DC117-Oral Care Policy

Registration Number: {{org_field_registration_no}}

Oral Care Policy

1. Purpose

The purpose of this policy is to ensure that all service users receiving domiciliary care are provided with comprehensive, high-quality oral care that supports their overall health, dignity, and well-being. Poor oral hygiene can lead to pain, infections, difficulties in eating and speaking, and an overall decline in quality of life. This policy sets out clear procedures for assessing, planning, and delivering effective oral care, ensuring compliance with Care Quality Commission (CQC) Fundamental Standards and best practice guidelines.

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:

Oral health assessments and care planning.
Daily oral hygiene practices and interventions.
Preventative measures to reduce oral health risks.
Supporting service users with specific oral health conditions.
Managing dental emergencies and seeking professional intervention.
Staff training and responsibilities.
Monitoring, documentation, and compliance with regulatory standards.

3. Legal and Regulatory Framework

This policy aligns with the following legislation and regulatory guidance:

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Ensures safe and effective care practices.
Care Quality Commission (CQC) Fundamental Standards – Requires care providers to meet the needs of service users, including oral health.
NICE Oral Health for Adults in Care Homes (NG48) – Provides best practice guidelines for oral care delivery.
The Mental Capacity Act 2005 – Ensures that service users who lack capacity receive appropriate oral care in their best interests.
The Equality Act 2010 – Ensures non-discriminatory practices in delivering oral care.
General Data Protection Regulation (GDPR) 2018 – Governs confidentiality and data security related to oral health records.

4. Oral Health Assessments and Care Planning

Upon starting care services, each service user undergoes a comprehensive oral health assessment. This includes:

Identifying existing oral health conditions, such as tooth decay, gum disease, dry mouth, or dentures.
Evaluating the service user’s ability to perform personal oral care.
Recording any pain, difficulty chewing, or swallowing.
Assessing the need for special interventions, such as adapted toothbrushes or dental referrals.
Developing an individualised oral care plan tailored to their needs.

Oral health assessments are reviewed regularly and updated in response to changes in health status or oral hygiene needs.

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

Service users should brush their teeth at least twice a day (morning and evening) with fluoride toothpaste (1,350–1,500 ppm fluoride recommended for adults).
Care staff should ensure that toothbrushes are clean, replaced regularly, and stored hygienically.
If a service user requires full assistance, staff must use a gentle, circular brushing technique, ensuring all tooth surfaces are cleaned.
If a service user is unable to spit, a smear of toothpaste may be used, and excess foam should be wiped away.

5.2. Cleaning and Storing Dentures Hygienically

Dentures should be removed and cleaned daily using a soft brush and non-abrasive denture cleaner (not regular toothpaste).
Dentures should be soaked overnight in an appropriate cleaning solution (or plain water) when not in use.
Poorly fitting dentures can cause soreness, ulcers, and infections; therefore, staff should monitor for signs of discomfort and report concerns to a healthcare professional.

5.3. Rinsing with Antibacterial Mouthwash (If Prescribed or Recommended)

Chlorhexidine or other prescribed mouthwashes should be used as directed to help reduce bacteria and prevent infections such as gingivitis.
If a service user has difficulty swishing and spitting, staff can use a moistened oral swab to apply the solution safely.
Mouthwashes containing alcohol should be avoided as they can cause irritation and worsen dry mouth.

5.4. Monitoring Oral Discomfort, Sores, or Unusual Symptoms

Care staff should observe for signs of oral health issues including:
Red, swollen, or bleeding gums (potential gum disease)
White patches (possible fungal infection, such as oral thrush)
Persistent bad breath (sign of decay or infection)
Mouth ulcers or sores that do not heal (potential oral cancer)
Difficulty swallowing, chewing, or speaking (could indicate a serious issue)
Any concerns must be recorded and reported immediately to the care manager or healthcare professional.

5.5. Encouraging Hydration to Prevent Dry Mouth

Many medications (antidepressants, antihistamines, diuretics, and opioid painkillers) can cause dry mouth, which increases the risk of tooth decay and gum disease.
Service users should be encouraged to sip water frequently and avoid excessive intake of caffeinated or sugary drinks.
Artificial saliva products, oral gels, or sugar-free lozenges may be used for those experiencing severe dry mouth.

5.6. Personalised Oral Care Plans

Service users who require full or partial assistance with oral care receive a tailored support plan based on their:
- Cognitive abilities (e.g., dementia or learning disabilities).
- Physical limitations (e.g., arthritis, stroke recovery, or mobility issues).
- Oral health status (e.g., existing dental problems, denture needs, or ongoing treatments).
Care plans must be reviewed regularly, and oral hygiene routines must be adjusted as needed.

