Clinical update

Oral health for adults in care homes

With more than half of older people residing in care homes suffering from tooth decay, it is essential that staff are trained to administer proper oral care. 

Essential facts

It is estimated that more than 400,000 adults live in UK care homes, 80% of whom have dementia.

More than half of older people in care homes have tooth decay, compared with 40% of over-75s and 33% of over-85s in other accomodation. Care home residents are likely to have fewer natural teeth, and not have enough teeth to eat comfortably or socialise without embarrassment.
 

Tooth assessment
Staff should be trained to perform daily mouth care for those who are unable to do this for themselves Pic: iStock 

What’s new?

In July, the National Institute for Health and Care Excellence (NICE) published guidance on oral health (see www.nice.org.uk/guidance/ng48). It called for access to dental treatments to be given the same priority as general health for all adults in care homes.

The guidance includes recommendations on improving and maintaining residents’ day-to-day oral health care. It also recommends ensuring staff are trained to look after residents' oral health needs, and adequate access to dental services is available.

Why oral health is important

Oral health affects care home residents' wellbeing and quality of life. Poor oral health can have an adverse effect on speech, taste, chewing ability, self-confidence and ability to socialise. It can also cause pain and discomfort.

If the mouth is not adequately cleaned, gum inflammation and disease can cause bad breath, tooth loss, abscesses and pain.

Residents with dementia may not be able to describe problems with their teeth or gums. In this case, poor oral health can result in untreated pain and infection that can worsen over time.

Challenges

Good-quality information about oral health and dental needs in care homes is lacking. Many residents have complex oral health needs, but it is unclear how these are met, as practice varies across England. 

There are difficulties in identifying and meeting residents' needs. These include existing oral health problems, medicines that decrease saliva and treatments for chronic conditions, including dementia. Poorly trained staff, and a lack of access to dental services and advice, are also issues. 

How you can help your residents

Each resident should have an oral health assessment when they enter a care home. The results, including any treatment needs, should be entered into their personal care plan.

Staff should be trained to perform routine daily mouth care for those who may not be able to do this for themselves.

This includes: 

  • brushing natural teeth with fluoride toothpaste twice a day. 
  • daily oral care for full or partial dentures.
  • any mouth care products prescribed by dental clinicians. 
  • and any over-the-counter products preferred by residents.
     

Expert comment 

Elizabeth Kay, foundation dean of Peninsula Dental School, Plymouth University, and professor and consultant in dental public health

‘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, poor oral health can have a significantly negative effect, jeopardising 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 assist adults in care homes to have a comfortable, pain-free mouth.

‘Awareness of oral health needs to be raised within care homes. We want to see more staff being 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. We need to think about how we would like ourselves and our relatives to be looked after.’

 

Find out more

NICE guidance, Oral health for adults in care homes (July 2016): nice.org.uk/guidance/ng48

Oral health assessment tool: www.nice.org.uk/guidance/ng48/resources/oral-health-assessment-tool-2543183533

Public Health England, What is known about the oral health of older people in England and Wales (2015): www.gov.uk/government/uploads/system/uploads/attachment_data/file/489756/What_is_known_about_the_oral_health_of_older_people.pdf

NHS Health Scotland, Caring for Smiles Guide for Care Homes Better Oral Care for Dependent Older People (2013): www.nes.scot.nhs.uk/media/2603965/caring_for_smiles_guide_for_care_homes.pdf

British Society of Gerodontology: www.gerodontology.com

RCNi articles:

Essential guide to promoting older people’s oral health (2011): http://journals.rcni.com/userimages/ContentEditor/1373368451935/Promoting-older-peoples-oral-health.pdf

Guide to providing mouth care for older people (2011): doi.org/10.7748/nop2011.12.23.10.14.c8837

This article is for subscribers only

Jobs