It is estimated that among 440,000 people live in care homes in the UK, the majority of whom are over the age of 65. In addition the Alzheimer’s Society has also estimated that around 80% of residents have dementia or severe memory problems. Poor oral health can affect people’s ability to eat, speak and socialize and while older adults tend to have fewer natural teeth improvements in oral health in recent decades mean that increasing numbers have their own teeth. Consequently preventing oral diseases in this group of patients is important.

The guideline is aimed at health and well-being boards, clinical commissioning groups and health and social care professionals, commissioners and managers working within the NHS, local authorities and the wider public, private, voluntary and community sectors. It is particularly aimed at people who:

• manage care homes
• provide care in care homes (for example, care home staff and 
nurses employed by the home)
• provide services to care homes (for example, salaried dental 
teams, general dental practice teams, GPs and social services)
• monitor how care is provided in care homes (for example, local 
authorities and the Care Quality Commission)
• commission oral health programmes and dental services. 
It will also be of interest to people who live in care homes and their families or friends and other members of the public.

Methods

This guideline was developed using the standard NICE approaches and based on 3 evidence reviews conducted by an independent team. The review addressed 3 questions:-

1. What approaches, activities or interventions are effective in promoting and protecting oral health and ensuring access to dental care (including regular check-ups) for adults in care homes?
2. What methods and sources of information will help care home managers and their staff identify and meet the range of oral health needs and problems experienced by people living in care homes?
3. What helps and hinders approaches to promote and protect oral health and access to dental check-ups and treatment in care homes?

In addition an economic report on the cost consequences of two scenarios: –

1. An education session of 1 hours duration is provided to nursing home staff in year one with a refresher session in year two of 1 hours duration.
2. An education session of 4 hours duration is provided to nursing home staff in year one with a refresher session in year two of 2 hours duration.

Recommendations

Recommendations were made in relation to the following areas: –

• care home policies on oral health and providing residents with support to access dental services
• oral health assessment and mouth care plans
• daily mouth care
• care staff knowledge and skills
• availability of local oral health services
• oral health promotion services
• general dental practices and community dental services

To support the implementation of the guidance two tools are provided a baseline assessment and oral health assessment tool.

Comments

This guidance document from NICE calling for oral health and access to dental treatments to be given the same priority as general health for all adults in care homes is very welcome. As they note oral health care provision and support in care homes is very patchy with some examples of very good practice but an area that is often neglected.

Key recommendations focus on improving and maintaining residents’ day-to-day oral healthcare, ensuring staff are properly trained to confidently look after the oral health needs of residents, and there is adequate access to dental services when needed.   The economic report highlights the cost involved in training care staff and this is an on-going challenge. In Scotland where the ‘Caring for Smiles Programme’ has been running for a number of years the high turn over of care staff presents a continuing issue in terms of staff training and despite good support from the care sector this is likely to remain a key issue in introducing these recommendations.

Links

Primary paper

NICE- Oral Health Care for adults in care homes

Other references

Developing Better Oral Health

NICE Guidance development process

NHS Scotland – Caring for Smiles