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DCW117-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 all individuals receiving care from {{org_field_name}} are provided with appropriate oral health support. Oral health is a key factor in overall well-being, contributing to comfort, self-esteem, communication, and nutrition. Poor oral health can lead to pain, difficulty eating, infections, and a diminished quality of life.

This policy is designed to outline best practices for assisting individuals with their oral hygiene while respecting their dignity and personal preferences. It also ensures that all staff are trained and competent in providing oral care, understanding the risks associated with poor oral hygiene, and recognising when professional dental intervention is required. This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, including the Regulated Services (Service Providers and Responsible Individuals) (Wales) (Amendment) Regulations 2024, and the Welsh Government statutory guidance for service providers and responsible individuals for care home and domiciliary support services, Version 3, March 2024. It also supports Care Inspectorate Wales inspection expectations, including the inspection themes of well-being, care and support, environment, and leadership and management, and the requirement that care and support is delivered in accordance with the individual’s personal plan, communication needs, language needs, dignity, safety and well-being.

2. Scope

This policy applies to all care staff employed by {{org_field_name}}, including care workers, support staff, and the management team. It also extends to all individuals receiving domiciliary support services, regardless of their level of need, ensuring that each person’s oral health is appropriately managed.

Where oral care forms part of an individual’s assessed care and support needs, it must be recorded in the individual’s personal plan and delivered in accordance with that plan. The policy also applies when oral care support is identified through a local authority care and support plan, provider assessment, health assessment, risk assessment, service agreement, or any reasonable request made by the individual or their representative, where this falls within the service’s statement of purpose and agreed domiciliary support arrangements.

The Registered Manager and Responsible Individual are responsible for overseeing the implementation and adherence to this policy. It also applies to external professionals, such as dentists and healthcare workers, who collaborate with {{org_field_name}} to provide specialist oral care support when needed.

3. Policy Statement

At {{org_field_name}}, we are committed to ensuring that service users receive high-quality oral care as part of their overall health and personal care plan. We acknowledge that oral health plays a crucial role in maintaining self-esteem, preventing infections, and supporting good nutrition.

We strive to deliver oral care in a compassionate, respectful, and professional manner, always upholding the individual’s rights, preferences, and choices. We will take a proactive approach to oral hygiene, incorporating it into daily personal care routines and responding swiftly to any concerns. We will work closely with healthcare professionals to address oral health issues and ensure access to routine and emergency dental care.

Oral care will be treated as part of the individual’s wider well-being, dignity, communication, nutrition, hydration, infection prevention and safeguarding arrangements. Staff must not regard oral care as optional where it is an assessed need in the personal plan. Where an individual declines oral care, staff must respond in a person-centred, respectful and legally appropriate way, record the refusal, consider whether there are communication, pain, mental capacity, sensory, trauma, cultural or timing factors affecting the refusal, and escalate concerns where repeated refusal may place the individual at risk of pain, infection, poor nutrition, dehydration or neglect.

4. Managing Oral Care Efficiently

4.1. Oral Health Assessment

Oral care needs will be considered before the service commences, as part of determining whether {{org_field_name}} can meet the individual’s care and support needs and support the individual to achieve their personal outcomes. This will include consideration of any local authority care and support plan, health assessment, dental information, risk assessment, communication needs, swallowing or nutrition concerns, cognitive impairment, manual dexterity, sensory needs, personal preferences, cultural or religious needs, and the individual’s views, wishes and feelings.

Where oral care support is required, this will be included in the individual’s initial personal plan before the service starts. In urgent circumstances, where there has not been time to prepare the personal plan before the service starts, the oral care arrangements must be recorded within 24 hours of commencement.

Within 7 days of the commencement of care and support, the provider assessment will consider how the individual’s oral care needs can best be met, how the individual can be supported to maintain independence and personal outcomes, and what risks need to be reduced. The outcome of this assessment will be used to update the individual’s personal plan.

The oral care assessment must include, where relevant: the individual’s usual mouth care routine; level of independence; toothbrush, toothpaste, denture and mouth care preferences; presence of natural teeth, dentures, implants or bridges; dry mouth; mouth ulcers; bleeding gums; oral pain; loose, broken or sharp teeth; ill-fitting dentures; swallowing difficulties; nutrition and hydration concerns; risk of choking or aspiration; diabetes or other health conditions affecting oral health; prescribed oral products; allergies or sensitivities; and whether support is required to access a dentist or community dental service.

