People experiencing homelessness face several health issues and barriers that accompany these issues. A topic of concern that needs to be discussed are the dental issues and poor oral health among this community. Although there are barriers to obtaining quality oral care, there are also facilitators in which can enable easier access to quality dental care as well.

It is imperative that in order to understand the barriers and facilitators to achieving good oral health by homeless individuals, understanding and defining the terms should be a priority. According to the Centers for Disease Control and Prevention, “oral health refers to the health of the teeth, gums, and the entire oral-facial system that allows us to smile, speak, and chew” (2022). Additionally, poor oral health is associated with “other chronic diseases such as diabetes and heart disease” (CDC, 2022). More specifically, the CDC discusses that oral disease is related to risk behaviors such as using tobacco and consuming sugary foods and beverages” (2022). Oral disease also is associated with risk behaviors such as using tobacco and consuming sugary foods and beverages. These dental issues are prevalent in the homeless community and results in challenges when it comes to their oral health. In fact, ”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%)” (Dentistry Today, 2021). Even more so, “homeless persons are 12 times more likely than individuals with stable housing to have dental problems” (Clark, 1999). These studies reveal that the dental and oral problems pertaining to the individuals experiencing homelessness are at a much higher risk than the general population.

Homeless individuals also experience challenges and obstacles when it comes to oral and dental health. According to the National Health Care for the Homeless Council, healthcare barriers include “the inability to afford services out of pocket, lack of insurance coverage, and limited access to a provider” (2015). Moreover, Medicaid policies mandate that children be covered for dental screenings while it is not mandated for adults which means that it is up to the state to determine which groups of adults can receive coverage. “In some states, expanded dental services (such as teeth cleaning, x-rays, and minor to major restorative procedures) are limited to pregnant women and emergency services (such as tooth extraction and pain management) are the only dental services covered for other adults” (NHCHC, 2015). This shows that even if these individuals have access to care, the financial barrier of cost can still be an obstacle to receiving preventative care. Even more so, confusion over the payment structure proves to be another challenge that homeless individuals face. Additionally, “lacking a stable address made it very challenging for participants to gain an appointment and often to attend such an appointment” (Csikar et. al., 2019). Other barriers include social barriers because “oral health may not be a top priority among homeless youths because of more urgent life stressors and difficulties these youths encounter on the street such as substance use” (Chi & Milgrom, 2008). Therefore, social determinants of health should be considered because oftentimes they may pose as challenges to individuals in certain situations who are trying to access dental care.

Although there are several challenges to achieving quality dental and oral care for people experiencing homelessness, there are also facilitators in which they can achieve good oral health. It is important to remember, however, that there is not a one solution fixes and that every situation is different whether it is for financial, social, or economic reasons that that individual may not have access to preventative dental care. Policy changes would have to be made in order to ensure health care coverage of oral and dental care. Also, implementing “service delivery models to reduce and eliminate barriers to accessing vision and oral health services, such as integration into primary care” (NHCHC, 2015) could be a step in the right direction when it comes to improving access to oral health for homeless individuals. Increasing awareness of these issues will also help through initiatives and campaigns in order to spread the importance of oral health and how it affects the overall health of an individual, especially ones who have many barriers to care. Additionally, health care workers can “ensure that oral health promotion and treatment are available to all people experiencing homelessness” (Dentistry Today, 2021). This can be through social media posts, brochures, and advertisements shown in areas where health care services are available to the homeless community.

In conclusion, oral and dental care are very important when it comes to health care and the overall wellbeing of individuals. There are several barriers and challenges to accessing dental care, however, through policy changes and initiatives, this can facilitate better access to care. Project Downtown works to aid the homeless community in the best way possible; no act is too small and creating food and hygiene kits helps a long way. Being aware of these issues can improve health outcomes for the homeless population and increase their access to dental care in the future.

References

Centers for Disease Control and Prevention. (2022, April 6). Oral Health Conditions. Centers for Disease Control and Prevention. Retrieved May 11, 2022, from https://www.cdc.gov/oralhealth/conditions/index.html

Chi, D., & Milgrom, P. (2008). The oral health of homeless adolescents and young adults and determinants of oral health: preliminary findings. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 28(6), 237–242. https://doi.org/10.1111/j.1754-4505.2008.00046.x

Clark, M. (1999, June). Homelessness and oral health. National Maternal and Child Oral Health Resource Center. Retrieved May 11, 2022, from https://www.mchoralhealth.org/PDFs/OHHomelessfactsheet.pdf

Csikar, J., Vinall-Collier, K., Richemond, J. M., Talbot, J., Serban, S. T., & Douglas, G. V. A. (2019). Identifying the barriers and facilitators for homeless people to achieve good oral health. Community Dent. Health, 36(2), 137-142.

Dentistry Today. (2021, September 30). Homelessness compounds poor oral health. Retrieved May 11, 2022, from https://www.dentistrytoday.com/homelessness-compounds-poor-oral-health/

National Health Care for the Homeless Council. (June 2015). Vision and Oral Health among Individuals Experiencing Homelessness: A Quarterly Research Review of the National HCH Council, 3:3. [Author: Claudia Davidson, Research Associate] Nashville, TN: Available at: www.nhchc.org.