CH219. Oral Health in Care Homes
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Oral Health in Care Homes Policy
{{org_field_name}} recognises that good dental health is vital for the wellbeing of people using services and that a healthy mouth and teeth are important for speaking, chewing and for general overall health.
The home aspires to providing high-quality oral healthcare based upon individual people using services’ needs and as recorded in an individual care plan for each person. Each plan will be determined by a full needs assessment which will identify any mouth care needs. The plan will be drawn up in partnership between the home and the person using services, and any relatives or carers that the person wants involved.
{{org_field_name}} acknowledges the challenges post Covid-19 pandemic to primary dental care provision and continues to support oral health care for people using services as well as access to dental services. For those receiving domiciliary care visits from dentists, this area of dentistry has also been greatly impacted by the Covid-19 pandemic.
Guidance
{{org_field_name}} complies fully with recognised evidence-based guidelines on the provision of oral healthcare in residential adult social care.
Oral care in residential care is addressed in a guideline by the National Institute for Health and Care Excellence (NICE), NG48: Oral Health for Adults in Care Homes, published in July 2016. The NICE guideline states that care home policies on oral health should set out plans and actions to promote and protect people using services’ oral health.
Policy
In {{org_field_name}}, the following applies.
• People using services will be assessed, by a person trained to do such assessments, to identify oral healthcare needs. The assessment will include:
a) asking the person about their mouth care regime
b) asking the person if they require any help with their mouth care
c) finding out the name of the persons dentist, when they were last seen and whether they have an appointment for a check-up.
• The assessment will be regularly reviewed, particularly if the person using services circumstances change.
• Where the person using services has no support needs identified, they will be encouraged to attend their check-ups with their dentist and travel/escort will be arranged if required. Where the person is self-caring in relation to their dental hygiene and tooth brushing, the home will offer whatever support is required for them to maintain their independence.
• Where a person using services does have mouth care or dental support needs these will be identified and recorded in their needs assessment. Action to support those needs will be agreed with the person and entered in their personalised plan of care. The person using services’ oral healthcare plan should be reviewed and updated as their mouth care needs change.
• Daily oral healthcare, where it is identified in a person’s plan of care, should be given the same priority as other aspects of personal care. Care managers should ensure that staff are supported with effective training, supervision, equipment, time allocation and resources.
• Typically, daily dental care may involve:
a) a member of care staff helping the person with tooth brushing and flossing, both for their natural teeth and for any dentures they may have
b) assisting the person in attending dental appointments and check-ups or attending any other oral healthcare appointments they may have.
• All people using services will be encouraged to be registered with a dentist and to attend regular check-ups as advised by their dentist. Where a person does not have a dentist or wishes to register with a new dentist, the home will help to facilitate this with a local dentist of their choice. The home keeps information on all local dentists for people to see if they wish, including details on special care dentistry services.
• If a person exhibits any of the following signs or symptoms they should be encouraged to attend their dentist or, if they are agreeable, to be referred to a dentist:
a) bleeding, red, swollen or tender gums
b) toothache
c) changes in the way teeth fit together
d) changes or discomfort in the fit of dentures or partials
e) very bad breath (which may be a sign of infection)
f) loss of taste and weight loss
g) loose, broken or chipped teeth.
• The home will support whatever treatment regime is recommended by the dentist. For those people using services are unable to travel to a dentist then a community dental service is available.
• Where it is identified in the plan of care, care staff will support people using services in twice-daily brushing of the teeth/dentures and regular flossing or cleaning between the teeth. Teeth/dentures should be brushed twice a day for about two minutes each time using light and even pressure and fluoride toothpaste of the person’s choice.
• For a person using services with dentures, the initial needs assessment should identify what help they require in looking after their dentures and how they want it done. Where necessary, this plan of care should be agreed with the persons dentist and should determine whether they would like their dentures out at night, in which case the dentures should be placed in an appropriate cleaning solution.
• People using services with dentures will be asked whether the dentures are marked. If not, the home will recommend that marking is done and will offer to arrange this. In a residential care setting, it is good practice to ensure that dentures are marked with an identifier in case they get lost.
• In all cases, the home will support good oral health promotion by supporting people to eat a balanced diet.
• Where a person refuses oral healthcare support or does not want to register with a dentist, their choices will be respected. The risks of poor dental care will be explained to them and they will be given all relevant information should they change their mind. Where the person is suspected to lack capacity, the requirements of the Mental Capacity Act 2005 will be applied and a best interest’s decision made about their oral healthcare in collaboration with their relatives, carers and representatives.
• An oral health champion role will be supported whereby one member of staff will receive additional training and act as a source of support for other staff and as a link between the organisation and dental professionals. The champion will also be tasked with supporting the implementation of NICE guidelines within the organisation and ensuring that people have the right products in the right condition to assist with day-to-day oral care.
• Where a person using services has been known to have had Covid-19 infection, and subsequently developed “Long Covid”, additional care and observation will be undertaken to check for some of the documented related oral health issues, such as: discoloration of teeth, dry mouth, gum inflammation and disease, oral ulcers, tooth fractures or cracking or tooth loss. Any issues noted will be recorded in individual care plans and reported so people can receive any necessary treatment.
Oral care post Covid-19 pandemic
{{org_field_name}} is aware post Covid-19 pandemic, services continue to be affected with regards to delivery of oral healthcare, particularly in the availability of dentistry services. Post pandemic, issues which arose from appropriate infection prevention and control measures, have seen worsening of some people using services oral health and increased incidence of problems.
{{org_field_name}} acknowledges the CQC’s statement that access to NHS dental care was an ongoing issue pre-pandemic, and that problems were compounded by Covid-19. It also recognises the General Dental Council position that normal dental services are likely to take time to recover and will continue to be adversely affected for some time, particularly for older and more vulnerable people who require greater protection.
{{org_field_name}} believes that the oral health of people using services remains of utmost importance, both during and post pandemic as it was before. Oral care will therefore continue to be given the highest priority so that people using services enjoy good oral hygiene and remain free from dental pain and discomfort.
Training
Care staff working for {{org_field_name}} should be introduced to this policy during their induction. The need for effective daily oral care should be included within both induction and ongoing care staff training programmes.
{{org_field_name}} supports a system of staff appraisal whereby all staff have an annual performance review. During this review, the member of staff will be expected to identify with their reviewer any training requirements and needs they might have relating to providing oral healthcare. These will be recorded in a training plan.
In {{org_field_name}}, the following applies.
- Daily oral health and mouth care will continue to be provided to the high standards expected by people using services, including support for daily tooth-brushing and denture care.
- Staff will continue to use appropriate personal protective equipment (PPE) and infection prevention measures, where appropriate and outlined in the home’s infection control policies.
- Changes in the condition of peoples teeth and gums should be reported as soon as possible by care staff, including any concerns about their oral health.
This care service is aware CQC priority areas for 2022 included oral health and strives to ensure staff access training to support oral health, oral health care plans and arrangements for access to dental care and emergency dental treatment are in place for people using services. It will also continue to raise awareness of NICE oral health guidelines and identify those vulnerable to oral health issues.
Online, video and remote contacts may continue to be used where clinically necessary to provide consultations and support. Oral health promotion will continue to be prioritised by the home. {{org_field_name}} recognises that such prevention programmes remain important while routine dental check-ups and hygiene visits remain disrupted, in some areas.
{{org_field_name}} will comply fully with relevant guidance, including Covid-19 Supplement to the Infection Prevention and Control Resource for Adult Social Care (updated December 2022), available on the GOV.UK website
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.
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