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CH117-Oral Care Policy

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Oral Care Policy

1. Purpose

This policy sets out {{org_field_name}}’s arrangements for promoting and protecting the oral health of people living at the service and for ensuring that they receive safe, person-centred support with their mouth care and timely access to appropriate dental services.

Oral care forms part of a person’s overall health, wellbeing, dignity and personal care. Poor oral health may cause pain, infection, difficulty eating or drinking, deterioration in nutrition and hydration, communication difficulties and a reduction in quality of life. Changes in oral health may also affect a person’s behaviour, particularly where the person is unable to communicate pain or discomfort.

{{org_field_name}} will assess each person’s mouth care needs, preferences, abilities and risks, record these within the person’s care plan, provide the level of support identified as necessary, monitor for changes and arrange referral to an appropriate dental professional when required.

Oral care will be provided in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulations 9, 10, 11, 12, 14, 17 and 18, the Mental Capacity Act 2005 where applicable, and relevant nationally recognised evidence-based guidance, including NICE guideline NG48, Oral health for adults in care homes.

Care and support must be provided with the person’s valid consent. Where a person lacks capacity to make a particular decision about oral care or dental treatment, staff must act in accordance with the Mental Capacity Act 2005 and any decision must be made in the person’s best interests where required by that Act.

2. Scope

This policy applies to all care staff, nurses, and other employees at {{org_field_name}} responsible for assisting with or supervising oral care. It covers all aspects of oral hygiene, including daily mouth care, assessment, prevention of oral health issues, and access to dental treatment for the people we support.

3. Legal and Regulatory Framework

This policy must be read and implemented in accordance with the following requirements, where applicable:

4. Principles of Good Oral Care

5. Oral Health Assessment and Care Planning

A mouth care needs assessment must be completed for every person as part of the admission process or as soon as practicable after admission. This applies regardless of whether the person’s stay is intended to be permanent, temporary or short term.

The assessment must be undertaken by a member of staff with the appropriate knowledge and competence and, so far as reasonably practicable, must involve the person. Where appropriate and with the person’s consent, family members, representatives or others involved in the person’s care may contribute information about their usual mouth care routine.

The assessment must identify and record, as applicable:

The results of the assessment and all actions arising from it must be recorded in the person’s care plan.

Where an oral health concern requiring dental assessment is identified, staff must arrange or support access to an appropriate dental professional without unnecessary delay, taking account of the urgency of the concern.

The care plan must clearly describe:

The mouth care assessment and care plan must be reviewed and updated whenever the person’s needs, risks, abilities, preferences or circumstances change and at the person’s normal care plan review. Staff must not rely on a fixed review interval where earlier review is indicated by a change in oral health or general condition.

6. Consent, Mental Capacity and Refusal of Oral Care

Oral care is personal care and must not be provided without appropriate consent or other lawful authority.

Staff must seek the person’s consent before providing assistance with mouth care and must explain what they intend to do in a way the person can understand. Consent may be expressed verbally, non-verbally or through the person’s actions where this clearly communicates agreement.

A person who has capacity to make the relevant decision has the right to decline oral care, including where staff believe that accepting the care would be beneficial. Staff must not force, coerce or unlawfully restrain a person in order to provide routine mouth care.

Where a person refuses or resists oral care, staff must:

Capacity must not be judged solely because a person has dementia, a learning disability, autism, a mental health condition, communication difficulties or because they make a decision that others consider unwise.

Where there is reason to doubt the person’s capacity to make a specific decision about oral care, a decision-specific assessment of capacity must be undertaken and recorded in accordance with the Mental Capacity Act 2005.

Where the person lacks capacity to make the relevant decision, staff must establish whether there is a valid and applicable advance decision or a person with relevant legal authority, such as an attorney or deputy, and must comply with the Mental Capacity Act 2005.

Where a best-interests decision is required, this must be made and recorded in accordance with the Mental Capacity Act 2005. The least restrictive option must be considered and the person must remain involved in the decision as far as reasonably possible.

Repeated refusal, deterioration in oral health, suspected pain, infection or significant risk must prompt review and, where necessary, advice from an appropriate dental or healthcare professional.

7. Daily Oral Hygiene Support

Daily mouth care must be provided in accordance with each person’s assessed needs, preferences, consent and individual care plan.

Natural Teeth

People with natural teeth must be supported, where required, to brush their teeth at least twice each day using fluoride toothpaste.

Unless a dental professional has provided different individual advice, adults should use a fluoride toothpaste containing at least 1,350 ppm fluoride.

Where possible, one episode of brushing should take place last thing at night and another at a suitable time during the day.

Following brushing, the person should be supported to spit out excess toothpaste and should not routinely rinse the mouth with water immediately afterwards unless individual professional advice indicates otherwise.

Staff must support the person to use their preferred suitable toothbrush, whether manual or electric, wherever reasonably practicable.

Dentures

People with full or partial dentures must receive daily support with denture care where this is identified in their care plan.

Dentures should be brushed and food debris removed each day using an appropriate denture-cleaning method and products suitable for the individual.

Dentures should normally be removed overnight in accordance with the person’s care plan and preferences, unless a dental professional has advised otherwise or the person declines their removal.

Dentures must be handled carefully, stored safely when removed and protected from loss or accidental disposal.

Prescribed and Other Mouth Care Products

Prescribed mouth care products, including prescribed high-fluoride toothpaste or mouth rinses, must be used in accordance with the prescriber’s or dental professional’s instructions and the service’s medicines procedures where applicable.

