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Foreword 

Oral health is a fundamental part of overall health and an area that requires care and attention by all staff for all customers. As a care at home company we recognise that many of our customers can manage and maintain their own oral health independently, but where this is clearly not occurring we will offer advice, support and help to encourage them to maintain good oral health and wellbeing.

Policy

This policy aims to promote and protect our customers oral health and includes information about;

• Oral Health Assessments
• Customer's daily mouth care
• Supply of oral hygiene equipment if required or requested
• Local General Dental Services (GDS), Community Dental Services (CDS)
• (including Special Care Dentistry), Emergency Dental Treatment
• Referral process
• Oral Health Promotion and Preventive Care

This policy provides the framework for best practice with regards to oral care using NICE Guidelines and other national recommended evidence-based tools.

Customers are to have their preferences, wishes and needs in relation to mouthcare considered and addressed; and we will not look to intervene unless there is clear evidence that they are failing to maintain their oral care. By this we mean staff have never observed or supported the customer to clean their teeth or dentures, dentures are clearly faulty and not fit for use, teeth are causing pain and discomfort and this is having an impact on the customers wellbeing, causing pain and discomfort and in worst case scenario impacting their ability to eat and drink.

Our aims and expectations

1. For customers to be as independent as possible

2. For customers to express their wishes and preferences

3. To ensure that customers have timely access to oral healthcare services

4. Provide resources that promote oral health

5. Support care staff in all aspects of mouth care (training)

It is the responsibility of The Care Worker Agency to ensure that all staff are aware of and adhere to this oral care policy.

Oral Health Assessments

An oral health assessment is recommended to be included in our overall care planning and risk assessment prior to a customer beginning care services with our company. This should be included daily oral care.

Principles

1. To encourage the customer to maintain or improve their own standard of oral hygiene.

2. To keep customers informed regarding the procedure to be given

3. To maintain oral hygiene, if a customer is unable to provide his or own oral care.

4. Maintain dignity by protecting clothing and bedding.

Procedure

To use customer's familiar oral hygiene products.

Small headed medium-soft bristled manual toothbrushes or round, flat heads with electric toothbrushes if the customer has one.

Toothbrush handles can be adapted to enable customers with limited manual dexterity to continue with independent brushing.

Toothbrushes should be changed every 3 months

Teeth cleaning should be achieved at least twice daily

Dentures will be removed by staff and cleaned or prompted for customers to clean themselves as part of the daily oral care regime.

For customers' that are 'nil by mouth' the frequency of mouth care offered should be a minimum of every 4 hours or as the resident wishes

Fluoride toothpaste will be encouraged unless specific reason not to use (allergy or residents' choice to decline). High concentration fluoride toothpaste can be prescribed by dentists for customers at high risk of tooth decay.

Chlorhexidine allergies identified within personal care plans should be highlighted on resident's oral care plans.

Receding or Inflamed Gums must also be identified and raised with a dentist, as this will require specialist help with oral antibiotics and specific toothpastes, mount washes and other oral treatments.

Oral hygiene products can be bought by the care staff at the request of the customers, or we can request these items from family members supporting our customers with their shopping.

Refusal of Mouth Care

If a customer declines mouth care, staff should consider the following:

Rule out if any aspect of oral pain and if able to assess the mouth administer analgesia as prescribed and monitor the effectiveness.

Offer alternatives such as an antiseptic mouthwash

PRACTICAL SKILLS REQUIRED TO DELIVER GOOD ORAL CARE

This oral care guide is designed for care staff that deliver daily oral care to dependent people in care

Objectives

To keep the customer's mouth clean and pleasant

To avoid infection and subsequent complications

Principles

To encourage the customer to maintain or improve own standard of oral hygiene

To keep customers informed regarding the procedure to be given

To maintain oral hygiene, if resident is unable to cope by him/herself

Maintain dignity by protecting clothes and bedding

Prepare appropriate oral hygiene materials

Equipment

Customers own toothbrush (preferably soft bristles and small head) Toothpaste (fluoride)

Towel to protect clothes

Disposable gloves

Water based moisture gel for lips (if required)

Cup for water and receptacle to spit into (either the sink or a bowl if being supported out of the bathroom) Always ask the customer if you can clean his/her mouth and explain the reason why you need to do

Procedure

1. Ensure customer's privacy and comfort and explain procedure

2. Ideally it is better to carry out brushing with the person sitting down or in bed with the bed at 40-50 degrees brushing from the back/side of the person so that you have better access and visibility.

3. Place towel under chin

4. Place a flannel in the sink and part fill with cold water

5. Remove the denture/s brush with mild soap or denture cream and water in a denture pot (if cleaning teeth at night).

6. Ask the customer to open their mouth or open their mouth gently with your hand by pressing on their chin and moving their head back. If nil by mouth or resident with dysphagia, swab with damp gauze or Moutheze (MC3) over tongue, around inside of cheeks and around the gums and teeth.

7. Apply a pea size amount of fluoride toothpaste to the resident's toothbrush (manual or electric)

Supportive documents:

NG48: Oral Health for Adults in Care Homes (NICE, 2016)

Delivering Better Oral Health. An Evidence Based Toolkit (DH, 2017)

Your Care (NICE, 2017)

Mental Capacity Act (2005)

http://www.legislation.gov.uk/ukpga/2005/9/contents

QS151: Quality Standard (June 2017) Oral Health in Care Homes: