What Areas Of Oral Care Should A Mouth Care Plan Cover To Meet CQC Standards?

How would YOU feel if you couldn’t brush your teeth for two weeks? Just think about that for a moment …

I think I can make an educated guess and say dirty, disgusting, slimy mouthed, rotten tasting mouth, bad breath, embarrassed, ashamed, not feeling like talking to anyone, and the list could go on…

And yet in a recent poll, we carried out with our care managers, a staggering 43% said that staff did not see oral care as a priority for their residents! 

Evidence suggests that being in a care environment is associated with a deterioration in oral health of residents. 

“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.’

These words from Kate Terroni, Chief Inspector for Adult Social Care at the Care Quality Commission (CQC), following their research on the state of oral health care in care homes across England. 

So why is good oral care so important?

• Good oral care can have a positive impact on social and emotional well-being
• It reduces bacteria levels in the oral cavity 
• It helps maintain adequate levels of nutrition and hydration for weight maintenance
• It  keeps residents as comfortable as possible in palliative and end-of-life care,
• Dental decay and gum disease are entirely preventable
• It reduces the risk of a wide variety of illnesses including:

Dementia 
Pneumonia
Diabetes
Kidney and Heart disease
Cancer

In the NICE guidelines https://www.nice.org.uk/guidance/qs139/chapter/Quality-statement-3-Oral-health-in-care-plans,  oral health is featured as a key part of a person’s overall health and wellbeing. Including oral health in care plans for people receiving health or social care support and at high risk of poor oral health helps ensure that relevant needs are addressed. This may include day to day support to help people maintain food oral hygiene and referring to dental services if needed. 

As a result of their research findings and their subsequent report, Smiling Matters, https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes,  CQC will be continuing their focus on  oral health in care homes this year by checking oral health policies, staff training to support oral health, oral health care plans and arrangements for access to dental care and emergency treatment.

So what areas of oral care should a mouth care plan cover?

 All residents should have an oral health assessment when they first move into a care home, regardless of the length or purpose of their stay, with the results recorded in their care plans.

 Care staff should start by asking the following questions:

1. How do you usually manage your daily mouth care and what help would you like?
   
   
2. What dental aids do you currently use? For example, manual or electric toothbrush, mouthwash, floss.
   
3. Do you have dentures, and if so are they marked with your name? 
4. If not, would you like them to be marked?
   
   
   
5. When did you last see a dentist, and who did you see?
   
6. If you don’t have a dentist would you like help to find one?

Using an oral health assessment will highlight any areas where residents need specific care and support. Using it for reassessments will indicate any changes that may need action.

A mouthcare or oral care plan should contain the following information: 

When to reassess the oral health of a resident and how to support residents with their daily mouth care to:

Brush their natural teeth at least twice a day with fluoride toothpaste.

Use their choices of cleaning products for dentures

Clean their dentures (brushing, removing food debris, and removing dentures overnight).

Record all oral care given in care plans including refusal, so that it’s documented that you have attempted to deliver that care, but it is your resident’s choice not to have it. 

Providing evidence of how you support your residents to maintain good oral health, in mouth care plans will demonstrate that your service is both EFFECTIVE and  RESPONSIVE to CQC. 

You may also find the following articles we wrote helpful:

https://hcsuk.co.uk/why-oral-care-needs-to-be-given-greater-priority-in-care-homes/