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Teeth left to rot: The shocking state of oral health of people in care homes

Blog Author Charlotte Waite

Blog Date 26/06/2019



We've responded to a new CQC report which shines a light on the lack of access to dentists and lack of support being given to care home staff in England. Reading the report makes for a grim and distressing read. 

As a community dentist, I regularly see patients whose oral health has deteriorated rapidly, following admission to a care home, leading to pain and infection. Leaving patients unable to eat and drink comfortably. Oral health has an impact on general health, diet, speech, and appearance. Often this leads to pain and discomfort which many patients in care homes cannot communicate to their carers and can mean that people are often suffering in silence. So we must ensure that mouth care is implemented appropriately.   
What is really shocking about the CQC’s findings is that the oral health of those living in care homes is being failed. It’s well below the line of what we’d expect and find acceptable in a modern society and health inequalities are persisting.

Around half of the care homes surveyed did not provide training to their staff on oral health care, while nearly three-quarters of individual care plans did not cover oral health sufficiently. 

One in six care homes also said they did not assess residents' oral health on admission. 

One in three said they could not always access dental care. This was mainly related to the lack of specialist dental services that visit people in the community rather than expecting them to attend clinics. 

It is time for action, and we’ve called for a revolution in the approach to dentistry and oral care in care homes.

Our own research has found the NHS is also only paying for a fraction of the dental services needed by older people, or vulnerable adults. 

Around eight per cent of the general population’s activity is classed as "severely limited". One of the main challenges in providing access to NHS dental services is a lack of commissioning of domiciliary care provision. There must be appropriate commissioning, underpinned by robust needs assessment to ensure access to dental services for all people, in the right place, at the right time covering mainstream, domiciliary and urgent care.

We made a Freedom of Information request on the levels of commissioning and the data shows that they are low and falling – and provision is currently only covering 1.3% of the population whose activity is limited by disability or ill health.

I’ve been raising these issues in the national press, and I’m heartened to see support from so many colleagues and other key stakeholders, including the CQC. 

I highlighted a case study on Radio 4’s the You and Yours programme of a patient with dementia who had to have her denture surgically removed, as the right care plans were not in place and staff in the care home were not aware she had a denture. 

We also know it’s not just older people experiencing neglect. Another recent case study showed a 45-year old patient with learning disabilities and autism presenting with extensive decay and periodontal disease. The dentist asked the carers about support and as is sometimes the case, the patient refused mouth care and they said it was challenging to deal with. Carers must be appropriately trained and supported to deliver mouth care.

There was no mention in the patient’s care plan about oral hygiene, and although the carers were very attentive to the patient, no-one had focused on oral healthcare and the care home had not implemented the NICE guidance.

On the You and Yours programme, it was great to hear Kate Terroni, Chief Inspector of Adult Social Care at the CQC, saying she welcomed the BDA’s views on their report, and that they are working to ensure people in care homes get their oral health needs assessed and met more consistently. 

We hope that oral health care will not now be left at the bottom of the pile. We will continue to call on Government for better commissioning for vulnerable people, to ensure guidance is followed and staff are adequately trained and supported. 


We must ensure that these inequalities do not persist. With an improvement in oral health care will come an improvement in quality of life. Change will only come about with a truly collaborative approach cutting across health and social care systems. 

The NHS constitution, sets out “NHS Values” including: "Everyone counts. We maximise our resources for the benefit of the whole  community, and make sure nobody is  excluded, discriminated against or left  behind.” 

Now is the time for this value statement to become a reality for vulnerable people, many of whom are having their general health put at significant risk, as a consequence of poor oral health.  

Charlotte WaiteCharlotte Waite, Chair
England Community Dental Services Committee

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