Oral care needs must be reviewed whenever there is a change in the individual’s needs, oral health, diet, swallowing, behaviour, communication, medication, cognition, pain presentation or willingness to accept support. As a minimum, oral care needs must be reviewed as part of the individual’s personal plan review, which must take place at least every three months, and sooner where required.

4.2. Daily Oral Care Support

Service users who require assistance with oral hygiene will receive support in accordance with their personal plan. Unless otherwise advised by a dentist or healthcare professional, support will include brushing natural teeth at least twice daily with fluoride toothpaste, including last thing at night and at one other time during the day; cleaning the gums and tongue where appropriate; supporting the use of interdental aids where this is part of the individual’s routine or professional advice; supporting the use of prescribed mouth care products; and providing daily denture care, including brushing dentures, removing food debris and removing dentures overnight where this is safe, appropriate and agreed with the individual.

Staff will use a person-centred approach, encouraging service users to participate in their own oral hygiene as much as possible. If a service user is unable to perform oral care independently, staff will provide full assistance while ensuring that the individual is comfortable and respected throughout the process. If an individual refuses oral care, staff must not force care. Staff must respond calmly and respectfully, check whether the refusal may be due to pain, fear, communication difficulty, distress, poor timing, tiredness, sensory sensitivity, cultural preference, trauma history, lack of privacy, or not understanding the support being offered. Staff should offer reasonable alternatives, such as a different time, different staff member, adapted toothbrush, mirror, preferred toothpaste, mouth swab if clinically appropriate, or step-by-step prompting. The refusal, actions taken and outcome must be recorded in the daily care notes. Repeated refusal, signs of pain, infection, bleeding, poor nutrition, dehydration, weight loss, or concern that the individual may lack capacity to understand the risk must be escalated to the Registered Manager for review, involvement of representatives where appropriate, and referral to relevant health or dental professionals.

4.3. Consent, Mental Capacity and Best Interests

Oral care must be provided with the individual’s consent wherever the individual has capacity to make the relevant decision. Staff must explain what they are doing in a way the individual can understand, using the individual’s preferred language, communication method and any communication aids required.

Where there is reason to believe that an individual may lack capacity to make a specific decision about oral care or dental treatment, staff must escalate this to the Registered Manager. Any decision must be considered in accordance with the Mental Capacity Act 2005, including the principles of presuming capacity, supporting the individual to make the decision, recognising that an unwise decision does not necessarily mean lack of capacity, and ensuring that any act or decision made on behalf of the individual is in their best interests and is the least restrictive option.

Where a best interests decision is required, the Registered Manager must involve the individual as far as possible, consult with relevant representatives or attorneys where lawful and appropriate, and seek dental or healthcare advice where the risk to the individual’s health or well-being is significant. All decisions, rationale, advice received and actions taken must be recorded.

4.4. Use of Equipment and Hygiene Standards

All oral care tools, such as toothbrushes, dentures, floss, and mouthwash, must be kept clean and stored in a hygienic manner. Each service user’s toothbrush and oral hygiene products will be stored separately and replaced regularly to prevent bacterial contamination.

Where oral care support is included in the personal plan, staff must check that the individual has access to suitable oral healthcare supplies, such as toothbrush, fluoride toothpaste, denture brush, denture container, prescribed mouth care products, lip balm, interdental aids or other products identified in the personal plan. Where supplies are missing, unsuitable, damaged, contaminated or expired, staff must report this and support the individual or their representative to obtain replacements. Where the service is responsible for providing any supplies, the Registered Manager must ensure there are arrangements for monitoring stock, safe storage and contingency arrangements.

Dentures, including partial dentures, must be cleaned daily in line with the individual’s personal plan and any dental advice. Staff must handle dentures carefully to prevent loss or damage, clean them using appropriate products, remove food debris, and support overnight removal where this is safe, appropriate and agreed. Dentures must be stored hygienically in a clearly labelled container when not in use. Any lost, broken, painful or ill-fitting denture must be reported promptly to the Registered Manager and recorded, with support provided to access dental advice.

