Oral Public Health Specialist

North Somerset Council

Public Health, Post Point 11, Castlewood, Tickenham Road, Clevedon, BS21 6FW

catherine.wheatley@n-somerset.gov.uk

    Why Oral Health is Important

    Having a healthy mouth is something that helps everyone to live well. Pain free eating and drinking is something that many people can take for granted. Keeping teeth and dentures clean and in good condition can be a struggle for people living with disabilities, complex conditions or frailty. Maintaining good oral health improves a person’s general health and wellbeing and can also play a part in helping people stay independent for as long as possible.

    General health and wellbeing can be enhanced by maintaining good oral health throughout life, including for adults living in care homes. In the Smiling Matters report, the Care Quality Commission (CGC) found that residents are not always supported to maintain and improve their oral health. They go on to suggest improvements to oral health care and recommend that carers implement the NICE (National Institute for Health and Care Excellence)  guidance “Oral health for adults in care homes”, known as NG48. There are special guidelines for oral health care within the Enhanced Health in Care Homes Framework (EHCF) too.

    Oral Health Care can be achieved for all cared-for vulnerable adults, through staff training, oral health assessments, care plans, daily hygiene and supporting access to dentists. More information and tools to support your practice can be found on this page.

    These videos describe why oral health is important for maintaining good general health, and introduce Mouth Care Matters training to support staff in undertaking this duty.

    Oral Health Policy

    “Care homes should have an Oral Health Policy in place, with one staff member taking responsibility for this policy within the home.“ EHCF  (4.6.4.b)

    It is important to have an oral health policy which sets out actions to ensure the protection of your client’s oral health. Use and adapt an Oral Health Policy template, or if you wish to make your own, please check it against an Oral Health Policy Quality Assurance Checklist.

    Care Home Oral Health Policy (Example 1)Headings: Why mouth care matters, How a care home will help residents with oral health and, Available resources and referencesDownload ODT (17 KB)
    Care Home Oral Health Policy (Example 2)Headings: Improving the oral health of our residents, All residents will..., The manager of the care home will..., Care staff will..., Summary of oral care provision for residents, Available resources and references Download ODT (17 KB)
    Oral Health Policy Quality Assurance ChecklistIf you already have an oral health policy in place or are not planning to use one of the templates provided, then you can use this checklist to ensure your oral health policy includes all the relevant information.Download ODT (15 KB)

    It is expected that your policy includes how you provide people with access to routine, specialist and preventative dental care or treatment. If you are a manager concerned about the availability of dental services, please inform North Somerset Healthwatch.

    NHS 111 can be utilised when required.

    Follow this link to seek dental help from NHS 111 online.

    Oral Health Assessments

    “Every person’s oral health should be assessed as part of the holistic assessment of needs and personalised care and support planning process.“ EHCF  (4.6.4.a)
    “Assess the mouth care needs of all residents as soon as they start living in a care home, regardless of the length or purpose of their stay.” NG48  (1.2.1)

    Using an assessment tool, speak with every new client about their oral health needs.

    This assessment will highlight any areas where clients need specific care and support. Repeat the process for reviews to uncover any changes that may need action as per NG48 1.3.3. These assessments and reviews will form the input for individualised care plans.

    Make an appointment for the resident to see a dental practitioner, if necessary. This could be to get dentures made or repaired, to get a problem seen to or, for a check up. If the resident is registered with a dentist, consider what arrangements need to be made for them to continue to attend that clinic. If it isn’t possible to continue with their current practice, an alternative registration with associated arrangements will need to be made sensitively.

    Record the results of the assessment and the appointments that have been made, in the personal care plan.

    Mouth Care Assessment GuideUse this oral health assessment tool to highlight any areas where residents need specific care and support. Using it for reassessments will indicate any changes that may need action.Download JPEG (665 KB)
    Mouth Care Assessment, Plan and ChartAn all-in-one tool with an Oral Health Needs Assessment (pg1) Care Plan (pg2) and Daily Chart (pg3) combinedDownload PDF (424 KB)
    Mouth Care Risk AssessmentThis assessment aid helps carers identify problems in the mouth by providing photos of various levels of oral diseases.Download PDF (1 MB)

    Personal Oral Care Plans

    “Every person’s oral health should be enquired after and/or observed regularly by care home staff as part of their usual hygiene routine” EHCF  (4.6.4.c)

    The Oral Care Plan should be kept with the resident’s records and be updated daily.
    The plan should be reviewed every three months, or sooner if changes are noted.

    An individual’s personal care plan should lay out:

    • their choice and use of products, (both prescribed and over-the-counter)
    • support required to clean teeth and dentures
    • who their dentist is and when their next appointment is due
    • arrangements for accessing dental care

    Daily Support

    “Ensure care staff provide residents with daily support to meet their mouth care needs and preferences, as set out in their personal care plan after their assessment.“ NG48  (1.3.1)

    As per the individual’s preferences and support needs, carers should be aware of how to facilitate twice daily brushing of natural teeth with a fluoride toothpaste, and daily denture care. Staff should be trained for this and good mouth care should be encouraged throughout the practice.

