Improving oral health in care homes
The oral health of older people living in care homes needs to be given more priority, Michael Watson says.
A couple of weeks ago, the National Institute of Health and Care Excellence (NICE) produced new guidance on the oral health of older people living in care homes, mainly targeted on carers.
Since then we have had the political turmoil that has surrounded the appointment of a new Prime Minister and government, the ongoing ‘national disgrace’ of so many hospital admissions of children for extractions and questions over where ministers stand on sugar.
In all this the new NICE guidance has been somewhat neglected by the profession’s leaders.
This is a pity because it contains good advice on care home policies and providing residents with support to access dental services.
It covers oral health assessments and mouth care plans, including daily routines, as well as addressing the knowledge and skills required in this area by care staff.
NICE says that older people in care homes are unhappy and irritable because staff ignore the poor state of their teeth.
Most care home residents have cavities, compared with about one third of people the same age living at home.
Care home staff need to take teeth more seriously and help residents to brush twice a day.
Gillian Leng, deputy chief executive of NICE, said: ‘When oral health is ignored or poorly delivered in care homes it can lead to unhappy, irritable residents and for those with dementia, who often can’t describe problems with their teeth or gums, pain and infection may go untreated and worsen.’
Oral health in care homes
Many of us who were in practice before 2006 remember when almost all of those in care homes had full upper and lower dentures.
We remember the apocryphal stories of staff cleaning all the residents dentures in a big bowl and then being unable to sort out who owned which.
For that reason we started to make sure dentures were marked with the patients’ names, something reinforced in the new guidance.
The new guidance contains recommendations for dental practitioners, both those in practice and in the community service.
Dentists should provide those in care homes with routine or specialist preventive care and treatment as necessary, in line with local arrangements.
But whereas in the old days, we were paid a fee for such domiciliary visits, this is rarer since 2006.
The BDA has backed the NICE call to prioritise oral healthcare for adults in care homes and for oral health and access to dental treatments to be given the same priority as general health for all such adults.
However, it has warned that implementing these will require adequate funding, and identifying patients in care homes for dental treatment is hampered by the fact that IT systems for dentistry are not integrated into the rest of the NHS.
The NICE guidance is full of good intentions, but without effective commissioning of services backed up by adequate funding, it will not succeed.