The Care Quality Commission (CQC) has highlighted that many people in care homes are not getting good enough oral health care.
Poor dental health can lead to pain, trouble sleeping, discomfort whilst eating and difficulties with being able to communicate. The British Dental Association (BDA) realises the seriousness of the issue, and they have started a campaign for improved oral healthcare for older people across the UK.
The BDA disclosed several unpleasant and very serious cases of tooth decay and dental neglect which have occurred in care homes. A blind 93-year-old woman living with advanced dementia had to have her dentures surgically removed after they had been left in for weeks which led to her gums growing around them. It was discovered that another woman with learning disabilities had large amounts of decay & gum disease along with a tooth that had almost completely rotted away. The issue was only highlighted when the woman stopped eating due to the discomfort she was in.
STATS (based on 100 care homes)
73% of care plans only partly covered or did not cover oral health at all.
52% of care homes don't even have an oral health plan for a resident.
47% of staff never received training in dental care.
Why is dental care so important for older people?
Poor oral health can lead to a variety of issues such as difficulty eating, absorbing medications properly, and decreased confidence which can harm an older person's quality of life. The British Geriatrics Society claims that there are known links between poor oral health and pneumonia, heart disease & malnutrition.
The Office for National Statistics has estimated that there are at least 1.8 million people aged 65 and over who have an urgent dental condition. These conditions include dental pain, open dental pulps, oral sepsis or extensive decay in untreated teeth. Quite often, these issues would not have arisen should the person have been provided with the necessary dental care.
According to the Alzheimer's Society, there are more than 850,000 people across the UK who have dementia, some of which are living un-diagnosed. Due to the symptoms often experienced by people living with dementia, they may already struggle to eat and drink. If you then add poor oral health into the equation this can make these actions even more difficult. Pain and infection are known to add to the confusion associated with dementia and therefore having good dental health can help to reduce the risk of these.
Who is responsible for organising dental care in care homes?
The care home must make sure that all of their residents' health needs are met, dental care being no exception. Care home managers have a responsibility to provide information about their dental care process to current and prospective residents & their families. All Care Quality Control (CQC) registered managers are expected to take account of nationally recognised guidance. Quite often, care homes will have an arrangement where a local dentist visits regularly to provide dental check-ups, or alternatively there may be a local community dental service who visits.
Care homes have a duty to ensure that all residents have an oral health assessment when they move into the home and the result should be recorded in the residents' care plan. The care home should be asking questions such as what dental aids they use, whether they have dentures, and what level of support they require with their dental care.
It is important that care home managers ensure that all of their staff members have the knowledge and skills needed to take care of their residents' dental care. They should be provided with training on how to judge when a resident needs their oral health to be reassessed, and how to support residents with their everyday dental care regime. For instance, they should know that they need to brush the residents' teeth twice a day, clean their dentures (if applicable) and to use the residents' choice of dental care products.
What steps are the BDA taking to improve oral health for older people?
The BDA presented evidence to the National Institute for Health and Care Excellence (NICE) on a new quality standard for oral health in care homes including:
- Adults who move into a care home have their mouth care needs assessed on admission
- Adults living in care homes have their mouth care needs recorded in their personal care plan
- Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures.
Currently, only 7 of their 2003 recommendations have been met in full, and the BDA continue to work to improve oral health provision for older people.
In Northern Ireland, the BDA continues to highlight the issue in oral healthcare for older people. They have the fastest-growing ageing population in the UK with Northern Ireland Statistics and Research Agency (NISRA) disclosing that the number of adults aged 65 and over is to increase by 64% by 2033.
BDA has presented evidence to the Health and Social Care Board and shall be making sure that they begin to address the issue head-on.
In Scotland, the Public Dental Service (PDS) has reservations about the proposal in the Scottish Government's Oral Health Improvement Plan to allow accredited GDP's to provide care for people in care homes.
BDA is working hard to ensure that compulsory services are appropriately resourced and funded so that all patients receive the care they require, where and when they need it.
There is a gradual reduction in PDS dentists which will, of course, have effects on patient care. For instance, longer waiting times are to be expected, along with fewer patient appointments.
In 2015 a study was conducted which showed that a staggering almost 73% of care home residents had tooth decay. Not only this, they are less likely to brush their teeth or dentures twice a day than other older adults.
The BDA will persist on calling on the Welsh Assembly to make sure that the right provisions for older people are being made to ensure that their oral health is safeguarded.