Crisis in care homes: the dentists don’t come

Aim/Objectives: To present findings on challenges relating to access to dental care for older people in care homes from the Fluoride Interventions in Care Homes (FinCH) Trial. Methods: Thematic analysis of 11 interviews/focus groups with care home managers and care staff, analysed against a framework informed by the literature and lived experiences. Results: Challenges mapped to Penchansky and Thomas’s five dimensions of access, with additional themes specific to care home residents: lack of suitable services for routine and urgent domiciliary and clinic care; complex referral processes; operational challenges including need for appropriate care chaperones; information gaps regarding dental charge exemption; and capacity/consent processes within the home. Discussion: There is a paucity and misalignment of dental services to meet care home residents’ needs, resulting in a reactive, not fit-for-purpose system and widespread dental neglect. Conclusion: Urgent commissioning of adequate routine and urgent dental care is needed, delivered by appropriately skilled clinicians. At minimum, free routine dental examinations should be offered to all care home residents to enable advice, prevention, and pain-free functioning. Trial registration: EudraCT 2017-002248-34.