The content of this website is intended for healthcare professionals only

Care home residents’ dental health as important as general health, says NICE

It’s about maintaining basic human dignity, but staff poorly trained in this aspect of care

Caroline White

Wednesday, 06 July 2016

The mouth and tooth health of older adults in residential care should be given the same priority as their general health, says the National Institute of Health and Care Excellence (NICE) in new guidance.

It’s key to maintaining basic human dignity, but staff are often poorly trained in this aspect of care, says NICE.

More than half of older adults in care homes have tooth decay compared to 40% of over 75s and 33% of over 85s who live independently.

It is estimated there are more than 400,000 adults living in UK care homes, 80% of whom have some form of dementia, and 30,000 of whom are younger adults with learning disabilities.

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, says NICE.

The guideline includes recommendations on improving and maintaining residents’ day-to-day oral healthcare, ensuring staff are properly trained to confidently look after the mouth health of residents, and making sure that adequate access to dental services is provided.

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.”

She added that it was important staff knew how to carry out routine daily mouth care for those who may not be able to do this for themselves.

“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,” she said.

Current practice in care homes to monitor oral health varies from home to home and good quality information about the sector as a whole is not available. Managing existing oral health problems, residents who refuse assistance, and staff who have not been trained in oral health care pose additional difficulties for care homes, says NICE.

Professor Elizabeth Kay, foundation dean of Peninsula Dental School, Plymouth University, and professor and consultant in dental public health and member of the guideline development group, said the guidance was about “maintaining basic human dignity in those who may need help in looking after themselves.”

She added: “Poor or non-existent oral hygiene regimens can lead to gum disease and inflammation causing bad breath, tooth loss, abscesses and pain. 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.”

The guideline committee noted 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.

The 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 availability of services.

Jenny Godson, national lead for oral health improvement at Public Health England (PHE) said: “To have a clean mouth is a basic right, just like other aspects of personal hygiene when an adult becomes frail and vulnerable and unable to do this for themselves. It is a basic right that they have help and support to do so.”

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470