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It's time to prioritise the oral health needs of our vulnerable patients

Blog Author Natalie Bradley

Blog Date 24/07/2019

BDA CQC roundtable on older people's oral health group picture
Stakeholders at the CQC roundtable launch of the CQC report on oral health in care homes

At the beginning of this month, I was invited along to a roundtable discussion about the eagerly anticipated Smiling matters: oral health care in care home CQC report which was released in June. 

I was invited as a representative from the British Society of Gerodontology; just one of the stakeholders who attended the meeting where everyone from clinicians, patient groups, local authority leaders, health and social care and regulatory bodies were represented. 

The conclusions of the report highlighted the need to prioritise oral health in this vulnerable population of people and recommendations included:

  1. People who use these services, their families and carers need to be made more aware of the importance of oral care
  2. Care home services need to make awareness and implementation of the NICE guideline ‘Oral health for adults in care homes’ 
  3. Care home staff need better training in oral care 
  4. The dental profession needs improved guidance on how to treat people in care homes
  5. Dental provision and commissioning needs to improve to meet the needs of people in care homes 
  6. NICE guideline NG48 needs to be used more in regulatory and commissioning assessments 
It was great that this issue has been raised on a national level by the regulator and to hear some examples of good practice being showcased in the report. 

Feedback from many of the stakeholders who attended the day was positive; however, the report only confirms what many dental professionals experience every day when treating patients who live in care homes. 

I have come across many examples where the state of people’s oral health in care homes has raised concerns for me; from seeing patients who were not even provided with a toothbrush or toothpaste, to care home staff losing a denture I had made for a patient within two weeks of me fitting it!

We know that patients are now retaining their own teeth for longer. It breaks my heart when I see someone who had clearly valued and cared for their mouth, but once they are admitted to a care home, their oral health quickly deteriorates as soon as they have to rely on others to support them with oral care. 

The findings of this report are not just applicable to people who live in care homes, but also those who receive care in their own homes. I recall a patient I saw recently, a lady with dementia whose carers insisted she would not allow any toothbrushing. 

It was clear to me her teeth had not been brushed for weeks, but with some gentle persuasion, she allowed me to brush her teeth. When I had finished, she looked me directly in the eyes and said ‘Thank you’. 

We cannot underestimate the importance of good oral care which can improve nutrition, patient comfort, and self-esteem. 

The report is a great step forward, but what we really need now is action. 

There has been promising momentum surrounding the publication of the report - for example, I have already received requests from local care homes asking how their residents can access dentistry or oral health training for their staff. 

This momentum needs to be sustained and in my opinion, this should be by taking learning from programmes such as Scotland’s Caring for Smiles and Health Education England’s Mouth Care Matters to implement a national programme to address the oral health of residents in care homes and to integrate oral health into a resident’s holistic care plan. 

It’s up to all the stakeholders involved in this field to step up and make a difference. Community dentists like myself, on the ground, want to do the very best for our patients – we welcome these issues being raised and we hope there is an appetite from commissioners to help us improve people’s lives.

Natalie Bradley, special care dentist & community dental officer

PS I also have favour to ask - I've been shortlisted as one of 15 candidates (from 750!) for the chance to get a scholarship to help fund my MSc in Special Care, focusing on a dentistry and the homeless project. Please vote for me via the website, you just need to click on the heart next to my project profile! Thank you.

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