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CQC calls for improvements to oral health in care homes

The Care Quality Commission (CQC) has recently published the findings of an in-depth review on the state of oral health care in care homes across England.

The review draws on one hundred inspections of care homes on which CQC inspectors were accompanied by inspectors from dental regulation. It reveals that three years on from the publication of NICE guidance on oral health in care homes, steps are often not being taken to ensure that people get the oral health care they need to ensure that they are pain-free and that their dignity is respected.

Key findings include:

  • The majority (52%) of care homes visited had no policy to promote and protect people’s oral health
  • Nearly half (47%) of care homes were not providing any staff training to support people’s daily oral healthcare
  • 73% of residents’ care plans reviewed only partly covered or did not cover oral health at all – homes looking after people with dementia being the most likely to have no plan in place.
  • 17% of care homes said they did not assess people’s oral health on admission
  • Kate Terroni, Chief Inspector for Adult Social Care at the Care Quality Commission (CQC) said:
  • “Oral health has a huge impact on our quality of life and we need professionals across a number of sectors to make changes to ensure it is given the priority it needs in care home settings
  • “Oral health cannot be treated as an afterthought. It can make the difference between someone who is free from pain, enjoys eating and is able to confidently express themselves through talking and smiling – and someone who is in pain, unable to enjoy their food and who covers their mouth with their hand when they smile because they are ashamed of their poor oral hygiene but unable to address it themselves. No one should have to live like that.

Why is good oral care so important?

  1. Inadequate oral care can be detrimental to social and emotional well-being
  2. To maintain adequate levels of nutrition and hydration for weight maintenance
  3. To keep  residents as comfortable as possible in palliative and end-of-life care 
  4. Because dental decay and gum disease are entirely preventable
  5. There is mounting evidence that shows an association between poor oral hygiene and a wide variety of illnesses including:
  • Dementia
  • Pneumonia,
  • Diabetes,
  • Kidney and heart disease
  • Cancer.

So what is the difference between oral hygiene and oral care?

Oral Hygiene

  • Cleaning teeth and the oral cavity using toothpaste and toothbrush delivered twice daily

Oral Care

  • Ensuring that the mouth is clear of trapped food and debris with Moutheze oral cleanser
  • Ensuring that the mouth is pink, clean and moist
  • Checking regularly with a pen torch to ensure the oral environment hasn’t changed - delivered 2 hourly – perhaps when re-positioning
  • Interaction with the person to ask about how their mouth feels – especially for pain and dryness
  • Vulnerable adults are often unable to take proper care of their teeth due to overall weakness or problems like:
  • Arthritis
  • Memory loss
  • Anxiety
  • Sleep disturbance
  • Depression
  • Disorientation

Research has found the following challenges to achieving and maintaining good oral health for residents in care homes.

  • This aspect of care is sometimes considered as distasteful
  • With residents who retain some of their teeth, care staff can show reluctance to deliver mouth care for fear of personal harm from non compliance
  • Staff may not give oral care priority
  • Lack of fit for purpose tools and products with which to work 
  • Lack of formal guidance and training
  • Other workplace pressures

So what do care homes need to do to comply with CQC latest guidelines for oral care?

What the Care Quality Commission expects

The Care Quality Commission expects registered managers to take account of nationally recognised guidance, including guidance from NICE.

Evidence about how you support residents to maintain good oral health will help you demonstrate that your service is both effective and responsive.

NICE’s guideline on oral health for adults in care homes, including the baseline assessment tool, can be used as part of your preparation for inspection and to support requests for help to other services.

Oral health assessment

All residents should have an oral health assessment when they move into the care home, with the result recorded in their care plan. Care staff should start by asking the following questions:

How do you usually manage your daily mouth care and what help would you like?

What dental aids do you currently use? For example, manual or electric toothbrush, mouthwash, floss.

Do you have dentures, and if so are they marked with your name? If not, would you like them to be marked?

When did you last see a dentist, and who did you see?

If you don't have a dentist would you like help to find one?

Using an oral health assessment tool - like the one here - will highlight any areas where residents need specific care and support. Using it for reassessments will indicate any changes that may need action.

Care staff knowledge and skills

Care staff need to know when to reassess the oral health of a resident and how to support residents with their daily mouth care to:

Brush their natural teeth at least twice a day with fluoride

Use their choice of cleaning products for dentures.


Clean their dentures (brushing, removing food debris, and removing dentures overnight).

Use their choice of toothbrush, either manual or electric/battery powered, and mouth care products.

They also need to understand how dental pain or a mouth infection can affect residents’ general health, wellbeing and behaviour.

Make sure staff know who to ask for advice, how and when to report any concerns about a resident’s oral health, and how changes in a person’s condition might affect their ability to manage their mouth care.

For more information on Being CQC Ready in Oral Care we have attached a link to a Youtube training video by Knowledge Oral Health, which we hope you will also find useful. 

If you have any questions or would like to discuss any of our fit for purpose oral health product solutions then please don’t hesitate to contact us on 01773 713713 or email us at [email protected]

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