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Oral Health in Care Homes

Is it not time care home providers paid more attention to the oral health of service users?

The Care Quality Commission (CQC) recently published the findings of an in-depth review on the state of oral health care in care homes across England.

The review draws on one hundred inspections of care homes on 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 of the review

  1. The majority (52%) of care homes visited had no policy to promote and protect people’s oral health.

  2. Nearly half (47%) of care homes were not providing any staff training to support people’s daily oral healthcare.

  3. 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.

  4. 17% of care homes said they did not assess people’s oral health on admission.

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 – 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 us 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.

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 they are ashamed of their poor oral hygiene but unable to address it themselves. No one should have to live like that.

“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.

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.


CQC inspectors and Dental professionals recommend:

  1. sharing best practice

  2. repeating and reinforcing the guidance

  3. mandatory staff training

  4. oral health check-ups for all residents moving into a care home

  5. a multi-agency group to raise awareness

Practical approaches to improvement in services user’s oral health

Bettal Quality Consultancy has always recognised the importance of service user’s oral health. Readers of my blog will know that I wrote on this subject in January of 2017 on “The importance of supporting service users with their oral hygiene” and then in April this year “Oral health in care homes”.

The Bettal Cared 4 System includes a policy on oral health and in addition:

  1. Assessment of oral health on admission.

  2. Detailed in the services users the person centred care plan.

  3. Recorded appointments with dentist.


This review was a long time coming, but the focus on oral health will encourage those providers who do not have a policy on the subject to pay more attention to it. I have no doubt oral health will form part of CQC inspections in the future.

The importance of service user’s oral health is one of those services that has been neglected. But support for providers is available as part of Bettal Cared 4 Quality Management System. Is it not time that some providers recognised that attention to oral heath can have a significant impact on a service users’ quality of life.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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