A person’s preferred suitable over-the-counter oral care products should be supported where possible, provided that their use is safe and does not conflict with professional advice.

Monitoring During Daily Mouth Care

Staff providing or supporting oral care must remain alert to changes including:

Concerns must be recorded and reported promptly. Where necessary, dental or other healthcare advice must be sought according to the urgency and nature of the concern.

8. Preventing Oral Health Problems

Access to Dental Care

People must be supported to access appropriate routine, urgent and emergency dental services according to their individual needs.

Where a person does not have a dentist or has lost contact with dental services, staff must provide reasonable support to identify and access an appropriate local dental service.

The interval between routine dental reviews must follow the individual recommendation made by the person’s dental professional. Staff must not automatically apply a six-monthly recall interval to every person.

Where a person cannot readily attend a dental practice because of their health, disability or other assessed needs, staff must explore appropriate accessible dental arrangements, which may include community or special care dental services or domiciliary provision where available and clinically appropriate.

Urgent dental advice or treatment must be sought where there is significant pain, suspected infection, swelling, trauma, uncontrolled oral bleeding or another concern requiring urgent professional assessment.

Diet, Nutrition and Hydration

Oral health must be considered alongside the person’s nutritional and hydration needs.

Staff must follow the person’s nutrition and hydration care plan and relevant professional advice, including where changes to food texture, drinks or nutritional support are required.

Where oral pain, poor dentition, ill-fitting dentures, dry mouth or another oral condition affects the person’s ability or willingness to eat or drink, the concern must be recorded, escalated and assessed. Appropriate dental, medical, dietetic or speech and language therapy advice must be sought when indicated.

People should be supported to limit the frequency and amount of sugary food and drinks where this is consistent with their individual nutritional needs, preferences, clinical requirements and care plan.

People with Dysphagia, Enteral Feeding or Complex Needs

People with dysphagia or those receiving enteral nutrition, including PEG feeding, continue to require regular mouth care even where they take little or no food or drink orally.

Their mouth care plan must reflect their individual swallowing risk, ability to manage oral secretions, positioning requirements and any recommendations made by relevant healthcare professionals.

Staff must follow any individual instructions provided by speech and language therapists, dental professionals, nurses or other appropriately qualified practitioners.

Denture Safety

Dentures must be stored in a clean, appropriate and individually identifiable container when not being worn.

Where dentures are unmarked, the person should be asked whether they would like support to arrange appropriate denture marking.

Staff must monitor for poor fit, pain, damage, pressure areas or changes affecting the person’s ability to eat, speak or wear their dentures and arrange dental assessment where required.

9. Supporting Individuals with Dementia or Learning Disabilities

10. Infection Prevention and Control

11. Training, Knowledge and Competence

Staff who provide or support personal care must have the knowledge, skills and competence necessary to meet the oral care needs of the people they support.

The Registered Manager must ensure that staff receive appropriate oral health information, instruction, training, supervision and competency assessment according to their role and responsibilities.

Before providing oral care without appropriate supervision, relevant staff must understand and, where applicable, demonstrate competence in:

Training and competency must be reviewed and refreshed where necessary, including when:

Records of training, competency assessment, supervision and any required remedial action must be maintained.

12. Documentation and Record-Keeping

Accurate, complete and contemporaneous records relating to oral care must be maintained in accordance with the person’s care plan and the service’s record-keeping procedures.

Records must include, where applicable:

Records must accurately distinguish between oral care that was offered, oral care that was accepted and completed, oral care that was partially completed, and oral care that was refused or could not be provided.

Repeated refusals, recurring concerns or failures to complete necessary oral care must not be recorded as isolated events without appropriate review and escalation.

The Registered Manager, or a person delegated by them, must ensure that oral health records and care plans are subject to proportionate audit and monitoring. Identified omissions, recurring concerns or unsafe practice must result in appropriate corrective action and follow-up.

13. Access to and Collaboration with Dental and Other Healthcare Professionals

{{org_field_name}} must support people to access dental assessment and treatment according to their individual needs and the urgency of any oral health concern.

The service must maintain information about relevant local services, including, where available:

Where a person requires assistance to access dental care, staff must provide reasonable support with arrangements, communication, transport or other reasonable adjustments according to the person’s individual needs.

Only appropriately registered dental professionals acting within their professional scope of practice may diagnose or treat dental disease or make dental diagnoses requiring professional dental expertise.

Care staff must not attempt to diagnose dental disease or undertake procedures outside their role and competence.

Where oral health concerns interact with other health or care needs, staff must seek appropriate multidisciplinary input. Depending on the person’s needs, this may include:

Information necessary for safe continuity of care must be shared appropriately and lawfully with relevant professionals, subject to confidentiality, data protection requirements and the person’s consent or another lawful basis for sharing.

14. Related Policies

15. Policy Review and Governance

The Registered Manager is responsible for ensuring that this policy is implemented and that staff practice is consistent with its requirements.

The effectiveness of oral health arrangements must be monitored through appropriate governance processes, including review of care plans, records, incidents, complaints, oral health concerns, access to dental services, staff competence and relevant audit findings.

Where monitoring identifies a risk, omission or failure to meet a person’s oral health needs, appropriate action must be taken without unnecessary delay and the effectiveness of that action must be reviewed.

This policy will be reviewed at least annually and sooner where necessary following:

Any amendments must be communicated to relevant staff and reflected in training, care planning and operational practice 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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