Homelessness Compounds Poor Oral Health

Dentistry Today


Homeless people face significant challenges when it comes to their oral health, according to Groundswell, a registered charity that serves this vulnerable population in England. In a survey of more than 260 people experiencing homelessness in London, problems with the mouth, teeth, and gums were more widespread than they were in the general population. Specifically, the organization found the following:

  • 90% of participants have had an issue with oral health since becoming homeless, such as bleeding gums (56%), holes in their teeth (46%), and abscesses (26%);
  • 60% of participants had experienced dental pain since becoming homeless, with 30% of participants currently experiencing dental pain;
  • 70% of participants have lost teeth since becoming homeless, with 15% pulling out their own teeth, and 7% having no teeth at all;
  • 27% of participants have used alcohol to deal with dental pain, and 28% have used drugs;
  • 27% of participants have been to emergency rooms to treat dental problems;
  • 23% have been to a dentist in the previous 6 months;
  • 58% did not understand their rights to National Health Service dentistry;
  • 35% cleaned their teeth twice a day or more (compared to 75% in the general population), and 29% cleaned their teeth less than once a day or never.

Groundswell found that difficulties in accessing treatment, lifestyle, and low levels of self-care all were key barriers to maintaining a healthy mouth. Poor mental health and substance abuse also had a negative impact on self-care and utilization of dental services. However, Groundswell noted, participants still valued oral health and believed dentists were there to help.

“A civilized society does no leave homeless people handicapped by oral disease or resorting to pulling out their own teeth,” said Michael Cranfield, BDS, MSc, chair of England Community Dental Services with the British Dental Association. “There is no easy solution, but any progress is impossible without adequately resourced mainstream and dedicated services.”

Groundswell is now calling on health commissioners to ensure that oral health promotion and treatment are available to all people experiencing homelessness. It also has produced an Action Guide that offers steps for these patients to improve their oral health and make the most of trips to the dentist. It can be hung on the walls of locations that offer services to the homeless or folded up to be distributed as a brochure.  

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