Recommendations

The recommendations in this guideline should be considered alongside the advice in Public Health England's Delivering better oral health.

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including 'off-label' use), professional guidelines, standards and laws (including on consent), and safeguarding.

1.1 Care home policies on oral health and providing residents with support to access dental services

These recommendations are for care home managers.

1.1.1 Ensure care home policies set out plans and actions to promote and protect residents' oral health. Include information about:

  • local general dental services and emergency or out-of-hours dental treatment

  • community dental services, including special care dentistry teams (see the NHS Choices information on NHS dental services)

  • oral health promotion or similar services, depending on local arrangements (see recommendation 1.7.1)

  • assessment of residents' oral health and referral to dental practitioners (see section 1.3)

  • plans for caring for residents' oral health

  • daily mouth care and use of mouth and denture care products

  • what happens if a resident refuses oral health care (in line with the Mental Capacity Act and local policies about refusal of care)

  • supply of oral hygiene equipment (for example, basic toothbrush or toothpaste).

1.1.2 Ensure you set out your duty of care in relation to residents' oral health needs and access to dental treatments.

1.1.3 Ensure the oral health policy aligns with advice in the Delivering better oral health toolkit.

1.1.4 Ensure the oral health policy makes it clear that only practitioners registered with the General Dental Council and acting within its scope of practice may diagnose and treat dental disease or refer someone for specialist treatment (see NICE's guideline on suspected cancer: recognition and referral).

1.1.5 Ensure mouth care is included in existing care home policies covering residents' health and wellbeing and reviewed in line with local practice.

1.1.6 Ensure all care staff, new and existing residents and their families or friends (if they are involved in the resident's care) are aware of care home policies to promote health and wellbeing, including mouth care.

1.2 Oral health assessment and mouth care plans

These recommendations are for care staff carrying out admissions or assessments.

1.2.1 Assess the mouth care needs of all residents as soon as they start living in a care home, regardless of the length or purpose of their stay. Consider using the Oral health assessment tool. Where family and friends are involved in ongoing care, consider involving them in the initial assessment, with the residents' permission, if it will help staff understand the resident's usual oral hygiene routine. Ask:

  • How the resident usually manages their daily mouth care (for example, toothbrushing and type of toothbrush, removing and caring for dentures including partial dentures). Check whether they need support.

  • If they have dentures, including partial dentures, whether they are marked or unmarked. If unmarked, ask whether they would like to arrange for marking and offer to help.

  • The name and address of their dentist or any dental service they have had contact with, and where and how long ago they saw a dentist or received dental treatment. Record if there has been no contact or they do not have a dentist, and help them find one.

1.2.2 Make an appointment for the resident to see a dental practitioner, if necessary.

1.2.3 Record the results of the assessment and the appointment in the resident's personal care plan.

1.2.4 Review and update residents' mouth care needs in their personal care plans as their mouth care needs change (see recommendation 1.3.3).

1.3 Daily mouth care

These recommendations are for managers of care staff who support daily personal care.

1.3.1 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 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 (for example, this may include a high fluoride toothpaste or a prescribed mouth rinse, see NICE's guideline on managing medicines in care homes)

  • daily use of any over-the-counter products preferred by residents if possible, such as particular mouth rinses or toothpastes; if the resident uses sugar-free gum, consider gum containing xylitol.

1.3.2 Ensure care staff know which member of staff they can ask for advice about getting prescribed mouth care products, or helping someone to use them.

1.3.3 Ensure care staff know how to recognise and respond to changes in a resident's mouth care needs.

1.3.4 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 website page on your care).

1.4 Care staff knowledge and skills

These recommendations are for care home managers.

1.4.1 Ensure care staff who provide daily personal care to residents:

  • Understand the importance of residents' oral health and the potential effect on their general health, wellbeing and dignity.

  • Understand the potential impact of untreated dental pain or mouth infection on the behaviour, and general health and wellbeing of people who cannot articulate their pain or distress or ask for help. (This includes, for example, residents with dementia or communication difficulties.)

  • Know how and when to reassess residents' oral health (see recommendation 1.2.1).

  • Know how to deliver daily mouth care (see recommendations 1.3.1–1.3.4).

  • Know how and when to report any oral health concerns for residents, and how to respond to a resident's changing needs and circumstances. (For example, some residents may lose their manual dexterity over time.)

  • Understand the importance of denture marking and how to arrange this for residents, with their permission.

1.5 Availability of local oral health services

This recommendation is for health and wellbeing boards.

1.5.1 Ensure local oral health services address the identified needs of people in care homes, including their need for treatment. Identify gaps in provision. (See recommendation 1 in NICE's guideline on oral health: approaches for local authorities and their partners to improve the oral health of their communities.) This includes:

  • general dental practices

  • community dental services, including special care dentistry (for more information see NHS England)

  • oral health promotion or similar services, in line with existing local arrangements

  • emergency and urgent out-of-hours dental treatment.

This recommendation is for care home managers.

1.5.2 Tell local healthwatch and public health teams about any concerns you have about the availability of local dental and oral health promotion services.

1.6 Oral health promotion services

These recommendations are for oral health promotion teams or similar services, in line with existing local arrangements.

1.6.1 Develop and provide care homes with oral health educational materials, support and training to meet the oral health needs of all residents, especially those with complex needs. Also explain the role of diet, alcohol and tobacco in promoting good oral health, in line with advice in the Delivering better oral health toolkit and NICE's guideline oral health promotion: general dental practice.

1.6.2 Help care home managers find out about local oral health services and create local partnerships or links with general dental practice and community dental services including special care dentistry.

1.6.3 Tell local authority public health teams and dental public health leads about gaps in the services, so they can advocate for accessible oral and dental health services on behalf of residents of care homes.

1.7 General dental practices and community dental services

These recommendations are for dental practitioners.

1.7.1 Provide residents in care homes with routine or specialist preventive care and treatment as necessary, in line with local arrangements (see NICE's guidelines on dental checks: intervals between oral health reviews, oral health: approaches for local authorities and their partners to improve the oral health of their communities and oral health promotion: general dental practice).

1.7.2 Ensure dentures made for individual residents are appropriately marked by the lab during manufacture.

  • National Institute for Health and Care Excellence (NICE)