Good oral care is a fundamental part of daily personal care in residential settings. It supports comfort, nutrition, communication and overall health – particularly for older adults who may be living with frailty, dementia or complex medical conditions.
Guidance from the National Institute for Health and Care Excellence (NICE), alongside the Care Quality Commission’s (CQC) Smiling Matters report, makes clear that oral health is everyone’s responsibility in care settings.
Below are ten practical, evidence-informed oral care tips for carers working in UK care homes.
1. Assess oral health on admission
Every resident should have an oral health assessment when they move into the home, in line with NICE NG48 guidance. This should include natural teeth, dentures, soft tissues, pain, and ability to carry out self-care. Document findings clearly and create an individualised mouth care plan.
2. Create a personalised oral care plan
Oral care is not “one size fits all”. Plans should reflect the resident’s:
- Cognitive ability
- Manual dexterity
- Cultural preferences
- Denture use
- Risk factors (e.g. diabetes, dry mouth, medication)
Care plans should be reviewed regularly and updated if needs change.
3. Support twice-daily brushing
Residents with natural teeth should be supported to brush at least twice daily using fluoride toothpaste (usually 1,350–1,500 ppm fluoride unless otherwise advised). For those unable to brush independently, carers should provide hands-on support while maintaining dignity and consent.
Use a soft-bristled toothbrush and ensure toothpaste is not rinsed away excessively (spitting without rinsing maximises fluoride protection where appropriate).
4. Don’t forget denture care
Residents who wear dentures should be supported to clean them daily using a denture brush and non-abrasive cleaner, remove them overnight unless otherwise advised, store them safely in a labelled container, and ensure that gums and tongue are also gently cleaned to prevent infection, discomfort and reduced appetite.
5. Watch for signs of pain or infection
Residents – particularly those living with dementia – may not verbally report oral pain. Early recognition prevents avoidable deterioration, so be alert to:
- Refusing food
- Pulling at the face or mouth
- Increased agitation
- Bad breath
- Bleeding gums
- Loose teeth or broken dentures
6. Manage dry mouth (Xerostomia)
As many older adults take medications that can cause dry mouth (xerostomia), carers should help reduce the risk of decay and discomfort by encouraging regular sips of water where safe, avoiding alcohol-based mouthwashes, monitoring for soreness or cracking, and using prescribed saliva substitutes where appropriate.
7. Support residents who resist care
Some residents may resist mouth care due to confusion, fear or discomfort. Techniques that can help include:
- Explaining each step calmly;
- Using visual cues or demonstrating on yourself;
- Providing care at the best time of day for the individual; and
- Using the “tell-show-do” approach.
Providing regular, practical training equips care staff with the skills and confidence to deliver safe, compassionate oral care – including how to support residents who may feel anxious, confused or resistant – ensuring care is delivered respectfully and effectively in all circumstances.
8. Ensure access to dental services
Care homes should have clear arrangements for routine and urgent dental care. Residents should remain registered with a dentist where possible, and urgent concerns should not be delayed.
Information about accessing NHS dental services can be found online.
9. Record and report changes promptly
The Care Quality Commission requires oral health to be fully integrated into care planning and safeguarding processes. As such, oral health observations should be clearly recorded in daily notes to ensure continuity of care and effective communication with colleagues, families, and healthcare professionals. Any changes or concerns should be reported promptly, supporting safeguarding, regulatory compliance, and timely access to dental care when needed.
10. Invest in ongoing training
Confidence and competence in oral care do not happen by chance. Regular training ensures staff understand:
- The link between oral and systemic health;
- Safe brushing techniques;
- How to recognise oral disease;
- Denture hygiene; and
- How to support residents with dementia.
By partnering with an experienced provider such as Acute Training Solutions, care organisations can ensure their teams are not only compliant with current guidance and regulatory expectations, but also skilled, proactive and confident in delivering this essential component of person-centred care.
