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DC117-Oral Care Policy

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Registration Number: {{org_field_registration_no}}

Oral Care Policy

1. Purpose

The purpose of this policy is to ensure that people receiving domiciliary care from {{org_field_name}} are supported, where this forms part of their assessed care and support needs, to maintain good oral health, comfort, dignity, nutrition, hydration and overall wellbeing. Oral care includes support with natural teeth, dentures, gums, tongue, lips, mouth comfort, oral pain, dry mouth and access to dental advice or treatment. Poor oral health may contribute to pain, infection, reduced food and fluid intake, difficulty speaking, social withdrawal, avoidable deterioration and reduced quality of life.

This policy sets out how {{org_field_name}} assesses, plans, delivers, records, reviews and escalates oral care needs in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, CQC Fundamental Standards, the Mental Capacity Act 2005, equality and human rights principles, infection prevention and control expectations, and relevant NICE oral health best-practice guidance adapted for domiciliary care.

2. Scope

This policy applies to all care workers, managers, and stakeholders involved in the provision of domiciliary care on behalf of {{org_field_name}}. It covers:

This policy applies where oral care support is part of the person’s assessed needs, commissioned care package, care plan, risk assessment or agreed daily support. Care workers do not diagnose dental disease or provide dental treatment. Their role is to support agreed daily oral care, observe and report concerns, promote access to dental services, follow the person’s consent and preferences, and escalate risks or emergencies promptly.

3. Legal and Regulatory Framework

This policy must be read and applied in line with the following legislation, regulations and guidance, as amended:

3.1 CQC Quality Statements Relevant to Oral Care

Oral care practice will be monitored as part of {{org_field_name}}’s wider quality assurance arrangements and may provide evidence under CQC’s assessment framework, including quality statements relating to person-centred care, dignity, consent, safe systems and pathways, safeguarding, nutrition and hydration, staff competence, learning and improvement, governance, and equity in access and experience. Staff must be able to explain how oral care support is personalised, consent-based, recorded, reviewed and escalated when concerns arise.

4. Oral Health Assessments and Care Planning

When a person starts receiving care, and where oral care is relevant to the care package, {{org_field_name}} will assess the person’s oral care needs as part of the initial assessment and care planning process. The assessment must be proportionate to the person’s needs and must consider:

The outcome of the assessment must be recorded in the person’s care plan. The care plan must specify exactly what support is required, how often it is required, what the person can do independently, what staff must assist with, products or equipment to be used, consent and communication needs, signs of deterioration to monitor, and the escalation route if concerns arise.

Oral care needs must be reviewed at least annually, whenever the care plan is reviewed, and sooner if there is a change in oral health, general health, medication, nutrition, hydration, cognition, communication, manual dexterity, dentures, dental treatment, pain, infection, swallowing ability, or the person’s willingness or ability to receive oral care.

4.1 Consent, Refusal and Mental Capacity

Oral care support must only be provided with the person’s consent or other lawful authority. Staff must explain what support they are offering in a way the person can understand, allow time for the person to decide, and respect the person’s right to refuse oral care if they have capacity to make that decision.

If a person refuses oral care, staff must not force care. Staff should offer reassurance, explore whether the refusal is linked to pain, fear, embarrassment, trauma, communication needs, timing, product preference, sensory sensitivity, cultural needs or lack of understanding, and try again later where appropriate. Refusals, the reason if known, actions taken and any risks must be recorded.

If there is reason to believe the person may lack capacity to make a specific decision about oral care, the Mental Capacity Act 2005 must be followed. A decision-specific capacity assessment must be completed or escalated to the appropriate person. Any best-interest decision must be the least restrictive option, involve relevant people where appropriate, consider the person’s past and present wishes, and be clearly documented. Where there is significant resistance, distress, safeguarding concern, or potential deprivation of liberty, the registered manager must seek appropriate professional advice.

5. Daily Oral Hygiene Practices

Good oral hygiene is essential for overall health, well-being, and quality of life. Poor oral care can lead to gum disease, tooth decay, pain, difficulty eating, infections, and even contribute to systemic health conditions such as heart disease and pneumonia. In domiciliary care, maintaining a consistent and thorough oral hygiene routine is crucial, particularly for service users who may have physical, cognitive, or medical conditions that impair their ability to manage oral care independently.

To ensure service users maintain good oral health, domiciliary care workers provide support, encouragement, and direct assistance as required, in accordance with individual care plans.

5.1. Brushing Teeth Twice Daily with Fluoride Toothpaste

5.2. Cleaning and Storing Dentures Hygienically

5.3 Mouthwash, Oral Swabs and Prescribed Oral Products

Mouthwash, oral gels, artificial saliva products, oral swabs or prescribed oral products must only be used where this is included in the care plan, recommended by a dentist, GP, pharmacist or other appropriate professional, or requested by a person who has capacity and can use the product safely.