Staff must follow {{org_field_name}}’s Infection Prevention and Control Policy when supporting oral care. This includes hand hygiene before and after care, use of appropriate PPE such as gloves and aprons where required, safe disposal of PPE and waste, cleaning or safe storage of reusable oral care items, and prevention of cross-contamination between individuals. Staff must not use one individual’s oral care equipment for another individual. Any equipment that is visibly soiled, damaged, contaminated or unsafe must not be used and must be reported.

4.5. Identifying and Managing Oral Health Issues

Care staff must monitor oral health as part of day-to-day care where oral care support is included in the personal plan, and must record and report any concern. Concerns include, but are not limited to: toothache; facial swelling; bleeding gums; mouth ulcers lasting more than two weeks; oral infections; oral thrush; loose, broken, sharp or missing teeth; ill-fitting, lost or broken dentures; difficulty chewing; coughing or choking during mouth care; refusal of food or drink; unexplained weight loss; bad breath that is unusual for the individual; dry mouth; changes in speech; increased agitation during mouth care; facial grimacing; guarding the mouth; or any sign that the individual may be in pain but unable to express this verbally.

If a service user experiences oral discomfort or shows signs of a dental issue, staff will encourage them to seek dental treatment and will support them in arranging an appointment. In cases where an individual is unable to express discomfort verbally, staff will look for non-verbal signs of pain, such as facial grimacing, refusal to eat, or increased agitation.

If a service user persistently refuses oral care or experiences significant dental problems, the case will be referred to a healthcare professional for further assessment.

Urgent dental or medical advice must be sought where there is facial swelling, uncontrolled bleeding, suspected dental abscess, severe pain, trauma to the mouth or teeth, signs of systemic infection, difficulty breathing or swallowing, or any other concern that may require urgent treatment. If the concern may indicate neglect, self-neglect, abuse or avoidable deterioration due to unmet care needs, the Registered Manager must consider whether safeguarding procedures should be followed.

4.6. Access to Dental Services

Maintaining access to professional dental care is essential for ensuring good oral health. {{org_field_name}} will support service users in attending routine and emergency dental appointments by assisting with scheduling visits, arranging transportation, and providing emotional reassurance if required.

For individuals with mobility difficulties or complex health conditions, efforts will be made to arrange home visits from a dental professional whenever possible. {{org_field_name}} will work collaboratively with NHS and private dental services to ensure that service users receive timely and appropriate treatment.

Staff will support individuals, where this forms part of the agreed care and support, to access NHS dental services, private dental services, urgent dental care, community dental services or special care dentistry services as appropriate to the individual’s needs and local arrangements. Support may include helping the individual or their representative to identify the appropriate service, make or confirm appointments, prepare for appointments, communicate oral health concerns, and follow dental advice after treatment. Staff must not provide dental treatment or clinical advice beyond their role and competence.

4.7. Recording Dental Appointments and Professional Advice

Where staff support an individual to arrange or attend a dental appointment, or where dental advice is shared with the service, a record must be made in the individual’s care records. The record should include the date, reason for contact or appointment, professional or service contacted, advice or treatment provided, follow-up actions, changes required to daily oral care, and whether the personal plan requires updating.

Any dental advice that affects daily care, risk management, prescribed oral products, diet, swallowing, pain management, infection control or denture care must be communicated to relevant staff and incorporated into the personal plan as soon as practicable.

4.8. Oral Care for Individuals with Complex Needs

Some individuals may require additional or adapted support with oral care due to dementia, learning disability, autism, stroke, Parkinson’s disease, frailty, physical disability, sensory impairment, mental health needs, trauma history, dysphagia, end-of-life care, palliative care, tube feeding, reduced manual dexterity, pain, or heightened sensitivity. The individual’s personal plan must describe the support required, preferred approach, communication method, risks, equipment, timing of care, and any professional advice.

Staff must use a calm, respectful and person-centred approach. This may include step-by-step prompting, demonstration, hand-over-hand support where appropriate and consented to, use of mirrors, visual prompts, communication aids, adapted toothbrushes, electric toothbrushes, suction toothbrushes only where professionally advised and staff are trained, or support from a familiar staff member.

