Training and resources for care homes

LTP Priority: Better care for health conditions: Dental healthcare

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Training and resources for care homes to meet NICE Quality Standard QS151 and CQC recommendations for improvements.

Major driver of health inequalities in your area of work

Inequalities in oral health and access to quality preventive and treatment services for those in care homes.

Although it is encouraging that the oral health of older people has improved in England, with more adults keeping their teeth into old age, many of these teeth will have fillings and other restorations requiring long term review and complex care from dental teams.[i]

People in care homes frequently require support from carers to maintain good oral hygiene and to help them access appropriate dental care. Maintaining good oral health throughout life and into older age not only improves our general health and wellbeing, but plays a part in helping us stay independent for as long as possible. Having a healthy mouth and teeth is important for speaking, socialising and eating a range of foods.

Evidence shows that poor oral health in older people can lead to:

  • pain and discomfort,[ii],[iii]  which can lead to mood and behaviour changes, particularly in people who cannot communicate their experience,[iv],[v] speech problems and reduced ability to smile and communicate freely[vi],[vii] problems chewing and swallowing which limit food choices and can lead to impaired nutritional status[viii],[ix]
  • poor quality of lifeii, v,vi, [x], [xi]
  • reduced self-confidencei,viii,ix and increased social isolationvii, [xii]
  • impaired well-being and moodviii,ix
  • poor general health and premature mortality[xiii],[xiv],[xv],[xvi]

There is also a growing body of evidence to support a reciprocal relationship between poor general health and poor oral health. For example:

  • patients with diabetes and gum disease (periodontitis) would benefit from regular oral care[xvii]
  • there is a positive association between pneumonias and poor oral health[xviii]
  • there is a greater risk of developing tooth decay one year after being diagnosed with cognitive impairment[xix]
  • there are associations between coronary heart disease, stroke, peripheral vascular disease and oral health[xx]

[i] NHS Digital. Adult Dental Health Survey. 2009.

[ii] Rebelo, M, E Cardoso, P Robinson, and M Vettore, Demographics, social position, dental status and oral health-related quality of life in community-dwelling older adults. Quality of Life Research, 2016. 25(7): p. 1735-1742.

[iii] Zenthöfer, A, P Rammelsberg, T Cabrera, J Schröder, and AJ Hassel, Determinants of oral health‐related quality of life of the institutionalized elderly. Psychogeriatrics, 2014. 14(4): p. 247-254.

[iv] Morgan, R, K Sail, A Snow, J Davila, N Fouladi, and M Kunik, Modeling causes of aggressive behaviour in patients with dementia. The Gerontologist, 2012. 53(5): p. 738-747.

[v] Ahn, H, C Garvan, and D Lyon, Pain and aggression in nursing home residents with dementia: minimum data set 3.0 analysis. Nursing research, 2015. 64(4): p. 256-263.

[vi] Sheiham, A, J Steele, W Marcenes, G Tsakos, S Finch, and A Walls, Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain. Community dentistry and oral epidemiology, 2001. 29(3): p. 195-203.

[vii] Ramsay, S, P Whincup, R Watt, G Tsakos, A Papacosta, L Lennon, and S Wannamethee, Burden of poor oral health in older age: findings from a population-based study of older British men. BMJ open, 2015. 5(12): p. e009476.

[viii] Sheiham, A and J Steele, Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public health nutrition, 2001. 4(3): p. 797-803.

[ix] Emami, E, R de Souza, M Kabawat, and J Feine, The impact of edentulism on oral and general health. International journal of dentistry, 2013. 2013.

[x] Bidinotto, A, C Santos, L Tôrres, M Sousa, F Hugo, and J Hilgert, Change in Quality of Life and Its Association with Oral Health and Other Factors in Community‐Dwelling Elderly Adults—A Prospective Cohort Study. Journal of the American Geriatrics Society, 2016. 64(12): p. 2533-2538.

