Putting NICE guidance into practice

Baseline assessment: Oral

health for adults in care homes
(NG48)

Published: July 2016

Baseline assessment tool for Oral health for adults in care
homes (NICE public health guideline NG48)
This baseline assessment tool can be used to evaluate whether practice is in line with the
recommendations in Oral health for adults in care homes. It can also help to plan activity to meet the
recommendations.

The tool can be used by individual services or organisations. Alternatively, an assessment completed with
the involvement of all relevant services or organisations would help to develop a picture of activity in the
local area.

It should be used in conjunction with Oral health for adults in care homes (NICE public health guideline NG48).

In the first instance, consider whether the guideline is relevant and record the conclusion in the box below.

Is the guideline relevant?

The Data sheet contains the recommendations from the guideline. Information can be entered about current
activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the
names of the responsible leads. Useful documents can be added as hyperlinks.

The table can be adapted to include any other local information that is thought to be useful.

If it would be helpful to group the recommendations, for example those that are key priorities for
implementation or by deadline, use the Filter function in the Data menu.

Tools and resources to help put the guidance into practice are available on the NICE website.

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© National Institute for Health and Care Excellence, 2016 All rights reserved. This material may be freely
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 Baseline assessment tool for Oral health for adults in care homes (NICE public health guideline NG48)
Number of relevant recommendations
Number of recommendations met
Percentage of recommendations met

Is the
Guideline recommendation
NICE recommendation reference relevant? Current activity/evidence
1.1 Care home policies on oral health and providing residents with support to access dental services
These recommendations are for care home managers.

Ensure care home policies set out plans and actions to promote
and protect residents' oral health. Include information about:
 local general dental services and emergency or out-of-hours
dental treatment
 community dental services, including special care dentistry teams
(see the NHS Choices information on NHS dental services)
 oral health promotion or similar services, depending on local
arrangements (see recommendation 1.7.1)
 assessment of residents’ oral health and referral to dental
practitioners (see section 1.3)
 plans for caring for residents’ oral health
 daily mouth care and use of mouth and denture care products
 what happens if a resident refuses oral health care (in line with
other local policies about refusal of care)
 supply of oral hygiene equipment (for example basic toothbrush
or toothpaste). 1.1.1
Ensure you set out your duty of care in relation to residents' oral
health needs and access to dental treatments. 1.1.2
Ensure the oral health policy aligns with advice in the Delivering
better oral health toolkit. 1.1.3

Ensure the oral health policy makes it clear that only practitioners
registered with the General Dental Council and acting within its
scope of practice may diagnose and treat dental disease or refer
someone for specialist treatment (see NICE’s guideline on
suspected cancer: recognition and referral). 1.1.4
Ensure mouth care is included in existing care home policies
covering residents' health and wellbeing and reviewed in line with
local practice. 1.1.5

3
 Is the
Guideline recommendation
NICE recommendation reference relevant? Current activity/evidence
Ensure all care staff, new and existing residents and their families
or friends (if they are involved in the resident’s care) are aware of
care home policies to promote health and wellbeing, including
mouth care. 1.1.6
1.2 Oral health assessment and mouth care plans
These recommendations are for care staff carrying out admissions or assessments.

Assess the mouth care needs of all residents as soon as they start
living in a care home, regardless of the length or purpose of their
stay. Consider using the Oral Health Assessment Tool. Where
family and friends are involved in ongoing care, consider involving
them in the initial assessment, with the residents’ permission, if it
will help staff understand the resident's usual oral hygiene routine.
Ask:
 How the resident usually manages their daily mouth care (for
example, toothbrushing and type of toothbrush, removing and
caring for dentures including partial dentures). Check whether they
need support.
 If they have dentures, including partial dentures, whether they
are marked or unmarked. If unmarked, ask whether they would like
to arrange for marking and offer to help.
 The name and address of their dentist or any dental service they
have had contact with, and where and how long ago they saw a
dentist or received dental treatment. Record if there has been no
contact or they do not have a dentist, and help them find one. 1.2.1
Make an appointment for the resident to see a dental practitioner, if
necessary. 1.2.2
Record the results of the assessment and the appointment in the
resident's personal care plan. 1.2.3
Review and update residents' mouth care needs in their personal
care plans as their mouth care needs change (see recommendation
1.3.3). 1.2.4
1.3 Daily mouth care
These recommendations are for managers of care staff who support daily personal care.