For individuals with dysphagia, choking risk or aspiration risk, staff must follow the individual’s personal plan and any advice from speech and language therapy, nursing, dental or medical professionals. Staff must not use oral care techniques or fluids that increase risk unless this has been assessed and agreed by an appropriate professional.

Individuals who are nil by mouth or tube-fed must still be supported with regular mouth care where this is part of their assessed need, because oral dryness, coating, infection and discomfort can still occur. Any specialist mouth care requirements must be recorded in the personal plan.

Where oral care is required during end-of-life care, staff must provide gentle support focused on comfort, dignity, moisture, pain recognition and the individual’s wishes. Any concerns about pain, infection, bleeding, dryness or distress must be escalated promptly to the appropriate healthcare professional.

4.9. Staff Training and Competency

All staff who provide or support oral care must receive training appropriate to their role. This will include oral hygiene principles, daily mouth care, denture care, infection prevention and control, dignity and consent, recognising oral pain and deterioration, supporting individuals with dementia or communication difficulties, responding to refusal of care, recording requirements, escalation routes, safeguarding concerns linked to neglect or self-neglect, and when to seek dental or healthcare advice.

Staff must only provide oral care support that is within their role, training and competence. Where an individual has complex oral care needs, dysphagia, suction requirements, specialist prescribed oral products, significant behavioural distress, or clinical risks, the Registered Manager must ensure that staff receive appropriate guidance, training or competency assessment before providing that support.

Oral care competency will be checked through induction, supervision, spot checks, care record audits, direct observation where appropriate, and review of incidents, complaints, refusals or concerns. Refresher training will be provided at least annually, and sooner where there are changes in legislation, guidance, individual needs, professional advice, incidents, complaints, safeguarding concerns or audit findings.

4.10. Welsh Language, Communication and Accessible Information

Oral care support must be provided in a way that meets the individual’s communication and language needs. Staff must use the individual’s preferred language and communication method wherever reasonably practicable, including Welsh where this is the individual’s language of need or choice.

Where an individual needs support to understand oral care, staff must use accessible communication, which may include plain language, visual prompts, objects of reference, gestures, communication aids, Makaton, British Sign Language, family or representative input where appropriate, or other methods recorded in the personal plan.

Staff must check that the individual understands what support is being offered and must allow time for the individual to respond. Any communication needs that affect oral care, consent, refusal, pain recognition, dental appointments or professional advice must be recorded in the personal plan.

4.11. Records, Monitoring and Quality Assurance

Oral care support must be recorded in accordance with {{org_field_name}}’s record keeping procedures. Records must be accurate, timely, factual and sufficient to evidence that care has been provided in accordance with the personal plan.

Staff must record oral care provided, any refusal or partial completion, any concerns observed, action taken, escalation to the Registered Manager, contact with dental or healthcare professionals, and any advice received.

The Registered Manager will monitor oral care practice through care record audits, review of personal plans, supervision, spot checks, feedback from individuals and representatives, complaints, incidents, safeguarding concerns and professional feedback. Findings will be used to improve practice, update personal plans, identify training needs and inform the service’s quality assurance arrangements.

Any pattern of missed oral care, repeated refusal, poor recording, lack of supplies, delayed dental access, or deterioration in oral health must be reviewed and acted upon promptly.

4.12. Duty of Candour and Learning from Incidents

{{org_field_name}} will act in an open and transparent way with individuals and, where appropriate, their representatives where something goes wrong in relation to oral care. This includes missed oral care resulting in harm or risk of harm, avoidable delay in escalating oral health concerns, loss or damage to dentures, failure to follow professional advice, or any incident that affects the individual’s safety, dignity, comfort or well-being.

The Registered Manager will ensure that concerns are investigated, the individual is supported, an apology is offered where appropriate, actions are taken to reduce the risk of recurrence, and learning is shared with staff through supervision, team meetings, training or policy updates.

5. Related Policies

This Oral Care Policy aligns with and should be read alongside the following policies:

6. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to Welsh legislation, Welsh Government statutory guidance, CIW requirements, oral health guidance, infection prevention and control guidance, safeguarding guidance, or the service’s statement of purpose. The policy will also be reviewed following relevant incidents, complaints, safeguarding concerns, audit findings, inspection findings, professional advice or identified changes in the needs of individuals using the service. Any updates will be communicated to staff, and additional training or competency checks will be completed where required.

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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