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Smiling Matters: Oral Care in Care Homes

Charlotte Waite, British Dental Association, Chair England Community Dental Services Committee

Community dentists treat some of the most vulnerable patients in our society. I regularly see care homes residents, so I was keen to reflect on the recently published report “Smiling Matters: Oral Care in Care Homes” from the Care Quality Commission (CQC).

It shines a light on the lack of access to dentists, as well as a lack of support being given to care home staff in England on how to deliver oral care.

There are residents receiving excellent mouth care, but unfortunately evidence suggests these cases are still the exception rather than the rule.

The report shows a worrying lack of emphasis on oral health. 

Around half of the homes surveyed did not provide training to their staff on oral health care, while nearly three-quarters of individual care plans did not cover oral health sufficiently. One in six care homes also said they did not assess residents’ oral health on admission. One in three said they could not always access dental care.

The report makes key recommendations:

  • People who use these services, their families and carers need to be made more aware of the importance of oral care
  • Care home services need to make awareness and implementation of the NICE guideline ‘Oral health for adults in care homes
  • Care home staff need better training in oral care
  • The dental profession needs improved guidance on how to treat people in care homes
  • Dental provision and commissioning needs to improve to meet the needs of people in care homes 
  • NICE guideline NG48 needs to be used more in regulatory and commissioning assessments

Poor oral health impacts on quality of life and overall health for residents. After admission oral health can deteriorate rapidly, leading to pain and infection, leaving patients unable to eat and drink comfortably.

We see pain and discomfort which can leave them unable communicate to their carers, effectively suffering in silence. Conditions that are directly contributing to respiratory infections which have a high mortality risk and can often lead to hospital admission. And fundamentally this is about maintaining dignity, about being able to socialise, communicate and eat comfortably.

 Oral health care can no longer be left at the bottom of the pile.

The report states that: “Positive change across England can only happen by different parts of the health and care system coming together to improve oral health care to enhance the quality of life of people in care homes.”

 We must work together to ensure that mouth care is implemented appropriately and consistently and ensure that carers are appropriately trained and supported to deliver mouth care. 

We’ve called for nothing less than a revolution in the approach to dentistry and oral care in care.

We will continue to lead calls for better commissioning for vulnerable people, to ensure guidance is followed and staff are adequately trained and supported.

We must ensure access to dental services for all people, in the right place, at the right time, covering mainstream, domiciliary and urgent dental care. Inequalities must not be allowed to persist. With an improvement in oral health care will come an improvement in quality of life.

Change will only come about with a truly collaborative approach cutting across health and social care systems. We will need partnership working which will include; dental providers, care home providers, CQC, Healthwatch, Public Health England, Health Education England and NHS England. We all have a role to play.

The NHS constitution, sets out “NHS Values” including: “Everyone counts. We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind.” Now is the time for these values to become a reality for residents, many of whom are having their general health put at significant risk, as a consequence of poor oral health.

Let’s work together and start that revolution.









Edel Harris





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