-show promise for enhancing repair in aging populations.

Effective oral wound healing in older adults demands a multidisciplinary, personalized approach that integrates meticulous perioperative care with novel regenerative modalities. Standardization and clinical validation of emerging therapies are essential to translate biological insights into improved patient outcomes.