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Guest blog: Caring for the oral health of people experiencing homelessness

Written by: Dr Julia Csikar and Dr Karen Vinall-Collier - 2nd April 2024

People experiencing homelessness have a greater experience of material and social deprivation. This directly impacts on their risk of ill health and early death. Their oral health is similarly negatively affected, high levels of dental decay, pain and missing teeth are common in this group of people. Getting out of pain is a real challenge for this group. Previous work with people experiencing homelessness has outlined cost, dental anxiety, dental phobia, difficulty filling out forms, having the knowledge of how the service operates as reasons why routine dental care is not accessed. They often outline that dental care is a low priority due to competing hierarchy of needs and the often-chaotic lifestyle they experience. This is a particular issue for those using drugs and misusing alcohol.

People experiencing homelessness have reported they feel unwanted at health service locations and report being treated with a lack of respect. It is unsurprising then, that they will often avoid attending routine health care appointments and attempt to manage problems and pain by using illegal and prescribed drugs, alcohol and self-treatment. They often present at accident and emergency (A&E) hospital departments where appointments are not required but a queuing system is in place. Attending A&E departments, rather than dental services means that they do not get the most appropriate care for their needs and A&E services are further overwhelmed.

Based on national and international research, structural barriers for this group have shown to be reduced when dental teams and homeless charities work together to provide a service to meet their dental needs. In 2022, a pilot NHS dental service was established at two dental practices in Leeds with expansion of the service currently being explored across the country. The early signs of this primary dental care service is that it is able to identify and treat people experiencing homelessness with a dental need and all involved in delivering and receiving the service have seen tangible benefits.

Anecdotally the service is working well, so far over 300 people are getting the professional help to get out of pain and start to rebuild their confidence, this can be seen by a dentist’s quote who reported that one such patients….”has had no pain since being treated. Also, he has had a front tooth gap replaced with a bridge. Prior to this he felt self-conscious about his smile, now he feels more confident. His confidence has improved to a stage that he is now working with the charities acting as the chaperone bringing clients to the practice for their treatment. The program has built his confidence and allowed him to feel valued and that he can help give back to the charity after the help they have given him.”

With the support of funding by Health Innovation Yorkshire & Humber a formal evaluation of this service has been proposed to understand what is working well, articulate some of the wider benefits and if the current delivery could be improved. Julia Csikar & Karen Vinall-Collier from the University of Leeds are working with the two dental practices in Leeds, the homeless charities and people experiencing homelessness to fully understand the impacts of this dental service in a new project called Evolve’: Evaluation Of a dental care service in Leeds for Vulnerable people Experiencing homelessness’. This qualitative study will evaluate the acceptability and usage of the dental service. The project will explore the advantages and challenges for all stakeholders involved, including people experiencing homelessness, charities and the dental practices providing care. This evaluation will provide real-world evidence of the impacts of such a dental service on the health and wellbeing of people experiencing homelessness and if such a service could be rolled out in other locations.