4
 Is the
Guideline recommendation
NICE recommendation reference relevant? Current activity/evidence

Ensure care staff provide residents with daily support to meet their
mouth care needs and preferences, as set out in their personal
care plan after their assessment. This should be aligned with the
advice in the Delivering better oral health toolkit, including:
 brushing natural teeth at least twice a day with fluoride
toothpaste
 providing daily oral care for full or partial dentures (such as
brushing, removing food debris and removing dentures overnight)
 using their choice of cleaning products for dentures if possible
 using their choice of toothbrush, either manual or electric/battery
powered
 daily use of mouth care products prescribed by dental clinicians
(for example, this may include a high fluoride toothpaste or a
prescribed mouth rinse, see NICE's guideline on managing
medicines in care homes)
 daily use of any over-the-counter products preferred by residents
if possible, such as particular mouth rinses or toothpastes; if the
resident uses sugar-free gum, consider gum containing xylitol. 1.3.1
Ensure care staff know which member of staff they can ask for
advice about getting prescribed mouth care products, or helping
someone to use them. 1.3.2
Ensure care staff know how to recognise and respond to changes
in a resident's mouth care needs. 1.3.3
Ensure care staff know how to respond if a resident does not want
daily mouth care or to have their dentures removed. 1.3.4
1.4 Care staff knowledge and skills
These recommendations are for care home managers.

5
 Is the
Guideline recommendation
NICE recommendation reference relevant? Current activity/evidence

Ensure care staff who provide daily personal care to residents:

 Understand the importance of residents' oral health and the
potential effect on their general health, wellbeing and dignity.
 Understand the potential impact of untreated dental pain or
mouth infection on the behaviour, and general health and wellbeing
of people who cannot articulate their pain or distress or ask for
help. (This includes, for example, residents with dementia or
communication difficulties.)
 Know how and when to reassess residents’ oral health (see
recommendation 1.2.1 )
 Know how to deliver daily mouth care (see recommendations
1.3.1–1.3.4).
 Know how and when to report any oral health concerns for
residents, and how to respond to a resident's changing needs and
circumstances. (For example, some residents may lose their
manual dexterity over time.)
 Understand the importance of denture marking and how to
arrange this for residents, with their permission. 1.4.1
1.5 Availability of local oral health services

This recommendations is for health and wellbeing boards.

Ensure local oral health services address the identified needs of
people in care homes, including their need for treatment. Identify
gaps in provision. (See recommendation 1 in NICE’s guideline on
oral health: approaches for local authorities and their partners to
improve the oral health of their communities.) This includes:
 general dental practices
 community dental services, including special care dentistry (for
more information see NHS England)
 oral health promotion or similar services, in line with existing local
arrangements
 emergency and urgent out-of-hours dental treatment. 1.5.1
This recommendation is for care home managers.
Tell local healthwatch and public health teams about any concerns
you have about the availability of local dental and oral health
promotion services. 1.5.2
1.6 Oral health promotion services
These recommendations are for oral health promotion teams or similar services, in line with existing local arrangements.

6
 Is the
Guideline recommendation
NICE recommendation reference relevant? Current activity/evidence

Develop and provide care homes with oral health educational

materials, support and training to meet the oral health needs of all
residents, especially those with complex needs. Also explain the
role of diet, alcohol and tobacco in promoting good oral health, in
line with advice in the Delivering better oral health toolkit and
NICE's guideline oral health promotion: general dental practice. 1.6.1

Help care home managers find out about local oral health services
and create local partnerships or links with general dental practice
and community dental services including special care dentistry. 1.6.2
Tell local authority public health teams and dental public health
leads about gaps in the services, so they can advocate for
accessible oral and dental health services on behalf of residents of
care homes. 1.6.3
1.7 General dental practices and community dental services
These recommendations are for dental practitioners.

Provide residents in care homes with routine or specialist

preventive care and treatment as necessary, in line with local
arrangements (see NICE’s guidelines on dental checks: intervals
between oral health reviews, oral health: approaches for local
authorities and their partners to improve the oral health of their
communities and oral health promotion: general dental practice). 1.7.1
Ensure dentures made for individual residents are appropriately
marked by the lab during manufacture. 1.7.2

7
alth guideline NG48)
0
0

Is there a risk
associated with not
Recommendation implementing this Is there a cost or
met? Actions needed to implement recommendation recommendation? saving? Deadline Lead

8
 Is there a risk
associated with not
Recommendation implementing this Is there a cost or
met? Actions needed to implement recommendation recommendation? saving? Deadline Lead

9
 Is there a risk
associated with not
Recommendation implementing this Is there a cost or
met? Actions needed to implement recommendation recommendation? saving? Deadline Lead

10
 Is there a risk
associated with not
Recommendation implementing this Is there a cost or
met? Actions needed to implement recommendation recommendation? saving? Deadline Lead

11
 Is there a risk
associated with not
Recommendation implementing this Is there a cost or
met? Actions needed to implement recommendation recommendation? saving? Deadline Lead

12
Baseline assessment tool for Oral health for adults in care home
public health guideline NG48)
Who should do what at a glance

Who should take action

Care home managers.
Care staff carrying out admissions or assessments.
Managers of care staff who support daily personal care.
Health and wellbeing boards.
Oral health promotion teams or similar services, in line with existing local arrangements.
Dental practitioners.
are homes (NICE

Recommendation
1.1, 1.4, 1.5.2
1.2
1.3
1.5.1
1.6
1.7