According to NHS England, the oral health of the population has been steadily improving over the past 40 years. The upshot of this is that older people are keeping their own teeth for longer.
As people are keeping their teeth later in life, many people are entering residential care with their natural teeth, not dentures. Yet, National Institute for Health and Care Excellence (NICE) report that, ‘more than half of older adults who live in care homes have tooth decay, compared to 40% of over 75’s who do not live in care homes’.
The state of Oral Health in Residential Care
67.2% of people in residential care have at least some of their own natural teeth. (We calculated this by analysing electronic assessments from over 7,000 people in residential care).
Only 60.7% requiring help with personal care (to get washed and dressed) and assessed to have their own teeth had any evidence of oral care. The remaining 39.3% of people with natural teeth and receiving personal care did not have daily evidence of oral hygiene.
Why Oral Care is Important
Proper oral care is important for maintaining residents’ overall health. Poor oral care has been shown to lead to gum disease, tooth loss and is linked to other health issues. There is evidence to suggest a link between poor oral health and heart disease, and other systemic diseases linked to poor oral health such as respiratory infections and diabetic complications. There is even research to link poor oral health with dementia. Bacteria from inflamed gums may enter the brain through nerve channels in the head or through the bloodstream, which may lead to the development of Alzheimer’s disease.
According to Jane Peterson, a Registered Dental Hygienist who specialises in helping to deliver daily oral care to challenging residents in care homes, ‘delivering daily oral care to some residents can prove challenging, especially as people with advanced dementia can become resistant and uncooperative to oral care.’
Studies have also shown that carers’ perception of brushing residents’ teeth is seen as infringing on their personal space; they find oral hygiene procedures unpleasant; and have difficulty accessing the mouth, particularly from uncooperative residents.
Where to get help with Oral Health
NICE have produced guidelines on oral health for adults in care homes, which includes a baseline assessment tool.
Your local oral health promotion team should be able to provide you with educational materials, support and training for care staff.
Oral Health Matters delivers accredited training by dental care professionals suitable for all members in the care sector.
Standards for Oral Care in Care Homes
Guidelines from NICE
Professor Leng, Deputy Chief Executive of NICE (National Institute for Health and Care Excellence) declared ‘oral health is too often neglected’ and ‘oral health should be a priority in care homes’. NICE has issued 2 major papers related to oral care.
- Adults who move into a care home have their mouth care needs assessed on admission (oral health assessment)
- Adults living in care homes have their mouth care needs recorded in their personal care plan
- Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures
Inspection Expectations for Oral Care
Evidence about how you support residents to maintain good oral health will help you demonstrate that your service is both effective and responsive.
The Care Quality Commission (CQC), Care Inspectorate Wales (CIW) and Care Inspectorate in Scotland expects registered managers to take account of nationally recognised guidance. This includes guidance from NICE, who advocate that everyone has an oral health assessment when they move into the care home, with the result recorded in their care plan.
Easier Management and Evidence of Oral Health
We support management and evidence of oral health in care homes. Ensuring that an oral health assessment is completed and reviewed regularly alongside daily evidence of oral care is easier when using Mobile Care Monitoring. Our oral health assessment tool, developed with input from NHS Wales Community Dental Services and Oral Health Matters, uses the standardised NICE oral health assessment in a format that can be used by staff at any opportunity.