Quality statement 1: Oral health assessment in care homes

Quality statement

Adults who move into a care home have their mouth care needs assessed on admission.

Rationale

Self-care can deteriorate before a person moves into a care home, so they may be admitted with poor oral health. Mouth care needs may not be visible and can be missed if they are not specifically assessed. It is important that mouth care needs are assessed as soon as possible when someone moves into a care home, so that tailored care can start straight away.

Quality measures

Structure

Evidence of local arrangements to ensure that adults have their mouth care needs assessed on admission.

Data source: Local data collection, for example, mouth care policies.

Process

Proportion of adults living in a care home who had their mouth care needs assessed on admission.

Numerator – the number in the denominator who had their mouth care needs assessed on admission.

Denominator – the number of adults living in a care home.

Data source: Local data collection, for example, audits of personal care plans.

Outcome

a) Satisfaction of resident or carer with the care home admission process.

Data source: Local data collection, for example, comments, feedback or surveys from residents and carers.

b) Satisfaction of resident or carer with the mouth care they receive.

Data source: Local data collection, for example, comments, feedback or surveys from residents and carers.

What the quality statement means for different audiences

Service providers (care homes) ensure that the mouth care needs of adults are assessed on admission to a care home. They ensure that care staff are trained to understand mouth care needs and carry out the assessment, and that they are aware of signs of dental ill health, for example tooth decay, abscesses, dry mouth and gum disease.

Health and social care practitioners (care staff in care homes) assess the mouth care needs of adults on admission to a care home and are aware of signs of dental ill health, for example tooth decay, abscesses, dry mouth and gum disease.

Commissioners (commissioners of care home services) ensure that care homes assess the mouth care needs of adults on admission. They should also ensure that care home services train care staff to understand mouth care needs and carry out the assessment, and that they are aware of signs of dental ill health, for example tooth decay, abscesses, dry mouth and gum disease.

Adults moving into care homes have a check to find out if they need help with their daily dental and mouth care when they move in. They (or their family members or carers if appropriate) are asked if they need help with brushing their teeth and looking after their dentures. Care staff also record details of the person's dentist and their last appointment, or help them to find a dentist if they don't have one. They also check if the person wants their dentures marked with their name.

Source guidance

Oral health for adults in care homes (2016) NICE guideline NG48, recommendation 1.2.1

Definitions of terms used in this quality statement

Assessment of mouth care needs

This should include establishing:

  • 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.

  • If the resident is experiencing any dental pain.

  • 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.

Care homes can consider using an assessment tool, for example the Australian Institute of Health and Welfare's Oral health assessment tool, to help with carrying out mouth care needs assessments.

The timing of regular follow-up mouth care assessments can be agreed with the resident during the initial assessment because this will vary depending on need. Some people may not need support on admission. This should be monitored so that support can be offered if their requirements change.

Staff in care homes can carry out mouth care needs assessments, however full oral health care assessments should be carried out by dental professionals.

[NICE's guideline on oral health for adults in care homes, recommendation 1.2.1 and expert opinion]

On admission

The mouth care needs assessment should be completed as part of the admission process, or at least within a week of the person being admitted (sooner for people admitted for a short stay).

[NICE's guideline on oral health for adults in care homes, the committee's discussion]

Equality and diversity considerations

Adults with dementia and other cognitive difficulties may not be able to communicate their mouth care needs. When family and friends are involved in ongoing care, care staff should consider involving them in the assessment, with the resident's permission, if it will help staff understand the resident's usual mouth care routine. Some adults may have lost contact with family or friends, and care staff should make sure they establish the mouth care needs of these adults by carrying out the assessment.