    On a day to day basis it is important that staff know:

    • who they can ask for advice about getting prescribed mouth care products, or helping someone to use them
    • how to recognise and respond to changes in a resident’s mouth care needs
    • how to respond if a resident does not want daily mouth care or to have their dentures removed
    Carer sees to older gentlemanOral Health for CarersTaking care of another’s teeth In the day to day, please ensure those you care for have their teeth brushed,…Find out more about 'Oral Health for Carers'Save Oral Health for Carers to favourites

    Staff Training

    “Staff employed by care home providers should undertake training in oral healthcare to support delivery of oral health assessments and daily mouthcare for individuals and maintain this knowledge and skill through ongoing professional development.” EHCF  (4.6.4.d)

    Upon inspection, the Care Quality Commission will ask: if oral health care is covered in induction, if it is a mandatory component of regular training and if all staff have received the training; if staff feel confident to support oral health care and know how to identify deterioration in oral health or recognise signs of oral distress (such as behaviour change, tissue viability, weight loss etc)

    Nice Guidance 48 recommends that staff:

    • Understand: the importance of oral health and its effect on wellbeing, the impact of dental pain on people who cannot ask for help and the importance of denture marking
    • Know how and when to: reassess oral health, deliver daily mouth care, and report any oral health concerns
    • Know:  who they can ask for advice around prescribed oral health products, how to recognise and respond to changes in mouth care needs, and how to respond if someone refuses mouth care

    Mouth Care Matters aims to train staff in mouth care to ensure it is delivered in a safe and compassionate way. It was originally developed for hospital staff but is suitable for staff working in care. It comes as a small series of bite sized videos, or a 6 week programme complete with resources. There are extra elements that cover the additional challenges posed whilst caring for someone with dementia, autism or in end of life care.

    If you’d like to hear about more local offers of oral health or mouth care training, please contact us from this page for the most up to date information.

    Mouth Care Matters – 6 Week ProgrammeWe recognise that oral health is important at every stage of a person’s life and that all of us, at some stage, will need some help with our own mouth care. As you are involved in providing healthcare for another person, we want you to be confident in what you do.Follow link toMouth Care Matters – 6 Week Programme
    Mouth Care Matters – Bite-SizeMouth Care Bite-Sized Video Training. This course contains a series of assessments designed to test your knowledge and understanding of various topics relating to mouth care. A certificate of completion is available to download once all of the assessments have been passed.Follow link toMouth Care Matters – Bite-Size
    NICE Webinar Recording: Improving oral health in care homesFollow link toNICE Webinar Recording: Improving oral health in care homes

    Useful Links

    Listed here are some links that could help you to ensure your setting is doing all it can to maintain the oral health and therefore general health, of the adults in your care.

    Care Home Oral Health AuditUse this tool to help you produce an oral health action planDownload PNG (195 KB)
    Care Home Baseline Assessment ToolThis self-complete baseline assessment tool provides a checklist that will help your Care Home to review current practice against NICE guidance and quality standards for Oral Health for Adults in Care Homes (NG48, QS151). It can provide evidence for CQC inspections on current practice and help you produce an action plan to address the gaps identified.Download ODT (24 KB)
    Oral Health: A quick guide for care home managersMore than half of older adults who live in care homes have tooth decay, compared to 40% of over 75s who do not live in care homes. Thorough assessments, and support from skilled and knowledgeable staff can help prevent the pain, disturbed sleep and health problems that poor oral health can cause.Download PDF (949 KB)
    Enhanced Health in Care Home FrameworkGood oral health is important for general health and wellbeing and an essential part of active ageing. Older people living in care homes are more likely to have experienced tooth decay and the majority of residents with one or more natural teeth will have untreated tooth decay.Follow link toEnhanced Health in Care Home Framework
    NG48 Oral health for adults in care homesThis guideline covers oral health, including dental health and daily mouth care, for adults in care homes. The aim is to maintain and improve their oral health and ensure timely access to dental treatment.Follow link toNG48 Oral health for adults in care homes
    Quality Standard [QS151] Oral health in care homesThis quality standard covers oral health, including dental health and daily mouth care, for adults in care homes (with and without nursing provision). It describes high-quality care in priority areas for improvement.Follow link toQuality Standard [QS151] Oral health in care homes
    Alzheimers Society – Dental CareThis information describes some of the dental problems that people with dementia may face at different stages and methods for treatment and prevention, including maintaining good oral health and wearing dentures.Follow link toAlzheimers Society – Dental Care
    Dementia and nutritionCarers UK provide up to date nutrition information and support for adults with Dementia. Follow link toDementia and nutrition
    Adult Oral Health: applying “All Our Health”Poor oral health can lead to pain and discomfort, sleepless nights, loss of function and self-esteem, and in turn disrupt family life. It can also lead to time off work. Experiencing tooth decay or having missing teeth or ill-fitting dentures can lead to an individual becoming socially isolated.Follow link toAdult Oral Health: applying “All Our Health”
    Delivering Better Oral HealthOral and dental diseases are widely prevalent, and whilst oral health has improved in recent decades, most people are at risk of developing some oral disease during their lifetime. Follow link toDelivering Better Oral Health

    Taking Care of Your Teeth; for the busy care worker

    “Brush your teeth” “Eat less sugar” What’s the fuss about? And why should we look after our teeth? Come and find out in this workshop!

    In this workshop we will attempt to answer all these questions and more, taking you through where mouth problems come from and how best to protect your teeth and gums from problems in the future. We will cover the causes of diseases, how these can effect your general health, ways to look after your mouth and tips for doing this around your busy work life.