Smiling matters: Oral health in care homes - progress report

Published: 20 March 2023 Page last updated: 20 September 2023



Like everyone, people living in care homes take pride in the state of their mouths, teeth or dentures. They help them to chat, smile, socialise, and enjoy their favourite foods.

Oral health not only enhances people's quality of life, but it is vital to making sure they can eat, drink, take medication and stay healthy. This preventive approach should mean that care home staff are making fewer reactive interventions and relieves pressure on primary and secondary healthcare.

The NICE guideline NG48, published in July 2016, recognised the importance of good oral care for people in care homes.

Our review for our first Smiling matters report in 2019 set out to discover how well care home and dental providers were implementing the guideline. We found that staff awareness of the guideline recommendations was low, and not everyone was supported to keep their teeth or dentures clean.

Joined-up practice between care homes and dentists was uncommon and people using services and their professional and family carers often found it difficult to access routine NHS dental care.

Between April and June 2022, we inspected 50 care homes, where we asked in-depth questions about oral health care to find out what has changed since our original set of special inspections that were completed in January 2019.

Although this intervening period was dominated by the pandemic, which saw adult social care services under massive pressure, there is much to celebrate.

Care homes are much more aware of the NICE oral health guideline. In 2019, 39% of managers were not at all aware of the guidance; this reduced more than fourfold to only 9% in 2022.

This increased awareness really can translate into better day-to-day support. People living in care homes and their families told us how staff members' commitment to good oral health support makes a difference. This is, in part, due to the increase in oral health staff training, which has doubled over the period.

As well as seeing an increase in the proportion of people having their oral health assessed when they move into a care home, we also saw improvements on how this is reviewed, to reflect people's changing needs. More than double the proportion of care plans we reviewed fully covered oral health needs, compared to 3 years before.

Care home providers told us how they were now regularly reviewing oral health and its links to weight loss, so that they can take measures to prevent people's health deteriorating.

Although almost all the comparative figures have improved between 2019 and 2022, there was variation and still room for improvement in all areas. Some people told us about a lack of support, which could put a greater onus on family and other carers, and also affect people's quality of life.

Despite our recommendation in 2019 that providers establish an 'oral health champion' to promote good practice and provide a link between care homes and dental professionals, only 28% homes visited said they had done this. While we accept that workforce issues, such as staff vacancies and turnover, will hamper this, the benefits experienced by care homes that have a champion in post demonstrate their value.

We are concerned that people living in care homes are missing out on vital care from dental practitioners – both at the right time and in the right place. The proportion of care home providers saying that people who use their services could 'never' access NHS dental care rose by more than 4 times – from just 6% in 2019 to 25% in 2022.

Care home providers also highlighted that not enough dentists were able or willing to visit care homes to treat people who may be less mobile.

There is no doubt that, in putting a focus on the importance of oral health, our Smiling matters report helped to galvanise improvement action – both within care homes and the wider health and care system.

But there is still a long way to go before people in care homes get consistent care, and equal access to NHS dentistry. Based on our recent findings, we share more learning for adult social care and dental providers in this report. And we make further recommendations for improvement that need to be owned by providers, but also system partners as well as ourselves.

That way, the good experiences that people in care homes have told us about when they receive great, co-ordinated oral health care from care home providers and dental professionals can be an expectation for everyone.

Mary Cridge
Director of Adult Social Care

Dr Mani Hussain
Director of Primary and Community Care