How to identify poor oral health and improve it

November is Mouth Cancer Action Month and it got me thinking about oral care within the social care sector and how it plays such an important role in ensuring a good quality of life for the people we’re supporting. Poor oral health can lead to things that we often wouldn’t think about, including:

• Infections
• Pain and discomfort
• Disturbed sleep
• People not taking their medication
• Other health conditions, such as aspiration pneumonia and oral cancer
• People not being able to speak properly which can lead to social isolation
• People not eating/drinking properly which can lead to an increase risk of malnutrition.

“Approximately 650,000 people are affected by mouth cancer worldwide each year.”

A snapshot of oral care in homes

In June 2019, the Care Quality Commission (CQC) published their smiling matters report which reviewed the state of oral health care in care homes across England. This called for mandatory staff training care in oral care and a greater awareness of the importance of good oral care and what this means from employers, carers, people accessing care and their families.

Kate Terroni, Chief Inspector for Adult Social Care at the CQC, 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.”

Why do some people receiving care and support have poor oral health?

One of the biggest contributors is lack of awareness and training. NICE guidelines don’t state that oral health training is a requirement, but I believe that it’s imperative that care providers ensure that some form of oral care training is provided, so that care staff know how to provide efficient oral care, are able to identify and report any concerns, and respond to someone’s changing needs and circumstances.

Other factors include:

• Physical health conditions such as Dementia, Parkinson’s and Arthritis
  These can make it harder for people to hold a toothbrush and/or visit a dentist.
• Mental health conditions
  These can be due to the side effects of anti-psychotic and anti-depressant medications, smoking, alcohol and drug use.
• Poor dietary choice
  This includes excessive caffeine consumption and increased sugar consumption.
• Self-neglect
  People who’ve ignored their dental health typically suffer from tooth decay, staining and chipped teeth, and may be too embarrassed to visit a dentist.
• Lack of community dental services
  This is prevalent for people who can’t get to local dentists.
• Medication side effects
  Such as a reduction of saliva which can lead to a dry mouth.
• Inadequate exposure to fluoride
  This can be both in the water supply and oral hygiene products such as toothpaste.

Top tips for improving oral health

1. Prioritise oral health

Regardless of whether we work in a care home or community, it’s vital that oral health is a priority and not an afterthought. Help assist those in care to meet their daily oral care and hygiene needs.

2. Ensure oral health policies are in place

3. Train staff on oral health

You can access free general oral health training and more bespoke community training. Any training you do should be refreshed annually and cover these main points:

• What is oral health care and why it is important?
• How does poor oral health affect general health, wellbeing and dignity?
• How to carry out daily oral care tasks.
• Identifying toothpaste with fluoride for brushing natural teeth.
• How to use a specialist product when cleaning dentures to ensure food debris is removed.
• To encourage people to remove dentures overnight.
• How to support someone who doesn’t want daily mouth care.
• How to recognise and respond to changes in a person’s mouth care needs and know when to report concerns and who to go to for advice and support.

4. Create oral healthcare plans

Develop these so it’s clear how to support someone. Some of the things we could ask include:

• How do you usually manage your daily mouth care?
• How often do you usually brush your teeth?
• Do you prefer to use an electric or manual toothbrush?
• Do you floss, and if so, what flossing tools do you use? If they don’t, would they like to try any to see if they’d like it as part of their routine?
• What support do you need or would like?
• Do you use mouthwash? If so, do you prefer alcohol or alcohol-free?
• Do you have dentures (and if living in a care home, would they like them marked so they don’t get lost)?
• How often do you visit a dentist, which surgery do you use and do you require support going?

5. Provide ongoing support

It may be that someone hasn’t visited a dentist for a while, or they may need help registering with a dental practice. By assisting people who want to access dental services, we can ensure they receive regular check-ups and any necessary dental treatment. Support should be person-led, for example, do they just need signposting to a practice or do they need support accessing services?

6. Challenge the system

It’s important as a care provider or member of staff that we challenge, especially if:

• Dentists aren’t willing to visit care homes or people in their homes
• Dental practices aren’t accepting new patients
• There are long waiting times to get an appointment with an NHS dentist.

7. Implement NICE guidelines and standards

The National Institute for Health and Care Excellence (NICE) published evidence-based guidelines and standards for oral health in care homes in July 2016, which cover oral health, including dental health and daily mouth care. The guidelines are aimed at helping care providers to prevent oral ill health in the people that they support and to promote good oral health.

8. Use oral health assessment tools

These are great at highlighting any areas where people require specific care and support. Reviewing these will help you identify any changes that may require action and in turn prevent pain, health problems and poor oral health.

9. Utilise resources online

• ‍Mouth care matters‍
• Oral health toolkit for adults in care homes

Conclusion

Oral care is often not prioritised, however if we can change this and ensure that staff are trained and people have a clear oral health plan in place, we can reduce infections and promote good oral health.

Remember to look out for:

• Red or white patches that do not heal in three weeks
• Lumps or swelling within the mouth
• Difficulty swallowing
• Unexplained loose teeth
• Numbness within the mouth.

Oral health can no longer be an afterthought and must form part of every social care provider’s initial assessment paperwork.