March 2017

Objective: To gather accurate data on the daily mouth care provided in care homes including tooth brushing, oral health assessment, and recording of care provided. Basic research design: Direct observation and notes review. Clinical setting: Both nursing and ‘regular’ care homes. Participants: 365 Residents living in 16 care homes and their carers underwent observation, notes review or data collection in some form. Main outcome measures: Provision of mouth morning care. Results: Of 161 residents observed, most (93, 58%) did not have their teeth/dentures brushed. If performed, brushing was often carried out by the resident themselves (36 cases, 53%), rather than by a carer (32 cases, 44%). Carers used a toothbrush to clean inside a resident’s mouth in just 7 cases (4.3% of all personal care routines observed). Smaller care homes were no more likely to brush residents teeth than larger care homes, and nursing homes were no more likely to brush teeth than other care homes. Of the 309 sets of notes available for review, 41 (13%) contained a dedicated oral health needs assessment, and 109 (35%) contained a daily oral care chart in some form. Mouth care was often recorded inaccurately (15% of cases). Conclusions: This is the first observational study in the UK to assess oral care actually provided to residents by carers in care homes. The findings reveal a substantially different picture of daily mouth care than was previously understood and suggest that many of the nation’s care home residents may not be receiving adequate, or any, oral health care. Key words: older people, care home, mouth care, dental, oral, England