Enhancing the care of people's teeth and gums in care homes by training staff

Not many of us realise that high levels of bacteria in our mouths have been linked to heart disease, diabetes and pneumonia. As dementia progresses people can have twice as much plaque on their teeth and gums, and so the risks increase.

A 2012 survey by the British Dental Association found the oral health of care home residents to be deplorably poor, with inadequate training for staff. A new initiative aims to help care workers brush up on their skills.

Training staff

Through the Improving Oral Health of Older Persons Initiative, dentists and dental hygienists have been training staff from 160 care homes in south-east England. There are also plans to develop a package for hospitals and for care in people's own homes.

The initiative was introduced last year by Professor Stephen Lambert-Humble, Postgraduate Dean of Dentistry for Health Education Kent, Surrey and Sussex, after talking to oral practitioners who go into hospitals and care homes.

He says,

'I thought it was important to get over the message about the link between poor oral health and disease.

'For example, we now know that when levels of bacteria rise to a certain level in the mouth it can lead to pneumonia and in a large number of cases people end up in hospital and never come out.'

Changing practice

Mike Wheeler leads the training and says feedback from care home staff has been amazing. Shocked by what they learnt, many pledged to put their new techniques into practice.

Mike says,

'The training has been incredibly well received. Most staff say they didn't realise the importance of having healthy teeth and gums, and that if you let someone's teeth deteriorate this can exacerbate ill health.

'Evidence in the past has suggested that care workers have a negative approach to oral health. We didn't find this at all. Workers are very keen to change things, but the challenge was educating the managers that it should be a priority.'

It is hoped that support from the Care Quality Commission (CQC), the regulator of health and social services in England, will make a difference.

Professor Lambert-Humble says,

'The CQC has agreed we can teach its inspectors about oral health, and from September 2016 homes and hospitals will have to carry out initial oral care assessments and will be required to have dental care plans in place in time for their inspections.'

Next level

Emma Berwick, dementia care manager at Miramar care home in Herne Bay, attended the training along with five colleagues earlier this year.

She says,

'We found the training really useful. Of course, we do our best to take good care of residents' teeth, but this showed us how to take oral care to the next level.

'For example, we have always brushed residents' teeth after breakfast but we discovered brushing should be carried out before as the fluoride protects against acid erosion from food.

'We learnt lots of different techniques and about the links with overall health. It was very insightful.'

Vital to tackle

The project team is reviewing the training's success and will present their findings to NHS England in the hope it will be rolled out elsewhere.

Professor Lambert-Humble acknowledges that maintaining oral health as dementia progresses can be challenging, but says it is vital to tackle problems with teeth, gums and ill-fitting dentures since these can affect self-esteem, nutrition and overall health.

He says,

'People may be resistant to having their teeth cleaned, you have to consider whether to approach from the front or back and if you need to use a specially adapted toothbrush.

'But you don't have to be a dentist to look after someone's mouth properly. The right kind of care can be provided by anybody. They just need the right training to make a world of difference to an older person's health and wellbeing.'

See our factsheet Dental care and oral health or call 0300 303 5933 to order.

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