CQC tells care home managers to improve dental health care for residents

The CQC have told care homes they need to make sure residents are receiving proper oral health care after a report has revealed half of all care home staff have not received the required training on it.

In the CQC report entitled ‘Smiling matters: oral health care in care homes’ figures show 39 per cent of care home managers spoken to by the CQC did not know about the NICE guideline on dental care in care homes and only 28 per cent had actually read it.

The report also revealed a variety of challenges to older people getting proper dental treatment including local dentists not accepting new patients and the length of time it took to get an appointment with an NHS dentist – this included procedures for getting dentures fitted.

‘Oral health cannot be treated as an afterthought’

Despite poor oral health care potentially leading to further health complications, including dangerous ones such as aspiration pneumonia which can result in death, the report revealed the majority of care homes spoken to (52 per cent), had no policy to promote and protect people’s oral health.

Nearly half of care homes (47 per cent), weren’t providing any staff training to support people’s daily oral healthcare.

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.”

It was revealed nearly a third of all care homes visited by the care watchdog had no access or limited access to out-of-hours dental services.

The NICE guideline (NG48) to maintain and improve the dental health and daily mouth care of adults in care homes, was introduced in July 2016.

Oral health training isn’t a mandatory requirement within the NICE guideline but it does recommend care home managers ensure care staff know how and when to deliver daily mouth care, report any oral health concerns, and respond to a person’s changing needs and circumstances.

Unfortunately, only 28 per cent of care home managers questioned by the CQC had heard of the NICE guidance and read it. Another 33 per cent had heard of it, but not read it.

Care home staff ‘often find oral care procedures unpleasant’

In the report, two-thirds of care homes that were visited by the CQC (67 per cent), said people who used their services could always, or nearly always, access NHS dental care.

However, the report did show there was a lack of dentists willing or able to visit care homes. Of the homes visited, 10 per cent reported they had no way of accessing emergency dental treatment for people - 34 per cent of homes said they have no or limited access to out-of-hours services.

Some care home managers complained that they’d had to call GPs, NHS 111, or even take the person requiring emergency care to A&E.

Ms Terroni said: “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.”

Jane Peterson is a dental hygienist who works within a care home environment. A primary part of her job is to warn care staff of the "potentially life-threatening conditions that poor oral health can pose on the elderly".

She said: “Most of the care staff I interviewed admitted that they find oral care procedures unpleasant and no one had received training in oral care.

“A few staff were aware of the link between poor oral health and its effects on the body but no one was aware of the potentially life-threatening conditions that poor oral health can pose on the elderly, particularly aspiration pneumonia, which is when bacteria from the mouth get inhaled to cause an infection in the lungs.”

‘Mouth pain can have a huge impact on people with dementia’

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.”

Sally Copley is the director of policy and campaigns at the Alzheimer’s Society which developed a Dementia Friendly Dentistry Guide to address oral health in dementia. She believes it is ‘vital’ that oral health care issues are properly dealt with in care homes.

She said: “Mouth pain can have a huge impact on people with dementia and can lead people to stop eating completely. Looking after a person with dementia’s oral health is vital, especially in the advanced stages when they might have trouble communicating if something is wrong, or if they are in pain, and where they may have other symptoms that affect their ability to eat or drink.

"Following on from our work with the Faculty of General Dental Practice and CQC in developing a Dementia-Friendly Dentistry Guide, it’s great to see the CQC shining a light on poor practice in care homes to drive up standards. From the report, it’s shocking that nearly half of care home staff haven’t had any training in oral healthcare, and that people affected by dementia are struggling to access dental care they are entitled to."

Ms Copley urged health chiefs to cover oral health hygiene in training, and for it to have its own mandatory component in the Care Certificate.

She said: “We urge Skills for Care, Health Education England and Skills for Health to take up the recommendation to introduce a mandatory oral health component in the Care Certificate – it would have a huge impact on so many people with dementia across the country, who may be suffering silently, and unnecessarily, from mouth pain."