Abstract
BackgroundPeople who experience homelessness have higher dental treatment needs compared to the general population. However, their utilization of dental services and levels of treatment completion are low. Peninsula Dental Social Enterprise, a not‐for‐profit organization in the United Kingdom, established a community dental clinic to improve access to dental care for this population.ObjectivesTo evaluate the impact and acceptability of the community dental service for patients and examine the barriers and enablers to using and providing the service.MethodsThe evaluation included a retrospective assessment of anonymous patient data and thematic analysis of semi‐structured interviews with patients, support staff and service providers. The interviews were thematically analysed. A cost analysis of the dental service was also conducted.ResultsBy 18 February 2020, 89 patients had attended the clinic. These included 62 males (70%) and 27 females (30%), aged 38.43 years on average (SD ± 11.07). Of these, 42 (47%) patients have completed their treatment, 23 (26%) are in active treatment and 24 (27%) left treatment. In total, 684 appointments (541.5 hours clinical time) were given. Of these, 82% (562) of appointments were attended (452.5 hours clinical time). The 22 interviews that were conducted identified flexibility, close collaboration with support services and health‐care team attitudes as key factors influencing service utilization and continuity of care.ConclusionsThis study provides details of a highly acceptable and accessible dental care model for people experiencing homelessness, with recommendations at research, practice and commissioning levels.
Highlights
Homelessness is associated with increased morbidity and mortality.[1]
Barriers to accessing dental care in general Patients and staff members identified a number of barriers including previous dental care experiences that “create a fear based around attending and receiving treatment”, anxieties, a “needle or dental phobia”
Barriers to accessing the clinic The main barrier described related to patient-preparedness
Summary
Homelessness is associated with increased morbidity and mortality.[1]. Dental problems are among the most common health concerns affecting people experiencing homelessness,[2,3] with higher levels of untreated dental disease and more missing teeth than the general population,[4,5] causing poorer oral health-related quality of life.[6]. Disproportionate differences in oral health between population groups are due to an interaction of a number of factors (e.g. socioeconomic and political environment), many beyond an individual’s control.[11,12] Dental service utilisation contributes to oral health inequalities.[13] Watt and colleagues, state that addressing this requires “coordinated strategic action at both clinical and population levels”.12. Freeman and colleagues[14] have developed a theoretical framework for ‘inclusion oral health’ focusing on innovative solutions to tackle inequalities associated with poor oral health in individuals experiencing social exclusion. Their action plan addressing oral health services, research, and dental education can make dentistry a powerful catalyst to reduce inequalities.[14]
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