2.1 Summarise current national guidance and organisational policy relating to oral health relevant to adult care

This guide will help you answer 2.1 Summarise current national guidance and organisational policy relating to oral health relevant to adult care.

Oral health plays a significant role in overall health and well-being. In adult care, maintaining oral health is especially important to ensure individuals’ comfort, dignity, and quality of life. There are national guidelines and organisational policies in place to guide care workers in supporting oral health for adults. Below is a detailed summary of these.

NICE Guidelines on Oral Health for Adults in Care

The National Institute for Health and Care Excellence (NICE) published recommendations to address oral health needs in adults receiving care services. These are outlined in their standard NG48: Oral Health for Adults in Care Homes, which is widely used as a benchmark for best practice in oral care. Key points include:

1. Oral Health Assessment

• Care organisations must assess the oral health needs of individuals upon admission to the service.
• This assessment should identify existing dental issues, oral hygiene routines, and risks such as dry mouth or tooth loss.

2. Personalised Oral Care Plans

• Care plans should include tailored oral hygiene support as part of an individual’s daily care routine.
• Local dental services or oral health practitioners may need to be involved where complex needs exist.

3. Supporting Adequate Daily Oral Hygiene

The guidance emphasises providing regular, proactive oral care to maintain good health. Recommended practices include:

• Cleaning natural teeth twice daily with fluoride toothpaste.
• Assisting individuals with dentures, ensuring they are cleaned daily and fit comfortably.
• Regularly moisturising the mouth in people with dry mouth (xerostomia).

4. Staff Training

The guidelines stress that care teams should be adequately trained in oral health care. Training topics may include:

• Recognising signs of oral health problems, such as gum disease, ulcers, or infections.
• Proper techniques for brushing and denture cleaning.
• Understanding how systemic conditions, such as diabetes or stroke, may affect oral health.

5. Collaboration with Dental Professionals

The guidance recommends fostering strong relationships with local NHS dental services and arranging regular check-ups for individuals in care. It supports providing access to urgent dental treatment if needed.

Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention

This toolkit, published by Public Health England (PHE), offers evidence-based recommendations for improving oral health in all populations, including adults in care. It highlights preventive measures that can reduce oral health problems. Key recommendations include:

• Fluoride Use: Fluoride toothpaste containing at least 1,350ppm fluoride should be used to reduce the risk of decay. Fluoride varnish application may also be recommended by dentists.
• Dietary Advice: Reducing the frequency of sugar consumption to prevent tooth decay. Drinks like water and milk are promoted over sugary beverages.
• Oral Health Promotion: Highlighting the importance of educating adults in care about maintaining oral hygiene, particularly those who are capable of self-care.
• Smoking Cessation and Alcohol Reduction: These habits are identified as major risk factors for oral cancer and other dental problems. Regular support to help individuals quit smoking and reduce alcohol consumption is strongly endorsed.

NHS Standards on Oral Health in Adult Care Settings

The NHS supports oral health through routine dental check-ups, treatment services, and community dental teams. Within adult care settings, NHS priorities include:

• Ensuring all individuals have access to NHS dental care, including home visits for those physically unable to travel to a dentist.
• Promoting regular oral examinations by a dentist to identify early signs of problems, such as cavities or oral cancer.
• Addressing inequalities in oral health. Vulnerable adults, such as those with disabilities or dementia, are at greater risk of poor oral health and require tailored services.

The Care Quality Commission (CQC) Requirements

The Care Quality Commission (CQC) oversees the quality of care provided in health and social care settings, including oral health care. Its guidelines emphasise oral health as a critical aspect of personal hygiene and care. Key points include:

• Inspectors will assess how care providers meet the oral health needs of residents.
• Providers must demonstrate policies and procedures that ensure oral health is prioritised.
• Family members or carers should be involved in oral care routines wherever possible.

CQC inspection frameworks now place oral health under the broader category of “Safe, Effective, and Responsive to Needs” care.

Organisational Policies in Adult Care

Care organisations must put policies and procedures in place to integrate national guidelines into daily practice. These policies are typically designed to:

1. Support Daily Oral Care

Staff must help service users maintain their oral hygiene, particularly those who require assistance due to physical or cognitive limitations. Good oral care practices are documented in the individual’s care plan.

2. Train and Support Care Staff

Policies often require all staff to receive specific training on oral care. This ensures employees feel confident when carrying out oral hygiene tasks and recognising when specialist advice is needed. Organisations may access training resources from organisations like NICE, PHE, or dental associations.

3. Facilitate Access to Dental Services

Policies should outline procedures for contacting community dental teams or referring individuals for treatment. Care homes may partner with local dental practices to provide routine or emergency dental care onsite.

4. Address High-Risk Groups

People with severe disabilities, learning difficulties, or conditions like Alzheimer’s are often at higher risk of neglecting oral health. Organisational policies should provide additional safeguards for these groups to ensure they receive appropriate care.

Guidance for Specific Groups of Adults in Care

People with Dementia

Individuals with dementia may refuse oral care or forget to clean their teeth, leading to a higher risk of gum disease or dental decay. NICE guidelines encourage tailored approaches to addressing these challenges, such as using communication that calms and reassures individuals.

End-of-Life Care

Oral health support is vital for individuals in palliative or end-of-life care. Sore gums, dry mouth, or infections can significantly impact comfort. Policies often require mouth care to be delivered frequently, aligning with a person’s wishes and dignity.

Barriers to Implementing Oral Health Guidance

While national guidelines and organisational policies provide clear frameworks, care workers may face challenges when implementing these in practice. Common issues include:

• Limited availability of training.
• Difficulty in accessing NHS services in certain areas, particularly for housebound individuals.
• Anticipating and overcoming resistance to oral care from service users with cognitive impairments or behavioural issues.

Promoting Good Practice in Oral Health

To provide effective oral health, it is essential to embed oral care within the daily routines of adult care settings. Below are some good practices derived from national guidance and organisational policy:

• Perform regular reviews of oral care plans, adapting them to changes in the individual’s health or preferences.
• Encourage a multidisciplinary approach, involving dentists, dietitians, and occupational therapists as needed.
• Place reminders or checklists in individual care plans to ensure routine oral hygiene tasks are not overlooked.

Regular staff audits and feedback sessions can also help organisations monitor their adherence to policies and look for ways to continuously improve oral care outcomes.

By aligning with national guidance and embedding effective organisational policies, care providers can play a crucial role in supporting the oral health of adults, contributing to their overall health and well-being.