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3 years after Smiling Matters: How Care Providers are still failing in Oral Health Care

Updated: Jan 31, 2023

A CQC Report from an Inadequate service said that the care provider was putting people's oral health care needs at risk.


An area of focus in the coming weeks is oral health. In the CQC News Update May 2022 CQC wrote that it 'made a commitment to follow up on the recommendations made in the Smiling Matters report'. The follow-up report, which is anticipated to be published next month looks at whether improvements have been made in oral health care.

The Smiling Matters oral health report was published 3 years on from the NICE guidelines [NG48] in July 2016. It found that, of the 100 care homes CQC visited, steps were often not being taken to ensure that service user's oral health was being addressed.



Poor oral health can be fatal

Poor mouth care can adversely affect a person's general health, leading to potentially life- threatening conditions particularly in the elderly, leading to further health complications including aspiration pneumonia which can be fatal. If daily mouth care isn't being carried out and plaque bacteria on the teeth and/or dentures is allowed to mature, this will get inhaled into the lungs which can lead to pneumonia, a leading cause of death in the elderly.



Failings in oral health care from a care provider

A care home that was rated Inadequate. In the Effective standard it stated its failings in oral health care. It reported that the Pre-assessment form for new admissions consisted of two tick box questions for mouth care. One asked about whether the person had dentures and the other asked if they had any sores or pains. No information was taken relating to oral health daily routines, dental hygiene products used or the persons’ preferences. It stated that 'the lack of proper oral health assessments put residents oral health care needs at risk'.


​The Care Quality Commission would like to see care homes treat mouth care as an equal priority to other personal care needs. Care homes need to document that an effective assessment of a person's oral hygiene has taken place.


Oral assessments must be carried out for all new patients/service users regardless of how long their stay and incorporated into their care plan where it should be documented what dental products are used and whether the person is exempt from NHS dental charges.


In an oral assessment it should be noted if

  • A service user has broken teeth

  • Wears a denture [note if it is broken or loose]

  • Has any obvious sores or lesions [may require emergency treatment]

  • If complaining of any discomfort in the mouth [ensure they are pain free]

  • If registered with a dentist [oral health check ups]

  • Whether they have adequate capacity and can brush their own teeth or require assistance A variety of oral health assessment forms can be downloaded . KOHC Resources, NICE website, NHS Mouth Care Matters resources website.


Confidence and skills

Staff who complete the oral health assessment should have the necessary confidence, skills and knowledge.

Staff that carry out the assessment should be trained to understand mouth care needs and they are aware of signs of dental ill health, for example dry mouth and gum disease. When looking for training, view the learning objectives of a course to ensure that oral health assessments are included.


Appointing an oral health champion

Nominating an oral champion is left to the choice of the care home although it would be beneficial to consider someone. They play a significant role; to raise awareness about the importance of oral health and promoting best practice; Having a person that is responsible to oversee that daily oral care is carried out.


They can be responsible for putting systems and processes into place that cover oral health in care plans and ensure they are adhered to. An oral champion is not expected to be an oral health expert but this person should have a basic understanding of what is needed for good oral care.

Sign up to 'The Role of an Oral Champion' Live webinar. Next available date Weds 8th Feb at 10am [40 mins] Register HERE



CQC's new regulatory approach

The care quality commission has stated in its new assessment framework that they will gather information for their reports from people's experiences of care services in a variety of ways and not solely from on-site inspections. We anticipate that residents' and next of kin will be questioned about the level of service received.



Family members unhappy about lack of mouth care

The lack of mouth care is an area of personal care that family members often comment on. Many residents in care homes are dependent on carers to assist, prompt or remind them to brush their teeth. Unfortunately mouth hygiene often gets forgotten or eliminated. A neglected mouth will contribute to halitosis and can impact on contact with friends and family members. An unpleasant aroma from the mouth can be off putting causing loved ones avoid having close contact or kiss the person.



Providing easy access to routine and emergency treatment

The full CQC report revealed that nearly a third of all care homes visited by adult social care inspectors were unable to access emergency dental treatment.

It can be a challenge for some care managers to register a person living in their home with an NHS dentist. Prompt referral to a dental service is important to avoid lengthy waiting times. Admittedly it is a challenge in these current times when the dental profession is at its knees.

Local commissioners need to address oral health in care homes. Individuals that are bed-bound and have difficulty accessing a dental practice require a domiciliary dentist. There are very few dentists in general practice that have an NHS contract to provide a domiciliary service. In addition, the community dental service does not always provide a domiciliary visits for routine dental care. Patients are often triaged to those in most need; to relieve pain.


Time to brush up on oral health education

It is recommended that managers of care homes make sure their staff know when and how to deliver oral care. The smiling matters oral health report found that 'Nearly half of care homes (47%) weren't providing any staff training to support people's daily oral healthcare'. Four months after the Smiling Matters report was issued, two oral health questions were added to the KLOEs. Question 1 asks if staff have received training.


  1. Do all staff have training in oral health care?

•Is oral health covered in induction? •Is oral health a mandatory component of regular training?


Although the NICE oral health guidelines don’t state that training in oral health is a requirement, it does 'recommend' that managers of care homes make training mandatory.

Of those care homes that had received training in oral health, "Our inspectors saw the lack of detailed training as a barrier to implementing the NICE guideline" [Smiling Matters full report].


How do I know what training to choose?

When looking for training, in addition to mouth care delivery and tools the learning should include:

  • Tips and coping strategies for people that resist

  • Mouth care and people with complex needs eg. people with swallow difficulties

  • Palliative and end of life mouth care management

  • Understanding of what to look for when carrying out an oral health assessment

Time constraints and financial implications

Of the care homes that had not implemented training, a summary of the comments made to inspectors was because 'engagement activities to staff was due to a lack of time, financial resource, or perceived priority'.


Knowledge Oral Health Care are dental professionals that deliver oral health care training to the care sector in a variety of ways. We understand the time constraints of a care homes and offer affordable ongoing training to care providers which enables all staff to enrol attend training in oral healthcare by eLearning or a Live Zoom webinar which is held twice a month. For more details contact Knowledge Oral Health Care info@kohc.co.uk T|01243 710119



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