Oral health in care homes carries a regulatory profile most daily care tasks do not: it has its own dedicated NICE guideline and its own CQC thematic report, and the most recent national data shows it getting harder for residents to access dental care even as staff awareness improves. Poor oral hygiene does more than cause tooth decay. It is linked to pain, reduced appetite, aspiration pneumonia in residents with swallowing difficulties, and a measurable drop in a resident’s ability to eat, speak, and take part in daily life.

CQC’s follow-up to its “Smiling Matters” report found that between 2019 and 2022, the share of care homes reporting residents could “never” access NHS dental care nearly quadrupled, from 6% to 25%, even as the share of staff receiving oral health training doubled over the same period (CQC, 2023). This guide sets out what a proper oral hygiene care plan covers, what a thorough assessment includes, and how to build both around NICE’s guideline on oral health for adults in care homes, rather than good intentions alone.

Why Oral Care in Care Homes Matters

Poor oral hygiene causes tooth decay, gum disease, and oral infections directly, and it worsens conditions that already carry serious risk for older residents. The British Geriatrics Society links poor oral health directly to malnutrition and aspiration pneumonia in older people, alongside pain that makes it harder to speak, eat, and take medication safely. NICE NG48 treats oral health as a distinct clinical priority in care homes, not an extension of general hygiene, and recommends every resident receive a mouth care assessment as part of their care plan on admission.

CQC’s Smiling Matters progress report found genuine improvement in some areas: oral health policies nearly doubled, from 25% to 53% of care homes, and formal assessments on admission rose from 73% to 83%. But only 28% of homes had a designated oral health champion, and detailed, resident-specific care planning was still the exception rather than the rule. That gap between policy and practice is exactly what a structured, resident-level oral care plan is built to close.

What Should an Oral Care Plan Include?

An oral care plan is a tailored guide that ensures each resident gets the specific support they need, not a generic checklist applied to everyone.

1. Initial Oral Health Assessment
   • Conduct a detailed oral health assessment upon admission. Use an oral health assessment tool to evaluate the condition of the mouth, gums, teeth, and dentures.
   • Look for signs of decay, gum disease, dryness, or any discomfort. Ensure the assessment includes checking for difficulties with chewing, swallowing, or cleaning teeth.
   • Ask: When should oral health be assessed? Ideally, assessments should be done within the first week of admission or immediately if concerns arise.
2. Daily Oral Care Routine
   • Outline a clear daily oral care routine, including brushing teeth twice a day with fluoride toothpaste, cleaning dentures, and rinsing the mouth after meals.
   • Ensure staff are trained in what you should do before supporting with oral care, such as washing hands, wearing gloves, and explaining the process to the resident to ensure comfort.
3. Regular Reviews and Updates
   • How often should you review residents’ oral health? At least every six months, or more frequently if a resident’s health changes or they experience oral discomfort.
   • Use a checklist to monitor progress and identify any emerging issues, ensuring care plans remain relevant.
4. Access to Professional Dental Care
   • Ensure residents have access to a dentist for regular check-ups and emergency care. Collaborate with local dental services to create a seamless referral process.

What Should an Assessment for Oral Health Include?

A thorough oral health assessment is the cornerstone of effective care. Here’s what it should cover:

• Teeth and Gums: Check for cavities, missing teeth, bleeding, or inflammation.
• Mouth and Tongue: Look for sores, dryness, or signs of infection.
• Dentures: Ensure dentures fit properly and are free from damage or build-up.
• Diet and Hydration: Poor oral health changes what and how much a resident can comfortably eat, so this needs checking both ways, whether oral pain is affecting intake, and whether diet is affecting oral health.
• Resident’s Ability: Establish whether they can manage their own oral care, need prompting, or need it done for them, since this determines the whole shape of the daily routine above.

Using a standard, repeatable assessment tool, such as the one in the government’s oral health toolkit for adults in care homes, lets staff document findings consistently and actually track change over time, rather than relying on memory of how a resident’s mouth looked last time.

Best Practices for Oral Healthcare in Care Homes

1. Training for Care Staff
   Equip care workers to deliver oral care confidently, including what to do before supporting a resident and how to recognise early signs of oral health issues. This is also where the numbers are weakest nationally: even after training rates doubled, only 60% of staff had received any oral health training by 2022, and fewer than three in ten homes had a nominated champion to keep standards consistent
2. Tailored Approaches
   Each resident’s needs are different. Some need gentle encouragement and reminders; others need adaptive tools such as electric toothbrushes or modified grips. A one-size approach is why oral care plans that look thorough on paper still fail in practice.
3. Promoting Awareness
   Build oral health into everyday care home activity, not a separate initiative. A five-minute demonstration on brushing technique, or a conversation about how diet affects oral health, does more for consistency than a laminated poster nobody reads twice.
4. Documenting Care
   Keep detailed records of assessments, daily routines, and any changes observed. This is what turns “we do oral care” into evidence CQC can actually see, and it’s what lets staff catch a developing problem before it becomes a dental emergency or an unplanned GP referral.

What Good Practice Looks Like

CQC’s national findings, rather than any single home, give the clearest picture of what separates homes that are managing oral health well from those that aren’t. The homes making genuine progress shared three things: a named oral health champion responsible for keeping the topic visible, an assessment completed and filed within the first week of admission, and oral care built into the daily routine staff already follow rather than treated as a separate task. Homes without these three things were the ones most likely to report that residents’ oral health only came up when something had already gone wrong: a lost denture, a swollen face, a sudden refusal to eat.

The Data Behind the Urgency

The clearest way to make the case for a proper oral care plan is CQC’s own before-and-after comparison, from its original 2019 Smiling Matters report to the 2023 progress update:

• Care home managers aware of NICE guidance on oral health: 61% to 91%
• Care homes with a written oral health policy: 25% to 53%
• Oral health assessments completed on admission: 73% to 83%
• Care plans that adequately covered oral health: 27% to 60%
• Staff who had received oral health training: 30% to 60%
• Homes reporting residents could “never” access NHS dental care: 6% to 25%

(CQC, 2023)

Every figure except one moved in the right direction. The one that didn’t, dental access, is the one least within a care home’s direct control, which is exactly why the assessment, the daily routine, and the documentation matter more, not less: they are what a home can control while the wider dental access problem gets sorted out elsewhere.

Actionable Insights for Care Homes

• Start this week: assess every resident’s oral health using a standard tool, don’t wait for the next scheduled review cycle to begin.
• Name a champion: CQC’s data points to this single change as the one most homes are still missing.
• Review on a schedule: six-monthly at minimum, sooner if a resident’s health or behaviour changes.
• Train the whole team: not just new starters, since oral care support happens on every shift.
• Involve families: consistency between what happens in the home and what families expect avoids confusion and missed history, such as a resident’s usual denture routine.

Download Oral Hygiene Care Plan

A working oral care plan is not a checklist bolted on at admission. It is regular assessment, a daily routine staff actually follow, a named person accountable for it, and documentation that holds up if CQC asks to see it.

Download the free Oral Hygiene Care Plan below to put a working assessment template in front of your team today, and enroll your staff in ecert’s Oral Healthcare course so the plan is backed by people who know how to run it.

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