[xi] Porter, J, A Ntouva, A Read, M Murdoch, D Ola, and G Tsakos, The impact of oral health on the quality of life of nursing home residents. Health and quality of life outcomes, 2015. 13(1): p. 102.

[xii] Rodrigues, S, A Oliveira, A Vargas, and A Moreira, Implications of edentulism on quality of life among elderly. International journal of environmental research and public health, 2012. 9(1): p. 100-109.

[xiii] Aida, J, K Kondo, T Yamamoto, H Hirai, M Nakade, K Osaka, A Sheiham, G Tsakos, and R Watt, Oral health and cancer, cardiovascular, and respiratory mortality of Japanese. J Dent Res, 2011. 90(9): p. 1129-35

[xiv] Padilha, DM, JB Hilgert, FN Hugo, AJ Bos, and L Ferrucci, Number of teeth and mortality risk in the Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci, 2008. 63(7): p. 739-44.

[xv] Watt, RG, G Tsakos, C de Oliveira, and M Hamer, Tooth loss and cardiovascular disease mortality risk–results from the Scottish Health Survey. PLoS One, 2012. 7(2): p. e30797.

[xvi] Schwahn, C, I Polzer, R Haring, M Dorr, H Wallaschofski, T Kocher, T Mundt, B Holtfreter, S Samietz, H Volzke, and R Biffar, Missing, unreplaced teeth and risk of all-cause and cardiovascular mortality. Int J Cardiol, 2013. 167(4): p. 1430-7.

[xvii] D’Aiuto, F, D Gable, Z Syed, Y Allen, KL Wanyonyi, S White, and JE Gallagher, Evidence summary: The relationship between oral diseases and diabetes. Bdj, 2017. 222: p. 944.

[xviii] Manger, D, M Walshaw, R Fitzgerald, J Doughty, K Wanyonyi, S White, and J Gallagher, Evidence summary: the relationship between oral health and pulmonary disease. British dental journal, 2017. 222(7): p. 527.

[xix] Daly, B, A Thompsell, J Sharpling, Y Rooney, L Hillman, K Wanyonyi, S White, and J Gallagher, Evidence summary: the relationship between oral health and dementia. British dental journal, 2017. 223(11): p. 846.

[xx] Dietrich, T, I Webb, L Stenhouse, A Pattni, D Ready, K Wanyonyi, S White, and J Gallagher, Evidence summary: the relationship between oral and cardiovascular disease. British dental journal, 2017. 222(5): p. 381.

Target groups

Protected characteristics: Age, disability ( all protected groups falling under these two characteristics).


Training and resources for care homes to meet NICE Quality Standard QS151 and CQC recommendations for improvements.


What is the intervention?

Implement the recommendations on improving oral health in care homes set out in recommendations from CQC report and implement the guidelines to be published by the care homes task and finish group of Adult Oral Health Oversight Group (AOHOG) in 2020.

The AOHOG is currently setting up a multi partner working group looking at improving oral health in care homes. Partners are from DHSC, NHSE, OCDO, CQC, professional dental associations and groups (including BDA, FDS, FGDP, specialist dental societies), dental school council, HEE, LGA, Healthwatch and care home providers.

The guidelines will standardise the approach to oral health needs assessment on admission and training for care home staff (both residential and nursing).


The outcome is to meet the recommendations from the CQC report on oral health in care homes, and to meet NICE quality standard.

NICE quality standard 151 – Oral health for adults in care homes.

Quality statement 1: Adults who move into a care home have their mouth care needs assessed on admission.

Quality statement 2: Adults living in care homes have their mouth care needs recorded in their personal care plan.

Quality statement 3: Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures.

CQC report on oral health care in care homes – Smiling Matters. The report provides recommendations on improvements in care, and governance in care homes.


The evidence base is that of NICE guideline [NG48] – Oral health for adults in care homes (July 2016).

Commissioning better oral health for vulnerable older people (PHE 2018). These are a suite of resources designed to support commissioners in improving the oral health of vulnerable older people in all settings (including care homes) including a rapid review of the evidence of interventions.