Call for “dental revolution” in care homes

CALLS have been made for a "dental revolution" in care homes in England after a survey found more than half do not have oral health plans in place for residents.

Staff in almost half (47 per cent) of homes had never received dental care training, while almost three quarters of care plans only partly covered or did not cover oral health at all. Homes specialising in dementia were even less likely to have such plans in place.

The figures were revealed in a survey of 100 care homes inspected by the Care Quality Commission (CQC).

The CQC said its findings revealed 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 they are pain-free and that their dignity is respected."

Whilst two-thirds (67 per cent) of the care homes visited by the CQC said service users could always, or nearly always, access NHS dental care, the report did reveal a lack of dentists who were able or willing to visit care homes. Other challenges people faced involved local dentists not accepting new patients and the length of time it took to get an appointment with an NHS dentist – even for a procedure such as getting dentures fitted.

Dentist leaders have responded by calling for a "dental revolution", backing calls for swift implementation of NICE guidelines amongst care home providers and for comprehensive staff training.

The CQC reported that one of the main challenges in providing access to NHS services was lack of domiciliary care provision. Freedom of Information requests by the British Dental Association (BDA) suggest levels of commissioning are low and falling, equivalent to providing coverage to under 1.3 per cent of the population whose activity is significantly limited by disability or ill health.

The BDA has stressed that appropriate commissioning, underpinned by robust needs assessment, is key to ensure all those most in need of NHS care can receive it. It said this would need to cover mainstream, urgent and domiciliary care.

NHS services, it added, have been struggling to meet the demand of an ageing population who are keeping their teeth longer, and often have complex medical histories.

Chair of the BDA’s England Community Dental Services Committee Charlotte Waite said: "We require nothing short of a revolution in the approach to dentistry in residential homes. Oral health can no longer remain the missing piece when it comes to care planning and budgets."

The CQC has called for a cross-sector approach to tackle the concerns raised in its report. It wants mandatory staff training in oral care, oral health check-ups for all residents upon admission and better signposting to local dental services. It also called for the creation of a multi-agency group tasked with raising awareness among care home residents, their families and carers of the importance of day-to-day dental hygiene and the need for routine check-ups.

The CQC’s Kate Terroni, chief inspector for adult social care, said: "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."