Smiling Matters - Oral Health in Care Homes by CQC

The Care Quality Commission (CQC) has published the findings of an in-depth review on the state of oral health in care homes across England.
Dentist looking at a dental x-ray

The review draws on 100 inspections of care homes during which CQC inspectors were accompanied by inspectors from dental regulation. It reveals that three years on from the publication of NICE guidance on oral health in care homes, steps are often not being taken to ensure that people get the oral health care they need to ensure that they are pain-free and that their dignity is respected.

Key findings:

  • The majority (52%) of care homes visited had no policy to promote and protect people’s oral health.
  • Nearly half (47%) of care homes were not providing any staff training to support people’s daily oral healthcare.
  • 73% of residents’ care plans 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.
By working in partnership, we can make a positive impact on the quality of life of people living in care homes.
— Kate Terroni, Chief Inspector for Adult Social Care at the Care Quality Commission (CQC)

Whilst two-thirds (67%) of the care homes that CQC visited said people who used their services could always, or nearly always, access NHS dental care, the report did reveal 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.

Of the homes visited, 10% reported they had no way of accessing emergency dental treatment. 34% of homes told 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.

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 Care Quality Commission (CQC) said,

Oral health has a huge impact on our quality of life and we need professionals across a number of sectors to make changes to ensure it is given the priority it needs in care home settings.

Oral health cannot be treated as an afterthought. It can make the difference between someone who is free from pain, enjoys eating and is able to confidently express themselves through talking and smiling – and someone who is in pain, unable to enjoy their food and who covers their mouth with their hand when they smile because of their poor oral hygiene but unable to address it themselves.

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, supporting 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.

Charlotte Waite, Chair of the BDA's England Community Dental Services Committee said,

This welcome report shines a light on 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.

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