Good oral health should be seen as a fundamental human right; it is inseparable from a person’s general health and wellbeing. Nurses are ideally placed in making every contact count, particularly with regards to oral health. Only by taking a holistic approach to health promotion, by addressing risk factors that are shared by systemic and oral diseases, can there be any success in achieving improved levels of oral health for the population – young, old and those in between.
When our NHS was launched on 5thJuly 1948 it meant that for first time ever, dental care was free at the point of use. This dramatically changed people's access to good oral healthcare, their expectations as well as their understanding of looking after their oral health. Anyone - rich or poor, man, woman or child could use any part of the NHS, there were no charges, no insurance qualifications and the NHS was not a charity, it was intended to relieve money worries in time of illness. This free at the point of need dental care did not last long, in 1951 charges for dentures were introduced. These were the first items to be charged for under the new NHS, or 'the thin end of the wedge', as some came to call it.
Fast forward to 2019, NHS dentistry looks very different today from the way it did in 1948. Contemporary techniques and state-of-the-art technology mean that dentistry today offers a range of treatments unthought of by the dentists of the past. NHS dentistry should be a global leader, making sure that everyone gets access to dental care that is associated with good oral health outcomes, regardless of where they live, whatever their financial situation. However, not everyone is experiencing good oral health care.
The Care Quality Commission (CQC) has undertaken a review of oral health care in care homes and found it lacking, considerably1. In 2019, the independent regulator of health and adult social care in England has had to undertake a review of something as fundamental as oral health care for the most vulnerable in our society, surely this cannot be right.
This is just as important for people who are living in care homes and these people should expect to experience good oral health care, including daily care and regular check-ups. To demonstrate the importance of good oral health the National Institute for Health and Care Excellence (NICE) has published best available evidence guidelines, just as it publishes guidance on other important health and care related issues2. The NICE recommendations aim to maintain and improve the oral health, including dental health and daily mouth care, of those adults in care homes. Yet there are some care homes who have ignored these guidelines. Care providers cannot choose not to follow NICE guidance3.
The upshot of this failure is negatively impacting on people. CQC dental inspectors attended 100 routine planned inspections of care homes together with CQC inspectors from the adult social care team undertaking a review to determine how care home and dental providers were implementing the guideline. Staff awareness of the guideline recommendations was low and not everyone was supported to keep their teeth or dentures clean. The CQC review revealed that only around 50% of the care homes provided specific staff training to support people’s daily mouthcare; it was uncommon for the inspectors to observe good practice.
Care homes (care home managers and staff) must embrace oral health, ensuring that it receives the same priority as physical and mental health. Oral health is intrinsically linked to over-all health as we eat, drink, smile and talk. All nurses and health professionals must have insight and understanding regarding the serious impact of oral diseases on the health, nutrition and well being of care home residents.
Ian Peate is Head of School of Health Studies, Gibraltar; and Editor-in-Chief of the British Journal of Nursing
References
1. Care Quality Commission. Smiling Matters. Oral Health Care in Care Homes. CQC 2019. Newcastle
2. National Institute for Health and Care Excellence. Oral Health in Care Homes. NICE 2017 https://www.nice.org.uk/guidance/qs151
3. National Institute for Health and Care Excellence. Court Warns CCG Over Disagreeing with NICE Guidance. NICE 2014 https://www.nice.org.uk/news/article/court-warns-c...