Chlorhexidine or other medicated mouthwash must be used only as directed, including any instructions about timing, dilution, duration of use, interactions with toothpaste, and whether the person must rinse, spit or avoid swallowing. Staff must record support given with prescribed or recommended oral products in line with the medication policy where applicable.

Staff must not use oral swabs as a substitute for toothbrushing unless brushing is not possible or professional advice has been given. If the person has swallowing difficulties, choking risk, reduced consciousness or palliative care needs, staff must follow the care plan and seek professional advice where required.

5.4. Monitoring Oral Discomfort, Sores, or Unusual Symptoms

5.5. Encouraging Hydration to Prevent Dry Mouth

5.6. Personalised Oral Care Plans

Reasonable adjustments must be made where a person has disability, sensory needs, communication needs, dementia, learning disability, autism, mental health needs, trauma history or cultural preferences that affect oral care. Adjustments may include easy-read information, pictures, demonstration, hand-over-hand prompting where appropriate and consented to, using the person’s preferred products, changing the time of care, involving a trusted person, using adaptive toothbrushes, allowing additional time, or seeking specialist advice.

6. Preventative Measures to Reduce Oral Health Risks

Preventative oral care is a key focus to avoid dental complications that could impact overall health, nutrition, and well-being. {{org_field_name}} implements a range of strategies to support service users in maintaining their oral health and preventing long-term issues.

6.1. Dietary Guidance to Reduce Tooth Decay

6.2. Regular Oral Health Monitoring

6.3 Access to Dental Care and Referral Pathways

{{org_field_name}} will support people to access routine and urgent dental care where this forms part of their care plan or where a concern is identified during care. Staff must establish, where possible, whether the person is registered with a dentist and record this in the care plan.

Where routine dental care is needed, staff should support the person, family, representative or advocate, as appropriate, to arrange an appointment with an NHS or private dentist. Where the person cannot access a dental practice because of mobility, disability, complex health needs or severe anxiety, staff must escalate to the office so that community dental services, domiciliary dental services, GP, NHS 111 or local dental access routes can be explored.

Where urgent dental symptoms are present, including severe pain, swelling, bleeding, trauma, infection or inability to eat or drink, staff must seek same-day advice through the person’s dentist, NHS 111, urgent dental care services, GP, or emergency services depending on severity.

Staff must record dental concerns, advice sought, appointments arranged, outcomes, any refusal of support, and any changes required to the care plan.

6.4. Smoking Cessation Support

6.5. Medication Review and Oral Health Management

6.6 Infection Prevention and Control in Oral Care

Staff must follow {{org_field_name}} infection prevention and control procedures when supporting oral care. This includes hand hygiene before and after care, use of appropriate personal protective equipment where required, safe handling and cleaning of toothbrushes, denture pots and oral care equipment, safe disposal of contaminated waste, and avoiding cross-contamination between people or between clean and used items.

Toothbrushes, denture pots and oral care equipment must be stored hygienically and separately. Staff must report equipment that is dirty, damaged, shared inappropriately, missing or unsafe. Where there is suspected oral infection, bleeding, thrush, ulcers or other infection risk, staff must follow standard precautions and escalate concerns for professional advice.

7. Supporting Service Users with Specific Oral Health Conditions

Some people may have additional oral care needs because of health conditions, disability, communication needs, medication, frailty or reduced ability to carry out personal care. Care plans must describe the person’s individual support needs rather than relying only on a diagnosis.

For people living with dementia or cognitive impairment, staff should use calm communication, familiar routines, visual prompts, step-by-step guidance, and reassurance. Staff must monitor for pain-related behaviours, refusal due to distress, and changes in eating, drinking or communication.

For people with learning disability or autism, staff must make reasonable adjustments and use communication methods that work for the person. Staff must consider sensory sensitivities, routine, preferred products, distress triggers, and involvement of people who know the person well where appropriate.

For people with Parkinson’s disease, arthritis, stroke, frailty or reduced manual dexterity, staff should consider adaptive toothbrushes, electric toothbrushes, enlarged handles, prompts, positioning support and referral to an appropriate professional if the person’s ability to manage oral care changes.

For people with diabetes, staff must be alert to increased risk of gum disease, infection, dry mouth and delayed healing, and must report concerns promptly.

For people receiving palliative or end-of-life care, oral care must focus on comfort, dignity, relief of dryness, pain, unpleasant taste, cracked lips, coating, secretions and distress. Staff must follow the care plan and professional advice, and must avoid causing unnecessary discomfort.

8. Managing Dental Concerns, Urgent Symptoms and Emergencies

If a person reports or shows signs of dental or mouth pain, bleeding, swelling, trauma, broken teeth, lost or broken dentures, oral infection, ulcers, difficulty eating or drinking, or sudden deterioration in oral health, staff must:

Staff must call 999 or seek emergency medical help immediately if there is facial, neck or eye swelling, difficulty breathing, difficulty swallowing, suspected sepsis, uncontrolled bleeding, serious injury, collapse, or any other immediate risk to life, health or wellbeing.

