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Poor oral health can affect people’s ability to eat, speak and socialise normally

People living in care homes are at greater risk of oral health problems for several reasons:

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Long-term conditions (including arthritis, Parkinson’s disease and dementia) can make it harder to hold and use a toothbrush, and to go for dental treatment.

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Many medicines reduce the amount of saliva produced and leave people with a dry mouth.

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People now keep their natural teeth for longer, but this can mean they need more complex dental care than people who have dentures.

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Thorough assessments, and support from skilled and knowledgeable staff can help prevent the pain, disturbed sleep and health problems that poor oral health can cause. 

More than half of older adults who live in care homes have tooth decay, compared to 40% of over 75s who do not live in care homes.

Oral health assessment

All residents should have an oral health assessment when they move into the care home, with the result recorded in their care plan. Care staff should start by asking the following questions:

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How do you usually manage your daily mouth care and what help would you like?

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What dental aids do you currently use? For example, manual or electric toothbrush, mouthwash, floss.

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Do you have dentures, and if so are they marked with your name? If not, would you like them to be marked?

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When did you last see a dentist, and who did you see?

If you don't have a dentist would you like help to find one?

Using an oral health assessment tool - like the one here - will highlight any areas where residents need specific care and support. Using it for reassessments will indicate any changes that may need action.

This tool has been reproduced with kind permission of the Australian Institute of Health and Welfare (AIHW). Source: AIHW Caring for Oral Health in Australian Residential Care (2009).

Modified from Kayser-Jones et al. (1995) by Chalmers.

Oral health assessment tool

print-friendly version (PDF) for you to use at work. 

Care staff knowledge and skills

Care staff need to know when to reassess the oral health of a resident and how to support residents with their daily mouth care to:

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Brush their natural teeth at least twice a day with fluoride

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Use their choice of cleaning products for dentures.

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Clean their dentures (brushing, removing food debris, removing dentures overnight).

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Use their choice of toothbrush, either manual or electric/battery powered, and mouth care products.

They also need to understand how dental pain or a mouth infection can affect residents’ general health, wellbeing and behaviour.

Make sure staff know who to ask for advice, how and when to report any concerns about a resident’s oral health, and how changes in a person’s condition might affect their ability to manage their mouth care.

What the Care Quality Commission expects

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The Care Quality Commission expects registered managers to take account of nationally recognised guidance, including guidance from NICE.

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Evidence about how you support residents to maintain good oral health will help you demonstrate that your service is both effective and responsive.

NICE’s guideline on oral health for adults in care homes, including the baseline assessment tool, can be used as part of your preparation for inspection and to support requests for help to other services.

If you are concerned about the availability of dental services, inform your local Healthwatch and public health teams. Your local oral health promotion team should be able to provide you with educational materials, support and training.

Further information 

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This content has been co-produced by NICE and SCIE and is based on NICE’s guideline on oral health for adults in care homes.