Oral Health for Carers: Managers Resources
Oral Public Health Specialist
North Somerset Council
Public Health, Post Point 11, Castlewood, Tickenham Road, Clevedon, BS21 6FW
General health and wellbeing can be enhanced by maintaining good oral health throughout life, including for adults living in care homes. In the Smiling Matters report, the Care Quality Commission (CGC) found that residents are not always supported to maintain and improve their oral health. They go on to suggest improvements to oral health care and recommend that carers implement the NICE (National Institute for Health and Care Excellence) guidance “Oral health for adults in care homes”, known as NG48.
Oral Health Care can be achieved for all cared-for vulnerable adults, through staff training, oral health assessments, care plans, daily hygiene and supporting access to dentists. More information and tools to support your practice can be found on this page.
Oral Health Policy
Enhanced Care for Care Homes 4.6.4.b states: “Care homes should have an oral health policy in place with one staff member taking responsibility for this policy within the home. This should be clearly aligned to NICE guidance 48 Oral Health for adults in care homes.”
It is important to have an oral health policy which sets out actions to ensure the protection of your client’s oral health. The Care Quality Commission will
On this page are two template Oral Health Policies, for you to download and use. However, if you already have one, wish to make your own, or if you make adaptations to these templates, please follow the Quality Assurance Checklist also available here.
It is expected that your policy includes how you provide people with access to routine, specialist and preventative dental care or treatment. If you are a manager concerned about the availability of dental services, please inform North Somerset Healthwatch.
NHS 111 can be utilised when required. They provide a useful guide online for accessing dental care in an emergency.
Oral Health Assessments
NG48 advices that vulnerable adults should have an oral health assessment as part of their general needs assessment, with the result recorded in their care plan. (1.2.1)
Using an assessment tool, speak with every new client about their oral health needs.
This assessment will highlight any areas where clients need specific care and support. Repeat the process for reviews to uncover any changes that may need action as per NG48 1.3.3. These assessments and reviews will form the input for individualised care plans.
Make an appointment for the resident to see a dental practitioner, if necessary. This could be to get dentures made or repaired, to get a problem seen to, or for a check up. If the resident is registered with a dentist, consider what arrangements need to be made for them to continue to attend that clinic. If it isn’t possible to continue there, an alternative registration with associated arrangements will need to be made sensitively.
Record the results of the assessment and the appointments that have been made, in the personal care plan.
Personal Oral Care Plans
The Oral Care Plan should be kept with the resident’s records and be updated daily.
The plan should be reviewed every three months, or sooner if changes are noted.
An individual’s personal care plan should lay out:
- their choice and use of products, (both prescribed and over-the-counter)
- support required to maintain clean teeth and dentures
- who their dentist is and when their next appointment is due
- arrangements for accessing dental care
NG48 1.3.1 states that staff should: “Provide residents with daily support to meet mouth care needs and preferences, as set out in personal care plans after assessment.”
As per the individual’s preferences and support needs, carers should be aware of how to facilitate twice daily brushing of natural teeth with a fluoride toothpaste, and daily denture care. These are laid out in this page, but staff should be trained for this.
On a day to day basis it is important that staff know:
- who they can ask for advice about getting prescribed mouth care products, or helping someone to use them
- how to recognise and respond to changes in a resident’s mouth care needs
- how to respond if a resident does not want daily mouth care or to have their dentures removed
Enhanced Health for Care Homes 4.6.4.d states: “Staff employed by care home providers should undertake training in oral healthcare to support delivery of oral health assessments and daily mouthcare for individuals and maintain this knowledge and skill through ongoing professional development.” (Enhanced Health for Care Homes 4.6.4.d)
The Care Quality Commission ask: if oral health care is covered in induction, if it is a mandatory component of regular training and if all staff have received the training; if staff feel confident to support oral health care and know how to identify deterioration in oral health or recognise signs of oral distress (such as behaviour change, tissue viability, weight loss etc)
Nice Guidance 48 recommends that staff:
- Understand: the importance of oral health and its effect on wellbeing, the impact of dental pain on people who cannot ask for help and the importance of denture marking
- Know how and when to: reassess oral health, deliver daily mouth care, and report any oral health concerns
- Know: who they can ask for advice around prescribed oral health products, how to recognise and respond to changes in mouth care needs, and how to respond if someone refuses mouth care
If you’d like your team to receive oral health face-to-face or virtual training, please contact us from this page. Otherwise, Health Education England have developed e-learning Mouth Care Matters modules which can be accessed via this link. Mouth Care Matters aims to train staff in mouth care to ensure it is delivered in a safe and compassionate way. It was originally developed for hospital staff but is suitable for staff working in care.