Providing care for residents of care homes takes seemingly countless forms – from continence care to dementia-friendly furniture, their health and comfort is vital, particularly when residents require additional help with taking care of themselves. However, worrying statistics released by the National Institute for Health and Care Excellence (NICE) have indicated that one aspect is being neglected in the care home environment: the oral health of residents, which can have significant impact not only on their health, but also on their overall dignity and wellbeing.
NICE, who recently published their new guidance ‘Oral health for adults in care homes’, have found that more than half of older adults living in care homes in England have tooth decay. This is compared to 40% of over 75s and 33% of over 85s who do not reside in a care home.
Older adults in care homes are also more likely to have fewer of their natural teeth remaining, and of those who do still have teeth, it is less likely that they will have enough to comfortably eat and socialise without embarrassment.
These statistics will no doubt come as a shock to care home staff and managers who pride themselves on providing a high standard of care for their residents. But as oral health is inherently linked to other aspects of physical health, as well as emotional wellbeing, the oral health of care home residents must also be valued.
Produced in partnership with RIS Healthcare, a family-run company dedicated to providing comprehensive oral health advice, bespoke training and products in the healthcare environment, this article will explain why and how you can easily make oral health a priority in your care home and ensure that every aspect of your residents’ comfort is well-taken care of.
NICE guidelines recommend changes in the approach to day-to-day oral healthcare in care homes which are simple, yet could make a vast improvement to residents’ oral health and their overall quality of life.
This includes ensuring that staff are thoroughly and consistently trained to take routine care of the oral health of their residents. They should be able to confidently perform daily mouth care for those who require assistance with this, which includes:
It is also recommended that all residents receive an oral health assessment from a trained nurse when they enter the care home, and that the findings of the assessment and their treatment needs are recorded in their personal care plan. When required, access to dental health services should also be readily available.
The NICE guidance on oral health in care homes is rooted in the belief that dignity is a basic human need, and that care and respect is deserved as much at the end of life as it is at the beginning. This means that residents of care homes should expect assistance with keeping their mouths clean and infection-free, where this is needed.
Professor 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.”
In addition to this, a resident’s oral status is a good indication of the overall care and attention they are receiving in their care home. When left untreated, oral health can deteriorate rapidly; at any one time there are 20 billion bacteria in a mouth and they reproduce every 5 hours, but after only 24 hours without brushing those 20 billion become 100 billion. What’s more, it can take just 48 hours without any oral care for the mouth to become over-laden with Gram-negative bacteria.
The long-term implications for poor oral hygiene are an even greater cause for concern, as they can have a serious impact on the quality of life of the care home resident. Poor oral health can lead to:
Periodontal disease in particular can lead to a host of further medical issues of varying severity. These include tooth loss and halitosis, but more seriously, aspirational pneumonia, and a double increased risk of heart disease. Periodontitis is present in 95% of patients with diabetes, and high levels of disease-causing bacteria in the mouth can lead to clogging of the Cartoid Artery, and an increased risk of stroke.
Oral health concerns much more than simply cleanliness of the mouth. A dry mouth, or excessive drooling, are also types of poor oral health and should be treated as part of a complete approach to oral healthcare in your care home.
Saliva performs many important functions in the mouth, but excessive drooling, which is defined as ‘saliva beyond the margin of the lip’, can be a problem. If care home residents exhibit drooling then there are treatments to manage it, from medication, postural changes or support collars, through to Botox to the salivary glands or even surgical intervention in more serious cases.
On the other hand, an excessively dry mouth can also have severe health implications, as not only can it be very uncomfortable but it can also cause halitosis, mouth infections, tooth decay and gum disease and also make speech difficult. It can be caused by mouth breathing or medication – more than 400 drugs can cause a dry mouth in an astonishing 90% of all cases – as well as other types of treatment including chemotherapy, head and neck radiotherapy, oxygen or enteral feeding. Saliva substitutes such as oral gel sprays, toothbrushes or mouth rinses may need to be used to keep the mouth moist.
Toothbrushing twice daily is the single most important way to improve and maintain the oral health of residents in your care home; however special attention must be taken with toothbrushing to ensure that it does not aggravate any existing health issues that residents may have.
For instance, toothpastes often contain Sodium Lauryl Sulphate (SLS), the ingredient that makes them foam during brushing. However, SLS can irritate oral mucosa and can also increase the risk of aspiration during brushing, so if this is a concern for any of your residents than a gentle, non-foaming toothpaste is recommended instead.
In addition to this, toothbrushes themselves harbour bacteria. Residents must have their toothbrushes replaced every 2-3 months, but if they become unwell, their toothbrushes must be changed at the beginning of their illness and then again when they are well again. If an oral fungal infection is present, the toothbrush must be changed every few days.
Routine oral care must also include dentures, which require careful and regular cleaning. The following is recommended:
Whilst the oral care and treatment itself is important, the physical approach that is taken in its delivery also matters, particularly when you are assisting residents that require additional support with their personal hygiene.
Assessing the oral care that an individual resident requires must take into consideration their ability, and in particular their ability to perform individual aspects of their own oral care – a ‘one size fits all’ attitude certainly doesn’t apply. Independence must be encouraged, but assistance should be made readily available when it is required.
A gentle and sensitive approach is crucial to ensure that you do not cause undue distress to any of your residents. Here are the recommended actions to take when delivering oral care in your care home:
However, to ensure that you are consistently taking the best approach to health in your care home and complying with the revised NICE guidelines, professional training from experts such as RIS Healthcare is always advisable.
Their training includes presentations and interactive hands-on sessions, delivered by their team of Dental Nurse Specialists and Oral Health Educators, including Emma Riley, a former Macmillan Oral Health Practitioner who worked within the NHS to provide oral care for palliative and end of life patients.
You can contact RIS Healthcare to find out more about oral care training in your care home, and can also find a great choice of oral care products recommended and used by RIS Healthcare available to buy online from Care Shop.
We hope that you have found this information useful, and welcome your thoughts on the current attitude towards oral health in care homes. Do you agree that not enough attention is paid towards it, and how do you ensure that it is made a priority in your care home? Leave us a comment below, or send us a tweet @CareShopBunzl to let us know.