Smiling Matters

The team at Swift Management Services Limited recently attended the CQC Webinar update on its Smiling Matters report.

It was encouraging to see that there is a greater awareness of oral health across domiciliary and nursing & residential care homes, however, the increasing difficultly in access dental services is a significant cause for concern, as this is affecting some of the most vulnerable people in society.

Access to good quality dental care should be a given, but with changes to the way in which the NHS reimburses dental health professionals for work, local commissioning arrangements for care home provision, it appears it is getting harder and harder for people to access services.

This coupled with a lack of dental health professionals who are prepared to offer domiciliary visits, or have suitable premises with accessible ground floor surgery and diagnostic facilities results in vulnerable people not being able to enjoy good oral health, something most of us take for granted.

So what can be done?

As a provider of regulated service there is an expectation from CQC that you can demonstrate how you ensure that people in your care are able to access dental support.   This should start from the day of admission or agreeing to support a person.

The following is not exhaustive, but provides some essential information that should be recorded on their care plan.  It is as important as details of the General Practitioner and Medication.

For all of these, consent should be obtained and people do have the right to not discuss their oral health or be supported.  You should document their decisions. Ask the person who their current dentist is.   If they are not registered, support them to access a dentist. Check their current oral health status using a recognised tool. The PHE oral Health Tool Kit is a good place to start for staff resources and suitable documentation.

Equipment: Does the person use a mouthwash? Do your staff support someone to clean their teeth a minimum of twice per day? For people with bridges & Dentures, do they have appropriate brushes (they are different to regular brushes), a denture pot for soaking, denture tablets.  Does the person have access to a mirror at a suitable height so that they can check their smile. To floss or not to floss,  is this recorded, can the person do this themselves, or do they require floss mounted on a stick?

Check that the person has access to a suitable toothbrush and toothpaste, cream, or powder of their choice. There is a range of low foaming, regular, low and high fluoride toothpastes/creams and powders available in most high street chemists.  An oral health professional may recommend a prescription strength fluoride toothpaste if the person has decay or requires treatment.

As a provider consider having a stock of regular and soft toothbrushes available with small and medium heads, plus a range of toothpastes. Toothpastes do have a shelf life, so check that the product is in date before issuing it to a resident.

Swabs on sticks are discouraged as there is a risk that the swab or sponge head could detach and become a choking hazard. There are a range of finger toothbrushes that are especially soft. Pineapple juice is highly effective in breaking down bacteria and stopping it sticking to surfaces. This may help someone who is reluctant to brush their teeth.  Traditional glycerin and lemon pre moistened swabs on sticks can actually dry a mouth, so are not recommended.

Does the person use a lip moisturiser-  there are a range of simple but effective options available to stop their lips from cracking.

Document what support a person requires. Are they independent, or do they need a member of staff to put the toothpaste onto their brush?  Do they need help to rinse their mouth or put in or remove their dentures? Do they just need a prompt twice a day to clean their teeth? When do they want to clean their teeth? For some people that may be as soon as they are awake, others after breakfast. Their routine is personal to them.

Do you as  a provider regularly check that toothbrushes are damp-  a dry toothbrush has not been used recently may mean that support is required and is a good indicator that you may need to review what is happening.

Do you have an oral health champion that welcomes people to your service and checks that they have everything they need to give them a great smile.

In photographs is the person smiling and proud to show their teeth, or concealing their teeth-  this could indicate that you need to take action to support them.

A great smile does not have to be complicated, but it makes a world of difference to the person that you are supporting, their family and how others may perceive your service.