Improving oral care in care homes

Good oral hygiene can affect many aspects of everyday living, from talking and smiling, to having self-confidence in how we look and being able to enjoy what we eat and drink. 

Oral health is important for people of all ages. However, a recent survey by the Care Quality Commission (CQC) found that 52% of care homes do not have an oral health policy or systems in place to support resident’s oral health.¹

So, why is the standard of oral health in care homes slipping, and what can be done to help them provide better oral care in the future? 

Why is oral care so important within care homes?

In care homes, poor standards of oral health could quickly lead to more serious medical issues.

Research by the Royal College of Surgeons Faculty of Dental Surgery suggests strong links between poor oral health and malnutrition. There is also evidence linking oral health with aspiration pneumonia, caused by people inhaling bacteria in dental plaque.²

As care homes provide services for such a vulnerable group, it is important that they help residents to maintain good oral health while they are in their care. 

What barriers do care homes face when it comes to oral care?

If oral care is so important for maintaining the health of older age groups, why are care homes struggling to keep oral care in check? 

For the most part, poor procedures for oral health in care homes comes down to awareness. 39% of care home managers are not aware of the NICE guidelines set out by the NHS.

The NICE guidelines for oral health were introduced in July 2016, providing care homes with an outline of how best to provide oral care for their residents. Unfortunately, these guidelines are not currently part of the sector’s main frameworks, so are still slipping through in 39% of cases.¹  

How to improve oral care in care homes

10% of care homes do not cover oral health at all.¹ 

NICE guidelines recommend that in order to provide adequate services, care homes should make oral health part of their central care policy. In order to help maintain a good standard of oral health, care homes should provide the following services:³

1. Regular assessments for oral health
   In order to keep on top of oral health needs, care homes should provide regular oral assessments. It should also be part of the admission process when welcoming in new residents. 
2. An oral care plan
   All care home residents should have an up-to-date oral health plan as part of their care. These should be detailed enough to guide carers and support workers in providing the appropriate oral care on a daily and long-term basis. A good oral care plan will include details of their last dental check-up and their preferred oral hygiene products. There should also be formal procedures in place in the case of an issue being reported with oral health. 
3. Daily oral care
   Those who are less able to maintain their own oral hygiene should be supported in brushing their teeth twice a day. This should include removing and caring for dentures. 
4. Oral care products
   Care homes should provide residents with toothbrushes, toothpaste and other oral care products, to help support them with oral hygiene. Toothbrushes should be replaced every 3-4 months.³
5. Training for care home staff
   47% of care home staff have never received training in oral care.¹ Staff who are required to help residents with any form of oral care should be provided with the proper training. This will raise any oral health concerns to be addressed as early as possible. 

_{1 CQC, Smiling Matters – https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes}

_{2 RCS – https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/older-people-oral-health/}

_{3 Colgate - https://www.colgate.com/en-us/oral-health/basics/brushing-and-flossing/how-often-should-you-change-your-toothbrush-0114}