The Dentist Magazine.

Oral health in London’s homeless population

Published: 08/05/2017

A new study by the homelessness charity Groundswell reveals the extent of the poor oral health facing London’s homeless population which, in many cases, may be preventing people from escaping homelessness.

The Healthy Mouths Health Audit project, funded by the independent charitable foundation Trust for London, engaged over 260 people currently experiencing homelessness in London through focus groups and one-to-one survey based interviews. Participants were in a range of accommodation situations ranging from street homeless, temporary accommodation and in other insecure accommodation like staying with friends and family.

The poor oral health that many are facing is not only causing massive discomfort but is having wider implications for homeless people’s wellbeing and lives.

A large proportion of homeless people are facing considerable pain on a daily basis, with three in 10 currently experiencing dental pain which limits their ability to live fulfilled lives and maintain social networks.

Twenty-one per cent had been “completely unable to function” due to dental issues in the last year, compared to one per cent in the general population. It may be no wonder that some homeless people are turning to substance misuse to manage pain: 27 per cent of participants have used alcohol to help deal with dental pain and 28 per cent have used drugs.

Access to dentistry is a real problem for homeless people who face significant barriers in signing up for dental practices and attending appointments. Only 23 per cent had been to the dentist in the last six months and 58 per cent were not clear on their rights to NHS dentistry.

Further to this, self-care was a significant issue for research participants. Drug, alcohol and mental ill-health meant that participants found it difficult to take care of their oral health. This was often compacted by the damaging effects on oral health of drugs, alcohol and poor diet.

Missing teeth is a particularly noticeable manifestation of the problems that people are facing. Seventy per cent of participants reported that they have lost teeth since they have been homeless.

Alarmingly, almost as many participants had teeth “fall out on their own” as those who had teeth removed by a medical professional (35 per cent). There were also a large proportion of participants who had lost teeth following acts of violence (17 per cent) or accidents (12 per cent). However, our findings reveal the lengths that some participants have taken to deal with dental issues that they face with 15 per cent of participants having pulled out their own teeth.

What makes the findings truly shocking is the level of disparity between the general population and people who are currently experiencing homelessness. For example, seven per cent of participants reported that they had no teeth at all. This compares to six per cent of the general population who have no teeth. However, the research cohort was significantly younger than the general population where 92 per cent of people with no teeth are over the age of 65 compared to 93 per cent of research participants with no teeth under the age of 65. One participant who reported to have lost all his teeth since he was homeless was only 27.

Athol Hallé, chief executive at Groundswell, added that, “Oral health is a huge issue for people experiencing homelessness and action needs to be taken to address this damaging health inequality. Our report has revealed that current dental service provision is failing people and pro-active steps need to be taken by commissioners and by dental services to improve access to treatment.

“This study has shown that improving the oral health of homeless people can make an important difference in people’s quality of life and ability to move on from homelessness. Reducing homelessness benefits everyone, such as by reducing reliance on emergency treatment.”

Despite the problems highlighted in this study, homeless people’s trust in dentists was high and there was significant value placed in oral health. This indicates that, with the right support and treatment, participants could have significantly better oral health.

One research participant explained how it was sorting out his teeth that changed his life more widely. He said, “When I got my teeth sorted, oh it was amazing. Even just seeing the look in peoples’ eyes – like it took me ages to stop putting my hand to my mouth. My mum and my dad, whenever I would see them periodically it was like, ‘oh your teeth are getting worse, your teeth are getting worse’. When I did get my teeth sorted I noticed it was almost like the way that people interacted with me – I don’t know if they sensed that I was more at ease with myself when I smiled kind of thing – so they could smile with me. Because I think when I was doing that, they felt embarrassed for me; do you know what I mean? I actually feel that getting my teeth sorted has helped me to turn a corner. They don’t hurt anymore and I’m not drinking now. I’m not embarrassed. I can start looking to the future.”

The scale of the problem and the support needs of people experiencing homelessness mean that new approaches are needed to tackle this issue. Groundswell is supporting partner organisations to pilot new initiatives to tackle the issue. While specialist homelessness services are doing great work to support people around their oral health needs, there is a need for highstreets dentists to be better meeting the needs of homeless people.

Commenting on the research, Michael Cranfield, chair of England Community Dental Services at the BDA, said, “This research is a stark reminder of how current dental policy is failing vulnerable patients. 

“A civilized society does not leave homeless people handicapped by oral disease or resorting to pulling out their own teeth. There is no easy solution, but any progress is impossible without adequately resourced mainstream and dedicated services.

“The failure to invest in community dentistry is hurting patients who can’t always be cared for in traditional settings. It’s hitting the homeless, the housebound, and patients with dementia, learning disabilities and phobias who are all entitled to effective care.

“This research should force government and health commissioners to reassess their priorities.”