Staff must not attempt dental treatment, drain abscesses, reinsert knocked-out teeth, adjust dentures using tools, or give non-prescribed medication. Pain relief may only be supported in line with the person’s medication care plan and the medication policy.

Where an oral care incident results in harm, risk of harm, safeguarding concern, complaint, or significant distress, the registered manager must ensure appropriate reporting, investigation, safeguarding referral, duty of candour consideration and care plan review.

9. Staff Training and Responsibilities

{{org_field_name}} will ensure that staff providing or supervising oral care are competent to do so. Oral care training will be included in induction where relevant to the role and refreshed at intervals determined by supervision, competency checks, audit findings, incidents, complaints, changes in guidance or identified learning needs.

Training and competency checks must cover:

In line with the Health and Care Act 2022 requirements, all relevant staff must receive learning disability and autism training appropriate to their role. {{org_field_name}} will use the Oliver McGowan Mandatory Training on Learning Disability and Autism, or training that meets the statutory code and CQC expectations, as applicable to the role.

The registered manager is responsible for ensuring that staff are trained, assessed as competent, supervised, and supported to raise concerns about oral care. Staff must not provide oral care support beyond their competence and must seek advice if unsure.

9.1 Role-Specific Responsibilities

Care workers are responsible for following the care plan, gaining consent before oral care support, maintaining dignity and privacy, using agreed products and equipment safely, recording care provided, reporting concerns promptly, and escalating refusals, pain, deterioration or emergencies.

Care coordinators and supervisors are responsible for ensuring oral care needs are reflected in care plans and visit instructions, reviewing records and alerts, responding to staff concerns, updating risk assessments, and checking staff competence during spot checks and supervision.

The registered manager is responsible for ensuring this policy is implemented, staff are trained and competent, audits are completed, concerns are investigated, safeguarding and duty of candour requirements are considered, and learning is embedded into practice.

10. Documentation, Records and Compliance

Oral care records must be accurate, complete, contemporaneous and proportionate to the person’s assessed needs. Where oral care support is part of the care plan, records must show:

Records must be handled in line with confidentiality, UK GDPR and Data Protection Act 2018 requirements. Oral health information must only be shared where there is a lawful basis, including with dentists, GPs, community health professionals, commissioners, safeguarding bodies, family members, representatives or advocates where appropriate and lawful.

{{org_field_name}} will monitor compliance through care plan audits, daily record audits, incident and complaint reviews, spot checks, supervision, competency checks, service user feedback and analysis of themes. Audit findings must be used to improve practice, update care plans, provide additional training and reduce risk.

10.1 Safeguarding Concerns Related to Oral Care

Poor oral health may indicate self-neglect, neglect, acts of omission, poor access to care, poor nutrition or hydration, financial abuse, domestic abuse, medication issues, or unmet care needs. Staff must report safeguarding concerns immediately in line with {{org_field_name}}’s Safeguarding Adults Policy.

Safeguarding concerns may include repeated failure to provide agreed oral care, unexplained injuries to the mouth, untreated pain or infection, refusal by others to allow access to dental care, coercion, discriminatory treatment, avoidable deterioration, or a person being unable to eat or drink because oral care needs are not being met.

The registered manager must consider whether a safeguarding referral is required, whether the local authority, commissioner, GP, dentist or other professionals need to be informed, and whether the care plan, risk assessment or staffing arrangements need urgent review.

10.2 Complaints, Incidents and Duty of Candour

Any complaint or concern about oral care must be recorded, acknowledged, investigated and responded to in line with {{org_field_name}}’s Complaints Policy. Learning from complaints must be shared with staff and used to improve care.

Any oral care incident resulting in harm, avoidable deterioration, missed care, significant distress, safeguarding concern or emergency escalation must be reported through {{org_field_name}}’s incident reporting process. The registered manager must review whether the incident meets statutory notification, safeguarding or duty of candour thresholds.

Where duty of candour applies, {{org_field_name}} must act in an open and transparent way, inform the relevant person, provide a truthful account of what is known, apologise where appropriate, explain actions being taken, and keep a clear written record.

11. Monitoring and Continuous Improvement

{{org_field_name}} will monitor oral care practice through a planned quality assurance process. This may include:

Findings from audits and reviews will be reported to the registered manager and used to update care plans, risk assessments, staff training, supervision, policies and service improvement plans.

12. Policy Review and Updates

This policy will be reviewed at least annually, or sooner if there are changes in legislation, CQC guidance, NICE guidance, local safeguarding procedures, dental access pathways, infection prevention and control guidance, organisational learning, incidents, complaints or audit findings. The registered manager is responsible for ensuring that staff are informed of changes and that any required training, competency checks or care plan updates are completed.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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