News
We all remember the havoc that the Covid-19 pandemic wrought in care homes – with the disease running rampant and elderly people unable to see their loved ones in their final days. The pandemic brought into sharp focus the failings in many care homes, and the lack of training and support given to the people working there, but there were already some people aware of this, and starting to try and make a difference.
Jane Peterson, a dental hygienist by profession, started to look into the state of oral hygiene among residents in care homes, and Knowledge Oral Healthcare Ltd was founded on her experience. ‘I was doing a degree in oral health promotion in 2015,’ explained Jane, ‘and as part of it I interviewed care home staff about their attitudes and perceptions about toothbrushing. I was shocked to find that none – not a single person – had had any training in oral hygiene. Bearing in mind that 70% of people in care homes have dementia in some form, I was amazed to be told that either they all brushed their own teeth, or they all had dentures. Domiciliary visits by dental professionals no longer took place. This was confirmed by all the local practices and the community dental services.’
Jane decided to carry out a simple oral health assessment within some homes and was horrified to find residents who had not had their dentures removed and cleaned for years; they didn’t have toothbrushes; there was rampant decay and jagged broken teeth. ‘Mouth care was just not prioritised,’ she said.
Her next step was to introduce an oral health service, brushing teeth and cleaning dentures in care homes, then spreading this out nationwide through a network of dental hygienists; but this soon backfired because the care staff performed no oral hygiene care in between visits, despite trumpeting the oral care service that they now offered.
‘I realised that what the care home staff needed was education. It’s not about preventing decay – these residents already have long-term decay - the aim is to lower the bacterial level in the mouth, and ultimately prevent fatalities due to aspiration pneumonia and other similar problems,’ said Jane. With many staff on low wages and having English as a second language, providing this education was going to be hard. Patients with dementia are often resistant to personal care, and even as a hygienist Jane knew managing situations like this was challenging – there was far more to it than just cleaning teeth.
And so Knowledge Oral Healthcare was formed, providing a range of training for care staff at all levels, and covering topics from dysphagia, palliative care, coping with resistant patients and autism, to the legal requirements of CQC, delivered both in person and online via webinars and other teaching sessions. Still, however, despite a range of guidelines being published, including the quality standards and the Smiling Matters report, produced in 2019 and revisited in 2023, oral care has not been prioritised and training in it remains a matter for the care homes to choose.
When the pandemic hit in 2020, ‘mouth care went out of the window completely,’ Jane said. ‘It was disastrous. We couldn’t get into the homes.’ All the evidence showed that vulnerable patients were particularly hard hit by Covid, care homes were in crisis, and research was also showing that good oral hygiene actually could help prevent Covid.
There were a few bright spots. BioMin donated products and reported on the personal efforts of some wonderful dentists and hygienists, like Tamsyn McKenna and Dr Victoria Sampson, who were visiting care homes to deliver oral care products and advise on oral care for the residents. Largely though, this area was overlooked – with fatal results.
Four years on, frustratingly, oral health training is still not a mandatory part of the care certificate that care workers need to complete on starting a job and, according to Jane, about 40% of staff still haven’t had any training. However, things are improving, she believes. As CQC inspections loom, many care homes come looking for training, and she’s gratified that when staff do attend her sessions, especially the webinars, which are very popular, they find them extremely valuable – not only for their work but also for their own oral health and that of their families. So the benefits go wider.
The KOHC training has been expanded to include a ‘train the trainers’ programme so that larger organisations can continue the training in house. There is also an Oral Care Champions course, which identifies a ‘go-to’ person within an organisation who is educated in oral care, knows about the quality standards and is responsible for an oral care policy in their workplace. These workers are armed with extra knowledge and advice, and know what to do in the case of a problem – including the need to escalate an issue to a healthcare professional if necessary.
KOHC has been running some free 20-minute webinars, on topics such as end of life mouthcare, which have been extremely well attended by people from all over the world. Over 500 people signed in. ‘They really do want this information,’ said Jane. The website includes a list of NHS dentists, a resource that is invaluable at a time when NHS dentists are hard to find.
The training is pitched for a variety of levels of education and understanding, and it's not just provided for elderly care home workers. ‘We deliver to learning disability and autism care staff, domiciliary care, nurses, mental health care workers, speech and language therapists and so on,’ she said. ‘And there’s no such thing as a dumb question. It’s valid to ask what plaque is, and many care staff don’t really know.’
‘Managers still don’t prioritise mouthcare, and historically CQC inspectors haven’t always asked about it,’ said Jane. ‘We’ve come a long way but there’s still a lot of work to be done.’
BioMin F can be of great value for vulnerable patients, both the elderly and those with special needs. Its unique, controlled release mechanism, delivering calcium, fluoride and phosphate ions over 12 hours means that it continues to protect the teeth around the clock, even if oral hygiene technique is patchy. Regular use of BioMin F means that a protective layer of fluorapatite is laid down, strengthening and replenishing lost or damaged tooth enamel, and it’s especially valuable to provide it that extra layer of protection for those that need it most – especially if they are not able to get to see a dentist.
Neurodiverse and autistic people often appreciate the mild flavour of BioMin F, or even the strawberry taste of BioMin F for Kids, and the tiny particles within the toothpaste mean that it is less abrasive than some other pastes, and more comfortable for those with dry or sore mouths.
For further information on the science behind BioMin visit our science pages.
To buy BioMin F, BioMin C or BioMin F for Kids go to: Upbeat Care | CTS Dental | Growing Smiles
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