Consent, refusal and supporting people with dementia or distress

NICE advises care home policies to set out how to respond when a resident refuses oral care, consistent with the Mental Capacity Act and local guidance. Staff should be aware of how to manage refusal of daily mouth care or refusal to have dentures removed.

In practice, staff should use a calm, person-centred approach, aim to reduce distress, consider whether pain or fear is a barrier, and avoid forcing care. A refusal may reflect a considered choice, but it can also result from pain, past experience, confusion, poor timing, unfamiliar staff or sensory overload.

Safer support when care is resisted

• Pause and explain: use one calm voice and simple language.
• Check the reason: pain, dry mouth, fear or poor timing may be involved.
• Try again differently: another time, another staff member or a familiar routine may help.
• Respect lawful choice: do not force mouth care into a struggle.
• Escalate repeated refusal with concern: especially if pain, swelling or poor intake is present.

Good mouth care support is respectful and persistent, but it is not forced.