Improving oral health for adults in care homes

Maintaining a healthy smile

What is oral health? 

Maintaining good oral health involves regularly brushing and cleaning your teeth and gums to keep your mouth free from disease, decay, and other issues - this is an essential part of personal care and hygiene and can help prevent tooth decay, gum disease, bad breath, and tooth loss. 

Why is oral health important? 

Good oral health is crucial for maintaining overall health, wellbeing, and quality of life. Poor oral health can result in various oral diseases and conditions that can cause pain and discomfort and impact a person's ability to eat, speak, and smile.  

Additionally, oral health problems are increasingly linked to a number of other serious health issues, such as dementia, heart disease, diabetes, malnutrition, and pneumonia. Individuals living in care homes are at even greater risk of oral health problems and related conditions due to high levels of dependency, effects of medication (some of the common over-the-counter medications can have an adverse impact on the teeth), co-existing medical conditions, reduced functional ability, physical disabilities, cognitive impairments, dementia, arthritis, etc.  



  Therefore, prioritising oral health care for those in care homes is crucial.

We've teamed up with mydentist, the UK's leading provider of affordable dental care, to provide tips on oral health care for older adults

Who is responsible for organising dental care in care homes? 

As a care home, it's essential to ensure that all residents receive the necessary dental care and that care home managers provide information about the dental care process to current and prospective residents and their families.  

Many care homes have arrangements with local dentists or community dental services who can visit the care home to provide regular check-ups.  

Upon moving into a care home, residents must undergo an oral health assessment, which is then recorded in their care plan. Care home managers must ask questions about the residents' dental health, such as whether they use any dental aids, have any dentures, and what level of support they require with their dental care.  


Additionally, care home staff must have the necessary knowledge and skills to care for their residents' dental health. Care home staff must be trained to recognise when a resident needs to have their oral health reassessed and how to support them with their daily dental care routine.

For example, staff should know to brush the residents' teeth twice a day, clean their dentures (if they have any), and use their preferred dental care products, such as mouthwash or floss, to maintain oral health. 

Does Person Centred Software have an oral health assessment tool? 

Our digital social care record system, mCare, has all the necessary features that a care provider needs. 

mCare's Oral Health featureallows 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.  

PCS Oral Care

Carers can automatically retrieve this data for reports and charts, providing evidence of oral care support that meets the NICE Quality Standards and CQC's Key Lines of Enquiries.  

 An oral health assessment tool will highlight areas where residents need specific care and support. Using the tool for reassessments will indicate any changes that may need action. 


What is the recommended daily mouth care for care home residents? 

NICE has recommended daily mouth care guidelines for care home residents. These guidelines aim to promote and maintain good oral health and hygiene practices, ensuring the wellbeing of care home residents:  

  • Ensure care staff provide residents with daily support to meet their mouth care needs and preferences, as set out in their personal care plan after their assessment - this should be aligned with the advice in the Public Health England delivering better oral health toolkit, including:  

    • Brushing natural teeth at least twice a day with fluoride toothpaste 
    • Providing daily oral care for full or partial dentures (such as brushing, removing food debris and removing dentures overnight) 
    • Using their choice of cleaning products for dentures, if possible  
    • Using their choice of toothbrush, either manual or electric/battery-powered  
    • Daily use of mouth care products prescribed by dental clinicians 
    • Daily use of any over-the-counter products preferred by residents (if possible), such as a particular mouth rinse or toothpaste 
  • Ensure care staff know which staff member they can ask for advice about getting prescribed mouth care products or helping someone to use them. 
  • Ensure care staff know how to recognise and respond to changes in a resident's mouth care needs.  
  • Ensure care staff know how to respond if a resident does not want daily mouth care or to have their dentures removed (see NICE's information on making decisions about your care).  


The Care Quality Commission's 'Smiling Matters' campaign 

The 'Smiling Matters' campaign was introduced to gain insight into how care homes were looking after their residents' oral care needs. 


On 20th March 2023, the Care Quality Commission (CQC) released a report of findings following the 2019 'Smiling Matters' campaign for care homes. 

 A selection of care homes were audited on things such as whether the care home: 

  • Had a policy to promote and protect people's oral health  
  • Implemented the National Institute for Health and Care Excellence (NICE) 'Improving Oral Health for Adults in Care Homes' framework' into practice 
  • Had care plans that fully covered the resident's oral health needs 

The 2023 report presents the findings of the changes made since 2019. Although there have been improvements in many areas, some areas still require more attention. 

The report found that the following areas had been improved: 

  • 9% of care home managers were not aware of the NICE guidance in 2022; this compares with 39% in 2019 
  • 53% of care home providers now have a policy to promote and protect people's oral health, compared to 25% in 2019 
  • In 2022, 83% of care home providers said that people had an oral health assessment on admission, compared to 73% in 2019 
  • The percentage of care plans fully covering oral health needs improved from 27% in 2019 to 60% in 2022 
  • The proportion of staff who received oral health training increased from 30% in 2019 to 60% in 2022 

The report also showed that there are areas for improvement: 

  • Some care plans only provided minimal information, such as whether a person has teeth or dentures. People's oral health needs can change over time. If their updated oral health needs are not recorded regularly, it can negatively affect their quality of life, including their diet.
  • Only 28% of care homes had a nominated oral health champion (recommended by the CQC in 2019 to promote good practice and provide a link between care homes and dental professionals). Some care providers mentioned staffing issues prevented them from appointing someone for this role.
  • In 2019, 6% of care providers said they could not access NHS dental care for those who needed to use their services. In 2022, this figure sharply rose to 25% 

The 'Smiling Matters' campaign has had an impact on the care homes' awareness and handling of oral health care. However, more still needs to be done to ensure that people living in care homes are supported to maintain and improve their oral health. 

Oral health is closely connected to your overall health and wellbeing, and unfortunately, it is often overlooked or given less importance than other health concerns.  

Care providers must follow the NICE guideline (NG48), which covers oral health, including dental health and daily mouth care, for adults in care homes. 

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