Last Updated on July 5, 2016
New National Institute for Health and Care Excellence (NICE) guidance Oral health for adults in care homes has been published. It calls for oral health and access to dental treatments to be given the same priority as general health for all adults in care homes.
According to Public Health England's What is Known About the Oral Health of Older People in England and Wales, more than half of older adults in care homes have tooth decay compared to 40% of over 75s and 33% of over 85s who do not live in care homes. Also, older adults in care homes are more likely to have fewer natural teeth, and those with teeth are less likely to have enough teeth to eat comfortably and socialise without embarrassment.
The NICE guideline includes recommendations on improving and maintaining residents’ day-to-day oral healthcare, ensuring staff are properly trained to confidently look after the oral health needs of residents, and there is adequate access to dental services when needed.
Professor Gillian Leng, Deputy Chief Executive of NICE, said, 'Whilst some care homes provide good daily oral health for their residents, we know oral health is too often neglected.
'When oral health is ignored or poorly delivered in care homes it can lead to unhappy, irritable residents and for those with dementia, who often can’t describe problems with their teeth or gums, pain and infection may go untreated and worsen.
'Our guideline calls for an oral health assessment of each resident when they enter a care home with the results – including any treatment needs – being entered into their personal care plan.
'Ensuring staff can perform routine daily mouth care for those who may not be able to do this for themselves means residents’ oral health can be actively monitored.
'Simple changes such as these will vastly improve the oral health and quality of life of people who are living in care homes across England.'
Current practice in care homes to monitor oral health varies from home to home, according to British Dental Association research, and good quality information about the sector as a whole is not available.
To confound matters care homes face a number of difficulties such as managing any residents’ existing oral health problems, residents who may refuse assistance and staff who have not been trained in oral health care.
Professor Elizabeth Kay, Foundation Dean of Peninsula Dental School, Plymouth University, Professor and Consultant in Dental Public Health and member of the guideline development group, said, 'This guidance is about maintaining basic human dignity in those who may need help in looking after themselves.
'Everyone should be able to speak, smile and eat comfortably, but all too often this is jeopardised by poor oral health, which can have a significant negative effect on a person’s wellbeing and quality of life.
'Poor or non-existent oral hygiene regimens can lead to gum disease and inflammation causing bad breath, tooth loss, abscesses and pain.
'The daily routines recommended in the guidance will help prevent these problems and assist adults in care homes to have a comfortable, pain-free mouth.
'Awareness of oral health needs to be raised within care homes and we want to see more staff given training about what they can do to help.
'Many of us will end up living in a care home and many of us have loved ones currently living in care, so we need to think about how we would like to be looked after and how we would like our relatives to be looked after.'
The guideline committee noted that funding and local arrangements for dental services provided to care homes are often poorly understood and confusing. For example, under the current general dental services (GDS) contract, dentists are not able to make routine visits to care homes because domiciliary care (care at any location other than a dental practice, mobile surgery or a prison) is not always part of the work they are contracted and paid to do.
Recommendations call on local health and wellbeing boards to ensure dental services are provided for people living in care homes, and for care home managers to contact their local board if they are concerned about the availability of services.
Andrea Sutcliffe, Chief Inspector of Adult Social Care at The Care Quality Commission (CQC), said, 'People who live in care homes have every right to expect that all aspects of their care and wellbeing are regularly monitored and any concerns acted upon – oral health is an important part of this, especially as it has such an impact on how people feel about themselves and how well they can eat and drink.
'I encourage everyone who is in charge of running care homes to be aware of this new NICE guidance so they can make sure they are following, and can demonstrate, good practice for the benefit of the people they support.'
Oral health for adults in care homes is available to read here.
Follow the links to read about other recent NICE publications.
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