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BASCD responds to the Care Quality Commission Review: Smiling Matters; Oral health care in care homes in England




Derek Richards, past president of BASCD said:


“BASCD welcomes this important review which highlights the ongoing need for work to improve fundamental care and dignity for people living in care homes in England.  The NICE 2016 guideline, ‘Oral Health for Adults in Care Homes’2 outlined the importance of this aspect of care. There is a real commitment to improving oral health for people in care homes from BASCD members who have been involved in the development of the programmes in Scotland3 and Wales4, the evidence reviews for the NICE guidelines 5 and the development of the evidence informed toolkit for commissioning better oral health for vulnerable older people.”6


Maria Morgan, President elect of BASCD said:


“Programmes for oral health in care homes are well established in Scotland and Wales (Caring for Smiles3 and Gwen am Byth4). Members of BASCD have provided input into the development of these programmes which are continuing to work with dental teams and other disciplines to improve oral health.”




A new review from the Care Quality Commission (CQC) has found that many people in care homes do not receive the support they need to maintain or improve their oral health.1

According the CQC, “the review draws on one hundred inspections of care homes on which CQC inspectors were accompanied by inspectors from dental regulation. It reveals that three years on from the publication of NICE guidance on oral health in care homes, steps are often not being taken to ensure that people get the oral health care they need to ensure that they are pain-free and that their dignity is respected.”

Key findings include:

  • The majority (52%) of care homes visited had no policy to promote and protect people’s oral health
  • Nearly half (47%) of care homes were not providing any staff training to support people’s daily oral healthcare
  • 73% of residents’ care plans reviewed only partly covered or did not cover oral health at all – homes looking after people with dementia being the most likely to have no plan in place
  • 17% of care homes said they did not assess people’s oral health on admission
  • Two-thirds (67%) of the care homes that CQC visited said people who used their services could always, or nearly always, access NHS dental care. Whilst 10% of homes visited reported they had no way of accessing emergency dental treatment for people
  • 34% of homes said they had no or limited access to out-of-hours services


The report described issues with services including:

  • A lack of dentists who were able or willing to visit care homes
  • Local dentists not accepting new patients
  • The length of time it took to get an appointment with an NHS dentist – even for a procedure such as getting dentures fitted

CQC is calling for “a cross-sector approach to tackle the concerns raised by this report” and highlights examples of success.

The recommendations include a call for:

  • mandatory staff training in oral care
  • oral health check-ups for all residents upon admission
  • better signposting to local dental services
  • convening of a multi-agency group tasked with raising awareness among people living in care homes, their families and carers of the importance of day-to-day dental hygiene and the need for routine check-ups.

Kate Terroni, Chief Inspector for Adult Social Care at the Care Quality Commission (CQC) said:

“Oral health has a huge impact on our quality of life and we need professionals across a number of sectors to make changes to ensure it is given the priority it needs in care home settings.

“Oral health cannot be treated as an afterthought. It can make the difference between someone who is free from pain, enjoys eating and is able to confidently express themselves through talking and smiling – and someone who is in pain, unable to enjoy their food and who covers their mouth with their hand when they smile because they are ashamed of their poor oral hygiene but unable to address it themselves. No one should have to live like that.”

“Care home managers must recognise the significance of oral health – and professionals including GPs, dentists, dental hygienists and community nurses need to work together to elevate the importance of oral health in care homes and to prioritise this as part of their work.”

“The changes needed can only happen with the efforts of all parts of the health and care system coming together, helping people who use services, their families and carers to be aware of the importance of oral care. By working in partnership, we can make a positive impact on the quality of life of people living in care homes.”

Charlotte Waite, Chair of the BDA’s England Community Dental Services Committee said:

“This welcome report shines a light on services that are failing some of the most vulnerable in our society.”

“There are residents left unable to eat, drink and communicate, as an overstretched NHS struggles to provide the care they need.”

“We require nothing short of a revolution in the approach to dentistry in residential homes. Oral health can no longer remain the missing piece when it comes to care planning and budgets.”


  1. CQC calls for improvements to oral health in care homes
  2. Oral health for adults in care homes

NICE guideline [NG48] Published date: July 2016

  1. Caring for smiles:
  2. Gwen am Byth:
  3. Oral health for adults in care homes NICE guideline Evidence [NG48] Published date: July 2016:
  4. Commissioning better oral health for vulnerable older people.