Quality statement 3: Supporting daily mouth care in care homes

Quality statement

Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures.

Rationale

For good oral health, adults with natural teeth should brush them with fluoride toothpaste twice a day and adults with full dentures should carry out daily care, such as brushing, removing food debris and removing dentures overnight. Adults with both natural teeth and partial dentures should do both. Good oral health is important to maintain self-esteem, dignity and quality of life. Adults with poor oral health often have problems with eating, speaking and socialising.

Quality measures

Structure

Evidence of local arrangements for adults living in care homes to be supported to clean their teeth twice a day and carry out daily care for dentures.

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

Process

Proportion of adults in a care home who are supported with daily mouth care.

Numerator – the number in the denominator who are supported with daily mouth care.

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

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

Outcome

Oral health-related quality of life for adults living in care homes.

Data source: Local data collection. Oral health-related quality of life can be established for some groups of residents using an Oral Health Impact Profile.

What the quality statement means for different audiences

Service providers (care homes) ensure that adults living in care homes are supported with daily mouth care, including cleaning their teeth twice a day and undertaking daily care for dentures, if support is needed. They ensure that care staff are trained to offer this support.

Health and social care practitioners (care staff in care homes) support adults living in care homes with daily mouth care, including cleaning their teeth twice a day and undertaking daily care for dentures, if support is needed. This may involve carrying out daily mouth care for residents who are unable to do this for themselves.

Commissioners (commissioners of care home services) ensure that care homes provide support with daily mouth care, if needed. They should also ensure that care staff are trained to offer this support.

Adults living in care homes who need help with mouth care are supported to brush their teeth twice a day, if they have their own teeth, and to care for their dentures every day, including cleaning and removing them overnight.

Source guidance

Oral health for adults in care homes (2016) NICE guideline NG48, recommendation 1.3.1

Definitions of terms used in this quality statement

Support to clean teeth and carry out denture care

This is the help that some people may need to carry out these tasks. This could include, but is not limited to:

  • 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 appropriate 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)

  • 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.

Some people may not need support to clean their teeth or dentures. This should be monitored so that support can be offered if their requirements change.

[NICE's guideline on oral health for adults in care homes, recommendation 1.3.1 and expert opinion]

Equality and diversity considerations

Care home managers should make sure care staff know what to do if a resident declines support with mouth care, in line with the Mental Capacity Act and local policies about refusal of care (see also NICE's information on your care). People should not be forced to receive mouth care against their wishes. However, repeated refusal should not be ignored and some people may need additional support to feel comfortable receiving mouth care.

Reasonable adjustments should be made, in line with the Equality Act, to ensure that people with disabilities can receive the mouth care which is most suitable for them.