OBJECTIVE: This pilot study assessed the feasibility of using facial thermography to detect intra-oral problems in older adults with cognitive decline and care-resistant behaviors, who are often unable to communicate pain or early symptoms. METHODS: Twenty-three older adults (mean age 73.7 ± 13.2 years) with cognitive decline were enrolled. Thermal images of four facial views were taken using a smartphone-connected thermal camera. Intra-oral examinations were conducted, and the thermographic data were analyzed to extract temperature values in the regions of interest (ROI). Point-biserial correlations and ROC curve analyses were performed to evaluate associations between temperature data and clinical findings, with a significance level of p <
0.05. RESULTS: Intra-oral issues requiring treatment were found in 12 participants, with six reporting clinical pain. The overall mean temperature in the ROI was 33.5 ± 3.9 °C, and significant temperature differences were found between the body and ROI temperatures. Correlations were observed between clinical problems and various temperature metrics, including the minimum and maximum ROI temperatures (r CONCLUSION: Thermographic facial imaging shows significant potential as a non-invasive tool for detecting oral health problems in vulnerable older adults. While promising, further research is essential to enhance image quality, streamline the technique, and incorporate AI for improved diagnostic accuracy and ease of use. CLINICAL SIGNIFICANCE: This non-invasive, inexpensive technique is easy to perform, independent of patient compliance and, is promising to detect early oral problems in noncommunicative patients.