Context

Poor oral health can affect people's ability to eat, speak and socialise (Dental quality and outcomes framework Department of Health). Tooth decay and gum disease are the most common UK dental problems, but are largely preventable (Levine and Stillman-Lowe 2009[1]). They can be painful, expensive and seriously damage health if not treated ('Dental quality and outcomes framework'). Oral cancer is rapidly increasing and half of new cases are in people aged 65 and over (Oral cancer – UK incidence statistics Cancer Research UK).

Age UK estimates 431,500 people live in care homes, approximately 414,000 of whom are over 65. Some younger adults also live in residential care because their physical or mental health prevents them from living independently. The Age UK figures imply there are 17,500 younger adults in care homes, but other data estimate they may be home to around 30,000 younger adults with learning disabilities (Emerson et al. 2013[2]).

The Alzheimer's Society estimates 80% of residents have dementia or severe memory problems (Low expectations).

Research with adults in care homes with moderate to severe dementia has reported poor oral health (Preston 2006[3]). A 2012 British Dental Association survey (Dentistry in care homes research – UK) found inconsistent oral health care in care homes. It found many residents had oral health problems but staff were reluctant to help and lacked training. Care staff showed little understanding about the importance of oral health or its relationship with general health and a range of risk factors (for example, mouth cancer, cardiovascular disease, aspiration pneumonia). Poor oral health (leading to pain or infection) can also precipitate crises in people with dementia.

Good quality information about oral health and dental needs in care homes is lacking. Many residents have complex oral health needs, but it is unclear how these are met. Practice varies across England. Poorly trained staff, lack of access to dental services and advice, existing oral health problems, medicines that decrease saliva, and treatments for chronic medical conditions (including dementia) make it difficult to identify and meet those needs.

More information

You can also see this guideline in the NICE pathway on oral and dental health.

To find out what NICE has said on topics related to this guideline, see our web pages on care homes and oral and dental health.

See also the evidence reviews and information about how the guideline was developed, including details of the committee.



[1] Levine RS, Stillman-Lowe CR (2009) The scientific basis of oral health education: sixth edition. London: British Dental Journal

[2] Emerson E, Hatton C, Robertson J et al. (2013) People with learning disabilities in England 2012. Learning Disabilities Observatory: Lancaster.

[3] Preston A (2006) The oral health of individuals with dementia in nursing homes. Gerodontology 23 (2): 99–105

  • National Institute for Health and Care Excellence (NICE)