Mouth and dental care for people with dementia often overlooked

A new England-wide study has found the health of people’s mouths and teeth is often overlooked by home care services.

The study, led by the University of Portsmouth in collaboration with King’s College London and Queen Mary University of London, has revealed critical insights that could improve social care practices. The research was funded by the National Institute for Health and Care Research – School for Social Care Research (NIHR SSCR).

The team analysed Care Act assessments for people with dementia who live at home and receive family support and/or paid care services. They found oral hygiene is not always addressed in the plans, and as a result, this aspect of personal care can be forgotten about or not recorded.

Project lead, Dr Dia Soilemezi from the University of Portsmouth’s Department of Psychology, said: “Good mouth and teeth care is important for people living with dementia in their own homes because they are at higher risk of dental problems and may find it difficult to report pain or discomfort.

“Poor oral health not only influences physical health but also impacts on self-esteem, dignity, nutrition and quality of life, so it needs to be taken seriously.”

Interviews with carers, homecare workers, and homecare managers highlighted challenges in delivering oral care. These include factors related to the person living with dementia (such as declining understanding, memory problems and physical disability), and problems facing many home care agencies such as high staff turnover, limited time, lack of training, misunderstanding of roles, and poor communication.

Despite the challenges, all participants recognised the importance of oral hygiene on health and wellbeing and offered various suggestions of how oral care could receive more attention.

Using this information, the research team has co-developed free checklists to promote mouth and dental care for local authority social workers and homecare providers. These were developed with people using homecare services and homecare providers as well as experts in dementia and dental care.

“Practitioners could utilise these resources as reminders to put assessments in place for oral hygiene and draw on the recommendations for care practices,” explained Dr Soilemezi.

“In contrast to care homes, few people working in homecare receive support and training about mouth and dental care despite its importance to people living with dementia. We hope the material we’ve produced will go some way to bridge the training gap.”

Former family carer, Valerie Hill, was involved with the study. She said: “I was so pleased to get involved with this research, as when I was caring for my mother who had dementia I found that some people did not realise how to help her keep her teeth clean or did not understand that she could not brush them properly anymore. 

“I was worried that the subject got overlooked when people asked about her needs and few home care workers reported that they had never had training or information on the topic. I was delighted to help with the development of the resources, so that other families can feel more confident that their relatives will get the care they need in this area.”

The resources can be accessed online here. For more information about the study and the resources please contact: dia.soilemezi@port.ac.uk 

Other members of the research team were Dr Kristina Wanyonyi of The Institute of Healthcare Improvement Studies, University of Cambridge (formerly Queen Mary University) and Professor Jill Manthorpe of King’s College London.

The first paper has been published in the International Journal of Geratric Psychiatry. The second is due to be published later this year.