Smiling matters; oral care in care homes

Healthwatch Brighton and Hove carried out a review of oral health care in care homes during 2019, speaking with 111 residents and 75 care staff across 20 care and nursing homes. The project was undertaken in response to concerns about dental service provision and to contribute to the national Care Quality Commission review of oral health in care homes. Overall, the findings showed that many residents managed their own oral hygiene, but support and monitoring by care staff was inconsistent and did not always meet recommended standards. 

The review identified gaps in daily oral care and assessment processes. While most residents cleaned their own teeth or dentures, many reported that staff did not regularly check their oral health, ask about any problems, or encourage routine dental check-ups. Care staff generally reported higher levels of involvement than residents described, suggesting variation in practice between homes. Healthwatch also found that only a minority of residents appeared to have received a full oral health assessment when they moved into a care home, despite this being recommended practice. 

Access to dental services was another significant issue. More than half of the care homes visited did not have access to a dentist who would visit residents in the home, despite many residents having mobility problems, dementia or other health conditions that made travelling difficult. Some residents had not seen a dentist for several years. Cost, transport, mobility limitations and difficulty arranging appointments were frequently cited barriers. Staff also highlighted challenges supporting residents who refused oral care or dental appointments, particularly those living with dementia. 

Healthwatch concluded that oral health care in care homes could be strengthened through more consistent daily checks, greater use of oral health assessments, improved staff training and stronger awareness of oral health policies. Recommendations included ensuring all residents receive an oral health assessment on admission, improving access to domiciliary dental services, maintaining records of oral care and dental appointments, increasing specialist training for care home staff, and ensuring residents and families are fully informed about oral health procedures and support available within the home.