New Standards Guide Oral Care in UK Nursing Homes

Dentistry Today


The residents of nursing homes and other assisted living facilities that provide long-term care should be helped with brushing their teeth twice a day, according to the National Institute for Health and Care Excellence (NICE) in the United Kingdom. The organization also has released a draft quality standard and an online guide that address oral health in care homes and hospitals. 

“Looking after someone’s mouth should be as much a part of the care expected as ensuring their personal hygiene and providing adequate clean clothing,” said Elizabeth May, MBE, foundation dean of the Peninsula School of Dentistry, and specialist committee member of NICE. “Helping care home residents with this basic daily routine maintains not only their oral health but, just as importantly, enhances their dignity and self-esteem.”

According to NICE, residents of these facilities have difficulties with maintaining their own oral health due to a variety of reasons. For example, conditions such as arthritis and dementia make holding a toothbrush and seeing a dentist for care difficult. Also, many medicines reduce saliva production, which increases tooth decay. And though many people keep more of their natural teeth into old age, dental care is more complex for them than it is for those with dentures.

NICE further reports that more than half of older adults who live in UK care homes have tooth decay, compared to 40% of those older than the age of 75 years who do not live in care homes. The draft quality standard, then, sets out four goals that all such facilities should be able to reach:

  • Adults who move into a care home should have their oral care needs assessed on admission;
  • Adults living in care homes should have their oral care needs recorded in their personal care plan;
  • Adults living in care homes should be supported in cleaning their teeth twice a day or in undertaking daily oral care for dentures;
  • Patients admitted to hospitals should have support in daily oral care.

When conducting the oral health assessment, for instance, personnel should ask residents how they usually manage their daily oral care and what help they would like; what dental aids they currently use, such as a manual or electric toothbrush, mouthwash, and floss; if they have dentures, and if those dentures are marked with their name; and, when they last saw a dentist, and who they saw. NICE also provides a printable tool to assist in these assessments.

Further, NICE also advises personnel to know when to reassess the oral health of their residents and how to support them with daily mouth care. This includes brushing their natural teeth twice a day with a fluoride toothpaste, using their choice of cleaning products for dentures, cleaning dentures daily, and using their choice of toothbrush and other products. Additionally, personnel should understand how pain and infections may affect general health and behavior.

AGE UK estimates that 426,000 people live in care homes in the United Kingdom, with 405,000 older than the age of 65 years. According to the Centers for Disease Control and Prevention, there were 15,600 nursing homes with 1.4 million residents in the United States in 2014.

“We know that supporting good daily oral healthcare in care homes varies enormously across the country. This draft quality standard prioritizes assessment of care home residents, recording of plans, and ensuring support is in place for those who need it,” said Gillian Leng, CBE, deputy chief executive of NICE. “We are confident that such simple measures could substantially improve the quality of life of many people living in care homes.”

The public is invited to comment on the draft quality standard through February 3, 2017. Publication is expected in June 2017.

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