Homelessness and oral health: a neglected issue

Dental problems are widespread among people experiencing homelessness – and in many cases they may be preventing people from escaping lives of poverty and addiction.

My name is Rob and I’m one of the peer researchers involved in Groundswell’s Healthy Mouths Health Audit. We spoke to over 260 homeless people from across London about their oral health, including people who are street homeless, in hostels and people in other insecure accommodation.

The great thing about ‘peer research’ is that we use our personal experiences of homelessness to shape the research and deliver all the fieldwork. This means participants are more likely to trust and answer our questions honestly.

A clear picture of homeless people’s oral health

We wanted to create a clear picture of the state of homeless people’s oral health, what the driving issues are, and to understand the impact this is having on people’s lives.

Before joining the staff team at Groundswell, I volunteered as a Homeless Health Peer Advocate, supporting people one-to-one to make and attend health appointments. This role involved helping people to identify any health concerns and encouraging them to take control of their health.

Problems with people’s teeth are a very visible problem and it is really common for people to report that are were in a lot of pain. Getting to the dentist is always a difficult appointment to get people to – in fact it has one of the highest drop-out rates of all of our appointments. Our research was aimed at better understanding why this was such a big issue for people.

One of the really hard-hitting findings was just how wide spread dental pain was among participants:

  • Sixty per cent of participants had experienced dental pain since they had been homeless.
  • Thirty per cent were currently experiencing dental pain. Many participants had had to go to A&E to sort out this issue as they were not able to get treatment through a dental practice
  • Fifteen per cent of participants had pulled out their own teeth since they had been homeless.

It’s no wonder that people are turning to drink and drugs to deal with dental pain.

Behind these problems are a set of complex and interlinked factors; lack of self-care often driven by drug and alcohol misuse and mental health issues is a big problem.

However, we also found that poor diet and other lifestyle factors like tobacco smoking, and also access to dental products, like toothbrush and toothpaste, can be limited.

Dental problems are having a really damaging impact on homeless people’s quality of life. In one of my early surveys, I interviewed someone who had been in chronic dental pain for more than two years.

The pain was so severe that he could only eat soups or anything that didn’t involve having to chew. I could not imagine what this person’s life must be like having to go through that daily struggle with eating.

The sad thing about this was all he needed was a tooth extraction to solve his problems, but he was an undocumented migrant and he was too scared to go to see a dentist, for the fear of being found out and getting deported.

Barriers to accessing dental care

However, the issues around access to dentistry are apparent for everyone no matter where they are from.

Attendance at the dentist is far lower than the general population and is was often due to the practical barriers and competing priorities that homeless people can face when trying to use mainstream services.

A key example of this was how confusion around entitlement to NHS treatment was so widespread among participants.

It’s not that homeless people don’t care about their teeth. What struck me is how resourceful people are when they have nothing.

One participant said that because he could not afford dental floss he uses a carrier bag to clean between his teeth. I am not sure how good this is to floss but shows me how initiative people can be when they are faced with hard times.

Another interesting finding is that levels of dental anxiety and phobia were not dissimilar to the general population.

It might also come as a shock to people that most homeless people really do care about their teeth – they just need the opportunity to do something about it.

However, the impact of social stigma and previous bad experiences of treatment meant that people are often only likely to attend a dentist once the problem gets really bad.

It’s through our research that we started to understand how many people relied on the Crisis at Christmas dentist. A really high proportion of people we surveyed only saw a dentist once a year when Crisis at Christmas is happening. I think this shows that offering a flexible service that meets people where they are, is really the key to improving oral health of homeless people.

We can make a huge difference to people’s lives by taking the time to understand the challenges individuals face, and working with them to take back control.

Rob’s story

Rob has been involved with Groundswell for over two years. Rob credits his volunteering work with Groundswell as playing a key part in his own move away from homelessness.

He began volunteering with Groundswell in 2014 offering one-to-one support as a Homeless Health Peer Advocate, first specialising in supporting people diagnosed with tuberculosis.

This has given him a deep understanding of the health issues homeless people face and the barriers they often meet to effective treatment.

He strongly believes that homeless people have a right to have their voices heard and that this is key to improving services and creating meaningful change.

Rob is also a board member for the London Homeless Health Programme.

Effective oral healthcare for the homeless

We’ve called on government and health commissioners to adequately resources NHS community dental services that care for vulnerable patient groups. The Groundswell report is a stark reminder of how current dental policy is failing the homeless and we’ve called for more investment.

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