Care Home Forum

Samantha Tomlinson

Mouth Care Matters Project Officer - HEE

What is Mouth Care Matters?

Oral health improvement programme working to

improve the oral health of all hospitalised patients

#Lift the lip

#Put the mouth back

into the body

@NHS_HealthEdEng #MCM @MCM_HEKSS

If you forgot your toothbrush for a weekend away?

How would you feel?

Had no time to stop for a drink?

A painful mouth ulcer?

“Oral health is multi-faceted and includes, but is

not limited to, the ability to speak, smile,

smell, taste, touch, chew, swallow and

convey a range of emotions through facial

expressions with confidence and free from

pain or discomfort, and diseases of the

craniofacial complex

FDI World Dental

Federation 2016

Oral Health is more than teeth

Compassion &

Dignity

“Oral Health is a

Fundamental Part of

Overall Health and

Well-Being that Should

Not Be Neglected”

• Tooth brushing

• Removing oral secretions

• Dry mouth care

• Denture care

Poor Oral Health and the links to

General Health

• Heart Disease

• Pneumonia

• Diabetes

• Stroke

• Alzheimer's/Dementia

• Cancer

• Premature/Low birth weight

Strong evidence based Links Weaker evidence based Links

A systematic review found the removal of dental plaque

reduces the incidence and mortality of pneumonia Scannapieco et al, 2003

Approximately one in 10 cases of death from

pneumonia in elderly nursing homes may be prevented

by improving oral hygieneSjogren et al, 2008

Studies

July 2016

Oral health for

adults in care

homes

“People living in care homes are at greater

risk of oral health problems for several

reasons”:

“People living in care homes are at greater

risk of oral health problems for several

reasons”:

Oral Health AssessmentAll residents should have an oral health assessment when they move into the care

home, with the result recorded in their care plan.

Care staff should start by asking the following questions:

Oral Health AssessmentAll residents should have an oral health assessment when they move into the care

home, with the result recorded in their care plan.

Care staff should start by asking the following questions:

Care staff need to know when to reassess the oral health of a resident and how to

support residents with their daily mouth care

knowledge and skills

Care staff need to know when to reassess the oral health of a resident and how to

support residents with their daily mouth care

knowledge and skills

What the CQC expect

NICE

Oral health

assessment tool

MCM

assessment

tool

@NHS_HealthEdEng @MCM_HEKSS #mouthcare

When to report any oral concerns

Abnormalities in the mouth Broken teeth that require dental treatment

White coating on the tongue Dentures that cause problems

How to access dental care?

• www.nhs.uk (search find a dentist) – usually unable to make home visits

• Urgent- NHS 111

• Private – May offer domiciliary service

Referrals to specialist services:

• CDS- community dental service - contact NHS England:

Telephone: 0300 311 22 33

Email: england.contactus@nhs.net

• HDS – Hospital dental service – referral for more complex treatment under

GA

How can you help?

Remember to Include mouth care as personal care

twice daily

Patient preference

Dry mouth?

Sore mouth?

Unsafe swallow?

Pink foam swabs

Safety risk

Effective tooth brushing

45* angle, circular motion along the gum line

Tip – Use a small headed toothbrush

Challenges with delivering mouth

care to all residents

• Positioning of person

• Patient refusing / Aggressive behaviour

• Confused? Feeling unwell?

• Asleep for long periods - EOL

• Issues with swallow/risk of aspiration

Dementia residents with dental issues

• Refusal to eat

• Regular pulling at the face/mouth

• Start to leave dentures out

• Increased restlessness

• Disturbed sleep patterns

• Refusal to take part in activities

• Aggressive behaviour.

• If no other explanation for change of

behaviour, an oral assessment

should be done.

• Calm and kind approach, talk to them, use music

• Maintain eye contact. Stand to side of person if possible

• Encourage own care

• Patient hold brush, assisting with hand over hand

• Relative carrying out oral care

• Different times of day, short bursts

• Oral sensitivity, (TP on lip, brush lip)

• use patients preferred products

Delivery of Mouth Care

Dentures should be left out of the mouth over night in a

labelled denture pot with clean water (changed daily)

The mouth should also be rinsed well with water to

remove debris

Daily mouth cleaning with alternative toothbrush and

paste for patient comfort

Ideally dentures should be removed after every meal and

cleaned

Denture care

Cleaning dentures

• Ask resident to remove or take

out of mouth

• Fill sink or bowl with water

• Brush with denture cleaning

product or liquid soap, ideally

not toothpaste

• Rinse well

• Store in clean water overnight

• If using sterident follow

instructions

Lost dentures

• Confusion of ownership

Discuss having them named by their dentist when

made or sent to lab for professional naming:

• Marking

Small piece of new kitchen scourer,

a pencil (or a pen that uses safe alcohol-based ink)

clear nail varnish

Dignity

Self esteem

Comfort & function

Cost/Time to replace

MCM Resources

www.mouthcarematters.hee.nhs.uk

Any questions?

Mouthcarematters.lase@hee.nhs.uk

@NHS_HealthEdEng @MCM_HEKSS #mouthcarematters