Dental care of people who live in care homes is in need of serious improvement as a Care Quality Commission (CQC) report* reveals residents do not always have access to dentists and are not getting the support they needed to look after their teeth.
CQC inspectors visited 100 homes caring for elderly and disabled people. They found:
- The majority (52%) had no policy to promote and protect people’s oral health
- Nearly half (47%) were not providing any staff training to support people’s daily oral healthcare
- 73% of residents’ care plans we reviewed only partly covered or did not cover oral health at all – homes looking after people with dementia being the most likely to have no plan in place
- 17% of care homes said they did not assess people’s oral health on admission.
Whilst two-thirds (67%) of the care homes visited said people who used their services could always, or nearly always, access NHS dental care, the report reveals a lack of dentists who were able or willing to visit care homes. Other challenges people faced involved local dentists not accepting new patients and the length of time it took to get an appointment with an NHS dentist – even for a procedure such as getting dentures fitted.
Of the homes visited, 10% reported they had no way of accessing emergency dental treatment for people. 34% of homes told the CQC they had no or limited access to out-of-hours services. Some care home managers stated that they had to call GPs, NHS 111, or even take the person requiring emergency care to A&E.
The CQC is calling for a cross-sector approach to tackle the concerns raised by this report, and highlights examples where this has been achieved. The review includes case studies of productive, joined-up relationships between care homes and local dental practices, including dentists providing routine check-ups, ongoing treatment and emergency care, both in and outside the care home.
The recommendations include a call for mandatory staff training in oral care, oral health check-ups for all residents upon admission, better signposting to local dental services and the convening of a multi-agency group tasked with raising awareness among people living in care homes, their families and carers of the importance of day-to-day dental hygiene and the need for routine check-ups.
Kate Terroni, chief inspector for Adult Social Care at the CQC said: “Care home managers must recognise the significance of oral health – and professionals including GPs, dentists, dental hygienists and community nurses need to work together to elevate the importance of oral health in care homes and to prioritise this as part of their work.
“The changes needed can only happen with the efforts of all parts of the health and care system coming together, helping people who use services, their families and carers to be aware of the importance of oral care. By working in partnership, we can make a positive impact on the quality of life of people living in care homes.”
The CQC report was released to coincide with British Dental Association (BDA) research which highlighted a number of distressing cases of decay and neglect of people in residential care. These included a blind, 93-year-old woman with advanced dementia whose dentures had become stuck in her mouth because they had been left in for weeks and her gums had grown around them. She was taken to A&E and the dentures had to be surgically removed.
Another case involved a woman with learning disabilities who was found to have huge amounts of decay and gum disease, including one tooth that had virtually rotted away. It was only spotted because she had stopped eating.
Charlotte Waite, chair of the BDA's England Community Dental Services Committee said the CQC report and its own research reveal services that are failing some of the most vulnerable in our society.
“There are residents left unable to eat, drink and communicate, as an overstretched NHS struggles to provide the care they need.
“We require nothing short of a revolution in the approach to dentistry in residential homes. Oral health can no longer remain the missing piece when it comes to care planning and budgets.”
*Smiling matters: oral health care in care homes. A report prepared by the CQC, June 2019.