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What CQC Expects

Smiling Maters Report [CQC June 2019]  found that many residents in care homes were not being supported to maintain and improve their oral health.  

picture of toothbrushes


NICE Quality Standard [2017] recommends that residents are supported to clean their teeth and/or dentures daily and have their oral health needs assessed on admission and recorded in their personal care plans.


However, health inspectors went into 100 care homes of all types and published their findings on oral healthcare.   The Smiling Matters Report [CQC] published in June 2019  revealed that one in six do not assess residents' oral health on admission, 52% do not have an oral health plan for residents, and 47% of staff had not received training in oral health care. 

Care homes specialising in dementia, which affects up to 70% of care home residents, were even less likely to have considered oral health needs. A third of homes also said they could not always access dental care for their residents.

It concluded that residents were not supported with oral health and that oral care training was not seen as a priority. 


The Care Quality Commission (CQC) expects care managers to take account of the nationally recognised guidance including CQC Guidance from NICE.

A quick guide for care home managers' which highlights areas for Care Managers to focus on.


CQC, in essence, would like to see care homes prioritizing oral care. Included in the guide are the tools for helping make those improvements.



New questions to improve oral care in care homes have been added to the Care Quality Commission’s ‘effective’ key line of inspection inquiry.

The new questions are:

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?

  • Do staff feel confident in supporting oral health care?

  • Do staff know what to look for to identify deterioration in oral health?

  • Do staff consider poor oral health when assessing reasons behind weight loss, infection, or tissue viability?

2. How do you ensure oral health care is assessed, considered and delivered as a part of a person’s care plan?

  • Is the service aware of the NICE Guideline NG48?

  • Is oral health assessed fully on entry to the care home in line with this guideline?

  • Is there a detailed oral health care plan in place?

  • Do people have easy access to toothpaste, toothbrushes, denture cleaning fluid?

  • Do people have access to routine and emergency dental care?

Report finds that 'most had no policy to protect people's oral health

Edit and update as and when required to ensure adherence to NICE's Best Practice recommendations

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Smiling Matters Report [CQC June 2019]

CQC inspectors from both dental and adult social care went into 100 care homes, the exercise was to review how care providers were using the NICE guidance and recommendations in Oral Healthcare for Adults in Care Homes.


The report was issued by the Care Quality Commission (CQC) in June 2019  “Smiling matters: oral health care in care homes”,  it highlighted that the operation of the NICE guidance was limited within the adult social care and primary care sectors, with people generally not being adequately supported to maintain their oral health and staff have a lack of awareness of the guidance.

CQC's key findings:

  • most had no policy to promote and protect people’s oral health (52%)

  • nearly half were not training staff to support daily oral healthcare (47%)

  • 73% of care plans reviewed only partly covered or did not cover oral health

  • it could be difficult for residents to access dental care

  • 10% of homes had no way to access emergency dental treatment for residents

What CQC recommend

  • sharing best practice

  • repeating and reinforcing the guidance

  • mandatory staff training

  • oral health check-ups for all residents moving into a care home

  • a multi-agency group to raise awareness


oral healthcare new standards