Oral Care Policy for Care Homes: Template & Checklist

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Most care homes have a medication policy, a moving and handling policy, and a safeguarding policy. Very few have a mouth care policy that is actually used. That gap is not just a paperwork problem. It directly affects resident wellbeing, CQC inspection outcomes, and your obligations under NICE guideline NG48, the definitive guidance on oral health for adults in care homes. Building a functional oral care policy for your care home is not complicated, but it does require structure, clear responsibilities, and the right clinical products to back it up. This guide gives you a working template, a month-by-month audit checklist, and practical guidance on what inspectors actually look for.

Table of Contents

Quick Takeaways

Key Insight Explanation
NICE NG48 is the baseline, not the ceiling NG48 sets minimum expectations for admission assessments, daily mouth care, and staff training. A policy that merely references it without detailing your local procedures will not satisfy a CQC inspector.
Assessment must happen on admission Mouth care needs should be assessed for every resident as soon as they move in, regardless of how long they are expected to stay. This assessment feeds directly into the personal care plan.
The personal care plan must be specific Vague entries like “assists with oral hygiene” are not compliant. The care plan should state which products the resident uses, whether they need staff assistance, and any known sensitivities or preferences.
Resident preference is a clinical consideration If a resident refuses standard mint toothpaste because of flavour sensitivity, the care plan must document an alternative such as an unflavoured, non-foaming toothpaste and record that the alternative was offered and accepted.
Audits need a fixed frequency A policy without a defined audit schedule is unenforceable. Build in at least one structured oral health audit per quarter, with results reviewed by the registered manager.
Denture marking is a policy requirement NG48 specifically requires that care homes check whether dentures are marked and offer to arrange marking if they are not. This should be a mandatory step in your admission checklist.
CQC inspectors ask staff, not just managers Training records alone will not satisfy an inspection. Inspectors ask care staff directly about mouth care routines, what products they use, and how they handle resistance. Your policy must translate into what staff actually do on the floor.

Why an Oral Care Policy Matters More Than You Think

Poor oral health in care settings is linked to pain, difficulty eating, aspiration pneumonia, and avoidable hospital admissions. These are not theoretical risks. They are documented consequences of gaps in daily mouth care that accumulate over weeks and months when there is no consistent policy guiding practice.

The Care Quality Commission’s Smiling Matters review identified widespread failings in oral health care across care homes in England, including residents with untreated dental pain, missing or broken dentures, and staff who had received no training in mouth care. Since that report, oral health has been a standing focus area during CQC inspections. Inspectors now routinely ask whether a written mouth care policy exists, whether staff have been trained, and whether care plans record individual mouth care needs.

A written oral care policy for your care home is the mechanism that connects national guidance to daily practice. Without it, mouth care depends entirely on individual staff initiative, which means it is inconsistent, undocumented, and invisible to inspection.

Professional oral care clinical products and equipment arranged on display

What NICE NG48 Actually Requires From Your Setting

NICE guideline NG48, published in 2016 and maintained since, is the primary clinical standard for oral health in adult care homes. It covers three domains: assessment, daily care, and access to dental services. Each has specific implications for your written policy.

Assessment on admission

NG48 requires that every resident’s mouth care needs are assessed as soon as they start living in the care home. The assessment should cover how the resident manages their daily mouth care, whether they use dentures, whether those dentures are marked, when they last saw a dentist, and whether they are experiencing any dental pain. The results must be recorded in the personal care plan.

The guideline recommends the use of a validated oral health assessment tool. The Oral Health Assessment Tool (OHAT) is referenced as an appropriate instrument for this purpose and is usable by trained care home staff without dental qualifications.

Daily mouth care

NG48 is explicit: residents should brush their natural teeth at least twice a day using fluoride toothpaste. Daily oral care for full or partial dentures is also required, including brushing, removing food debris, and removing dentures overnight. The guideline also states that residents’ choice of toothbrush and cleaning products should be respected wherever possible. This is where your product policy becomes a direct expression of clinical compliance.

Access to dental services

Your policy must describe how the home supports residents in accessing dental care, including how it identifies residents without a current dentist and what steps it takes to help them register with one. NG48 recommends making an appointment for a resident to see a dental practitioner where assessment indicates it is necessary.

