Spotting pain, infection and other mouth problems

NICE expects care staff to recognise and respond to changes in a resident's mouth care needs. The oral health assessment quality statement lists signs such as tooth decay, abscesses, dry mouth and gum disease. In care homes these issues may show through behaviour and daily function as much as through visible mouth changes.

Useful warning signs include bleeding gums, ulcers, bad breath, swelling, loose or painful dentures, broken teeth, difficulty chewing, new refusal of food, repeated touching of the mouth, facial grimacing, agitation during care, or a resident saying they cannot tolerate their dentures.

Signs staff should notice

• Pain signs: hand to cheek, flinching, grimacing, refusal to eat or drink.
• Mouth signs: redness, swelling, ulcers, bleeding, white patches or bad breath.
• Denture signs: loose fit, rubbing, breakage or refusal to wear them.
• Behaviour signs: new agitation, withdrawal or resistance linked to mouth discomfort.
• Health signs: unexpected weight loss or reduced food and fluid intake may have an oral cause.

People who cannot describe dental pain may still show it clearly through behaviour, eating changes and distress during care.