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May 15, 2020

Oral Care


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’.

Oral Care Statistics

  • 67% of people in residential care have at least some of their own natural teeth
  • Over 50% of older adults who live in care homes have tooth decay

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.

In January 2019, scientists found solid evidence that a common gum bug plays a central role in the development of Alzheimer’s.

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.

Knowledge Oral Health Care 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.

The NICE Guidelines ‘Oral Care for Adults in Care Homes’ was published in July 2016 and in June 2017 Quality Standards were issued which sets out 3 quality statements:

  1. Adults who move into a care home have their mouth care needs assessed on admission (oral health assessment)
  2. Adults living in care homes have their mouth care needs recorded in their personal care plan
  3. 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.

Mobile Care Monitoring gives you Best Practice Oral Care tools

Mobile Care Monitoring (MCM) supports management and evidence of oral care in care homes. We have developed our electronic evidence of care and care planning system with guidance from industry dental experts, NHS Wales Community Dental Services and Knowledge Oral Healthcare, to help staff reduce oral care risks and give them the confidence to support their residents.

We must use compulsory forms for oral care set by our Health Board. We worked with Person Centred Software to amend their previous oral health assessments to provide fully compliant oral health documentation.

"By having compulsory assessments available in Mobile Care Monitoring, Person Centred Software helps us to ensure best practice and compliance and means we don’t need to duplicate any forms or assessments in paper documentation."

Sharon Williams, Manager, Swn-y-Mor Care Home

With assistance from industry professionals, MCM enables care professionals to record Oral Health Assessments, update care plans tailored to people’s needs, and capture highly detailed real-time recordings of oral care. The information feeds automatically into reports and charts, providing evidence of the oral care support to meet the NICE Quality Standards and CQC’s Key Lines of Enquiries, with which the Quality Standard ‘Oral Care in Care Homes’ has recently been incorporated into to assess and identify areas in need of improvement.

“Mobile Care Monitoring software is an excellent tool to continually monitor, drive and measure improvement in quality. Person Centred Software was the first mobile device I came across that have incorporated Oral Health Assessments raising awareness of the importance of daily mouth care.”

Jane Peterson, Founder, Knowledge Oral Healthcare

Mobile Care Monitoring’s mouth care assessments help to create informed care plans with consistent quality. The care plan informs planned actions which can be monitored. And these planned actions enable staff to evidence the support provided in real-time to manage residents’ oral health and how this support is meeting NICE Quality Standards and CQC’s Key Lines of Enquiries. These form a holistic resident record that provides insight into a person’s health and wellbeing.

May 15, 2020

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