A policy that states good intentions without specifying who does what, when, and with what tools is not a policy. It is a statement of aspiration, and inspectors know the difference.

The Oral Care Policy Template: Structure and Essentials

A functional oral care policy does not need to be long. It needs to be specific, actionable, and understood by the staff who will carry it out. Below is the minimum structure your policy should follow, with notes on what each section must contain.

Section 1: Policy statement and scope

State the purpose of the policy, who it applies to (all residents, all staff involved in personal care), and the legislative and guidance framework it sits within. Reference NICE NG48 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the primary drivers.

Section 2: Roles and responsibilities

Name the job role responsible for each element, not a specific person’s name. The registered manager holds overall accountability. Senior care staff are typically responsible for completing admission assessments and reviewing care plans. All care staff delivering personal care are responsible for daily mouth care delivery. The policy should also name a lead for oral health, either a designated champion or a senior nurse role.

Section 3: Oral health assessment procedure

Describe step by step how the admission assessment is carried out, which tool is used, where results are recorded, and when the assessment should be reviewed. Include a clear trigger for early review: any significant change in the resident’s condition, new medication that causes dry mouth, or a reported episode of dental pain.

Section 4: Daily mouth care procedure

This is the operational core of the policy. Specify twice-daily toothbrushing as the standard. Detail how staff should approach residents who resist or who have sensory sensitivities. Include guidance on denture care, with overnight removal as the default unless there is a documented clinical reason to leave them in. Address what products are available in the home and what substitutes are permitted when a resident cannot tolerate standard products.

Pro tip: Build flavour sensitivity and foam intolerance explicitly into your daily care procedure. Many residents in memory care or with neurological conditions cannot tolerate standard mint-flavoured foaming toothpastes. Your policy should specify that an unflavoured, non-foaming alternative is available as a standard option, not a special request. This removes a common barrier to compliance and means staff do not need to escalate every case of toothpaste refusal.

Section 5: Dental access and referral

Describe how the home identifies residents who do not have a registered dentist, how appointments are arranged, how dental visits are documented, and what the escalation pathway is when a resident reports dental pain or when staff observe signs of oral deterioration.

Section 6: Staff training requirements

State the minimum training standard for all staff involved in personal care, the frequency of refresher training, and how training completion is recorded. Reference any nationally recognised training resources you use.

Section 7: Audit and review

Specify the frequency of internal audits, who conducts them, what is audited, and how findings are reported and acted upon. State the policy review date, typically annual or sooner if national guidance changes.

The Mouth Care Checklist: Admission to Daily Routine

A checklist translates policy intent into a daily action. The two checklists below are practical, CQC-ready tools your team can use immediately.

Admission mouth care checklist

Complete this checklist within 24 hours of a resident moving in. Record all responses in the personal care plan.

  • Has the resident’s current ability to manage their own mouth care been assessed?
  • Has the resident been asked about their usual toothbrushing routine and any products they prefer?
  • Has the resident been asked about any sensitivities to flavours, foam, or toothbrush textures?
  • Has the presence and condition of dentures or partial dentures been noted?
  • Have dentures been checked for marking? If unmarked, has the resident been offered marking arrangements?
  • Has the resident’s current dentist been recorded, or has the absence of a dentist been noted with a plan to register?
  • Has the date of the last dental appointment been recorded?
  • Has the resident reported any current dental pain or dental concerns?
  • Has the oral health assessment been completed using the approved tool and filed in the care plan?
  • Has a personalised mouth care section been added to the care plan, including preferred products and any support required?

Daily mouth care checklist (staff-facing)

This checklist is not intended to be completed in full for every resident on every shift. It is a framework for what trained staff should be doing routinely, and a reference to return to when care delivery is inconsistent.

  • Has the resident brushed their teeth or been supported to do so at least twice today?
  • Has the correct toothpaste been used as specified in the care plan, including any unflavoured alternative where documented?
  • Has the care plan been followed regarding toothbrush type, including soft-bristled or small-headed brushes where required?
  • If the resident wears dentures, have dentures been cleaned and removed overnight?
  • Has any resistance, pain, or concern raised by the resident during mouth care been documented in the daily notes?
  • Has any visible change in the mouth (sores, bleeding gums, swelling, or missing teeth) been flagged to a senior member of staff?

