Sir, the COVID-19 pandemic has resulted in a substantial increase in the number of intubated and ventilated patients in our trust. Many of these patients are 'proned' for 16 hours per day, in order to improve their gas exchange. The on-call OMFS team noticed a significant increase in the number of referrals regarding basic oral health and mouthcare queries. Staff caring for COVID-19 patients were often concerned by issues such as oral swelling and bleeding, and had limited knowledge of common oral conditions such as gingivitis, calculus, and thrush.

We conducted an audit of nursing staff caring for COVID-19 patients to assess the impact of the new PHE guidelines. We found that 74% (37/50) of nurses were unaware of the guidelines, and only 24% (12/50) met the standard of brushing their patients' teeth with fluoride toothpaste twice daily. Reported barriers to providing oral care were lack of stock, time constraints, and combative patients. Ninety-eight percent (49/50) of staff felt that they would benefit from oral health teaching.

Following the audit, we distributed oral health packs containing the PHE guidance, alcohol-free mouthwash, toothbrush, and toothpaste to COVID-19 wards throughout the hospital. PHE's Mouth Care Matters documentation was used as a teaching resource to educate staff about common oral problems, and to highlight when to escalate to dental or OMFS departments.

Our experience has demonstrated that with a small amount of engagement, nursing staff gain tremendously in confidence and motivation, and are much more likely to provide the regular oral care that COVID-19 patients need. We urge dental departments to ring fence time for disseminating the PHE guidance in person, with the aim of improving staff knowledge and hence patient care and comfort.