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The Problem

The problem of dental neglect and high levels of unmet dental needs among older people living in care homes has been identified as an area of concern[1].

Key issues regarding dental care include, the need for improved routine oral hygiene, adjustment of loose dentures, and dry mouth. It has been suggested that daily oral hygiene and regular check-ups by a dental professional are needed for all care home residents.

Based on anecdotal learning from the Enhanced Care Home Outcomes (ECHO)[2] study and an earlier piece of work supported by Health Education England Thames Valley (HEETV) about the need to improve dental care, it became apparent that dental needs and neglect in Oxfordshire’s care homes needed to be assessed.

At the start of the Enhanced Care Home Outcomes (ECHO) study an audit was carried out of its 104 care homes (approx. 4,000 residents) to collate baseline data on dementia diagnosis, nutrition, end of life care and medication use.

A further audit was planned for the end of the project, in January 2016, as part its evaluation. This audit was modified to include dental care in these care homes, making efficient use of the existing ECHO integrated care teams and resources.

The aim of the dental audit was to find out if the residents in the care homes had an oral health care plan. If they did have a care plan, whether the plan adheres to best practice guidelines. The audit took place in collaboration with the dental team for Oxford Health NHS Foundation Trust who were also involved in designing the data collection tools.

In total 3,305 resident’s notes were audited using the dental guidance. Results for each care home were categorised as either green, amber or red:

  • Green – Dental care plan completed as per guideline;
  • Amber – Dental care plan partially completed as per guideline; and
  • Red – No dental care plan.

The Impact

This audit is, to our knowledge, the largest audit in this subject area and highlights a number of care needs for a vulnerable population.

The results found that only 10% of care home residents in Oxfordshire had a fully completed dental care plan.

The results of the audit were fed back to each care home enabling them to examine their practices, and has also provided Oxford Health Dental Team with valuable information regarding the dental health of care home residents living in Oxfordshire’s care homes and to develop an action plan to address this.

Involving the Oxford Health NHS FT Dental team in the designing of the data collection tools also helped to further embed a culture of research in an NHS setting.

We know poor dental health is linked to weight loss, pain and a reduced sense of well-being[1], [2]. Improving dental care planning for care home residents will have a positive impact on resident’s health and well-being.

This work has led to a collaboration of organisations, including Oxford Health NHS FT and Health Education England Thames Valley, and the development of a bid (pending at time of writing, August 2017) for further research funding to investigate effective practice in relation to dental care for people with dementia in care homes.