Pro tip: Laminate a simplified version of the daily checklist and keep it in the personal care equipment trolley rather than in the office. Staff are far more likely to follow a process that is visible at the point of care than one they have to recall from a document they read during induction.

Modern care home bathroom and hygiene facility with accessibility features

Running an Oral Health Audit in Your Care Setting

An oral health audit is not the same as a care plan review. A care plan review checks whether the documentation is current. An audit checks whether what the documentation says is actually happening. These are different things, and both are necessary.

What to audit and how often

A quarterly oral health audit is a reasonable minimum for most care settings. The audit should sample a proportion of resident care plans (at least 20% or a minimum of five records, whichever is larger) and cross-reference what is documented with direct observation and staff interview. Key data points to capture include: whether an admission assessment was completed, whether the care plan contains a specific mouth care section, whether products specified in the care plan are physically present and accessible, and whether staff can describe the resident’s mouth care preferences without consulting the file.

Using audit findings to drive improvement

An audit that identifies gaps and then sits in a folder has no value. Build a simple action log into your audit template: what was found, what action is required, who is responsible, and by what date. Review the log at the next management meeting and carry it forward until every action is closed. This is the documentation trail that demonstrates continuous monitoring to a CQC inspector.

Common findings in oral health audits include: admission assessments completed but not transferred into personalised care plans; toothpaste in use that does not match what the care plan specifies; and staff who can recite policy headings but cannot describe what they do when a resident resists mouth care. Each of these has a specific remedy. The audit process exists to surface them before an inspection does.

Setting Product Standards Across Your Setting

Your policy is only as strong as the products available on the floor. A policy that specifies fluoride toothpaste twice daily is meaningless if the home stocks a single type of toothpaste that a significant proportion of residents cannot tolerate.

Fluoride toothpaste as the clinical standard

NICE NG48 explicitly requires the use of fluoride toothpaste for natural teeth. For adult residents, the appropriate fluoride concentration is 1450ppm fluoride, which aligns with standard adult recommendations. Your product stock should reflect this, and care plans should record the specific product in use for each resident.

Catering for sensory and physical needs

A substantial proportion of care home residents have sensory sensitivities, whether from dementia, neurological conditions, or a lifetime of flavour aversion. Standard mint toothpastes and sodium lauryl sulphate (SLS)-containing foaming formulas trigger refusal in these residents, and the refusal is misread as non-compliance rather than a product problem. The solution is to stock an unflavoured, non-foaming toothpaste at the correct fluoride concentration as a standing item, not as something families have to bring in themselves.

Oranurase’s unflavoured, non-foaming toothpaste is formulated specifically for this population and is available in both 1000ppm fluoride (used for children up to 3 years) and 1450ppm fluoride (used for children older than 3 and adults). It can be ordered through any pharmacy and is available through NHS supply chain channels, making procurement straightforward for care settings with existing NHS supply arrangements. Having this product available as a routine option removes the barrier that causes the most common documented failure in mouth care: residents who refuse standard toothpaste and are then simply not supported with any toothpaste at all.

Toothbrush selection

Your policy should specify toothbrush requirements beyond “manual or electric.” For residents with tender or receding gums, super soft bristles and small-headed brushes allow thorough cleaning without causing discomfort. For residents who clench or who resist standard brushes, silicone fingertip brushes can be used to clean accessible surfaces and maintain some level of oral hygiene while a more comprehensive approach is established. Both types of brush should be available on your equipment stock list and referenced in the policy as alternatives to standard brushes.

Staff Training: What Good Looks Like

Training in oral health is a CQC requirement, not optional CPD. Inspectors ask staff directly about mouth care practices, and the answers they get determine whether a care home is judged effective in this area. Training records show that someone sat through a session. Confident, accurate answers from care workers demonstrate that the training worked.