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

Service users should be encouraged to limit sugary foods and drinks, particularly:
Fizzy drinks, sweets, biscuits, and chocolates.
Acidic fruit juices (e.g., orange juice), which can erode enamel.
Frequent snacking on sugary foods, as it increases decay risk.
A nutrient-rich diet with sufficient calcium and vitamin D should be promoted to maintain strong teeth and gums.

6.2. Regular Oral Health Monitoring

Oral health checks should be part of routine care visits. Staff must:
Look for early signs of gum disease, infection, or decay.
Monitor for unexplained weight loss or difficulty eating (could indicate dental pain).
Record and report any concerns to management or medical professionals.

6.3. Referral Pathways for Dental Care

Early intervention is essential if a service user develops pain, swelling, or persistent oral problems.
Staff must assist in booking appointments with NHS or private dental services when necessary.
Where mobility issues prevent a service user from visiting a dental practice, staff must:
- Explore community dental services that offer home visits.
- Arrange transport and support for in-clinic appointments.
If a service user refuses treatment, their decision-making capacity must be assessed, and alternative support options should be considered.

6.4. Smoking Cessation Support

Smoking significantly increases the risk of gum disease, tooth loss, and oral cancer.
Service users who smoke should be encouraged to quit, and signposted to:
NHS Smoking Cessation Services.
Local support groups or GP clinics offering nicotine replacement therapy.
Advice on reducing smoking gradually if quitting immediately is not feasible.
Even if a service user chooses to continue smoking, oral care routines should counteract its effects, such as using fluoride toothpaste and antibacterial mouthwash.

6.5. Medication Review and Oral Health Management

Many long-term medications impact oral health by:
Causing dry mouth (xerostomia), increasing decay risk.
Inducing gum overgrowth (e.g., phenytoin, nifedipine).
Contributing to ulcers or fungal infections.
Care staff must liaise with GPs and pharmacists if a service user’s medication is causing significant oral health issues.
Prescribers may adjust the medication or recommend supplementary oral care products.

7. Supporting Service Users with Specific Oral Health Conditions

Certain service users may have additional oral care needs due to health conditions such as:

Dementia or cognitive impairments: Gentle encouragement and step-by-step assistance to support oral hygiene.
Parkinson’s disease or arthritis: Use of adaptive toothbrushes or electric toothbrushes for ease of use.
Diabetes: Enhanced monitoring for gum disease and mouth infections.
Palliative care: Providing compassionate, non-invasive oral care to enhance comfort and dignity.

Our care workers receive specialised training to support service users with these conditions and work in collaboration with healthcare professionals when necessary.

8. Managing Dental Emergencies

If a service user experiences dental pain, bleeding, or swelling, care workers must:

Provide reassurance and document symptoms.
Encourage saltwater rinses (if appropriate) for minor gum irritations.
Contact the service user’s GP or dentist for urgent advice.
Escalate serious concerns, such as facial swelling or difficulty swallowing, to emergency medical services.
Ensure accurate documentation of the incident and actions taken.

9. Staff Training and Responsibilities

To ensure high-quality oral care delivery, all care staff receive training that includes:

The importance of oral health and its impact on general health.
Techniques for supporting service users with different levels of oral care needs.
Recognising signs of oral health deterioration.
Effective communication techniques for encouraging oral hygiene.
Handling and storing oral hygiene equipment safely.
Safeguarding considerations in oral care.

Training is provided during induction and reinforced through annual refresher sessions.

10. Documentation and Compliance

All oral care activities and assessments are documented in the service user’s care plan. This includes:

Daily records of oral care assistance provided.
Observations of any oral health issues and actions taken.
Updates to care plans following dental visits or changes in oral health.
Incident reports for dental emergencies or safeguarding concerns.

{{org_field_name}} ensures compliance with CQC guidelines by conducting:

Regular audits of oral care records and practice.
Feedback collection from service users and families regarding the effectiveness of oral care support.
Policy reviews annually to align with best practice and regulatory updates.

11. Monitoring and Continuous Improvement

To maintain high standards, {{org_field_name}} regularly:

Engages with dental professionals for guidance and referrals.
Encourages service user feedback to refine oral care practices.
Provides additional training opportunities for staff where specific challenges are identified.
Collaborates with NHS dental teams and safeguarding boards to ensure best practice.

12. Policy Review and Updates

This policy is reviewed annually or whenever new guidance emerges. Any updates are communicated to staff, service users, and relevant stakeholders.

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.