Minimum training content

Staff delivering personal care should understand the link between oral health and general health; be able to carry out or support toothbrushing and denture care; know how to use the oral health assessment tool in use at the home; be able to describe what they do when a resident refuses mouth care or shows signs of oral pain; and know the referral pathway for dental concerns. This is not advanced dental knowledge. It is the practical foundation that every care worker should have before they are responsible for a resident’s personal care.

Handling resistance during mouth care

Resistance during mouth care is one of the most frequently cited reasons for incomplete oral hygiene in care settings. The standard response, stopping and documenting refusal, is often appropriate but must not become a default that removes mouth care entirely. Training should cover de-escalation approaches such as changing the time of day, changing the product, using a smaller or softer brush, involving the resident in holding their own brush, or using an alternative cleaning method. The personal care plan should document what works for each individual.

In practice, many cases of apparent refusal disappear when the trigger is removed. A resident who clamps their jaw shut at the sight of a mint toothpaste tube may accept brushing readily once an unflavoured product is used. This is a product sensitivity issue masquerading as a behavioural one, and staff training should make that distinction explicit.

Frequently Asked Questions

Does every care home legally need a written oral care policy?

There is no single piece of legislation that mandates a document titled “oral care policy.” However, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 require providers to meet standards of person-centred care, dignity, and safe care. NICE NG48 provides the clinical framework, and CQC uses it as a benchmark during inspection. In practice, a care home without a written oral care policy will struggle to demonstrate compliance, and the absence of a policy is itself treated as evidence of a gap in governance.

How often should the oral health assessment be reviewed after admission?

The initial assessment should be reviewed whenever there is a significant change in the resident’s condition, including new diagnoses, changes in medication that may affect oral health (such as drugs that cause dry mouth), episodes of dental pain, or observable changes in the resident’s mouth. Beyond triggered reviews, building a periodic review into the care plan cycle, typically every three to six months, ensures that mouth care needs are reassessed as the resident’s overall health changes.

What should a care home do if a resident has no dentist and cannot access NHS dental services?

NICE NG48 is clear that care homes should support residents in accessing dental services and should help them find a dentist if they do not have one. In practice, this may be difficult given current NHS dental access pressures. The policy should document the steps taken: searching for available NHS practices, exploring specialist services for care home residents, and in the interim, ensuring that the resident’s daily mouth care is maintained to the highest standard possible to prevent deterioration while dental access is sought. All attempts and outcomes should be recorded in the care plan.

Which fluoride toothpaste strength should be used for adult care home residents?

For adults and children older than 3 years, the recommended standard is 1450ppm fluoride. This applies to care home residents regardless of age unless a dental clinician has prescribed a high-fluoride product for a specific clinical reason, in which case that prescribed product takes precedence. The key requirement from NICE NG48 is that fluoride toothpaste is used, not that a specific brand is used. Your policy should specify the fluoride strength as the standard rather than naming a single brand, to ensure compliance continues even if product availability changes. For any residents who cannot tolerate standard flavoured toothpastes, an unflavoured formulation at the same 1450ppm concentration meets the clinical requirement.

What does a CQC inspector actually look for during an oral health check?

Inspectors look for evidence at three levels. At the policy level: does a written mouth care policy exist, does it reference NICE NG48, and has it been reviewed recently? At the care plan level: does each resident have a documented mouth care assessment and a personalised mouth care section in their care plan? At the practice level: can staff describe what they do during mouth care, how they handle resistance, what products they use, and where they would escalate a concern? Inspectors often speak to care workers directly rather than relying solely on documentation, which is why staff training that produces genuine competence, not just certificate completion, is essential.

Can a silicone fingertip brush be used as the primary toothbrushing tool for a resident?

A silicone fingertip brush is a useful transitional or supplementary tool, particularly for residents who strongly resist standard toothbrushes. It can provide some mechanical cleaning of accessible tooth and gum surfaces. However, it should not be treated as a permanent equivalent to a soft-bristled toothbrush unless there is a documented clinical or behavioural reason why a standard brush cannot be used. Where a fingertip brush is used, this should be recorded in the care plan along with the reason, and a plan should be in place to progress to a conventional brush where possible.

References