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Homelessness and oral health – a neglected issue

Author: Rob Edgar, Peer Research Project Worker, Groundswell

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 that was 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 experience of homelessness to shape the research and deliver all the fieldwork. This means participants are more likely to trust and answer your questions honestly. 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 were a very visible problem and it was really common for people to report that they were in a lot of pain. Getting to the dentist was always a difficult appointment to get people to – in fact it is one of the highest drop-out rates of all of our appointments. The 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 widespread dental pain was among participants. 60% of participants had experienced dental pain since they had been homeless. 30% 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, others had taken more extreme steps – 15% of participants had pulled out their own teeth since they had been homeless. It’s no wonder that people were turning to drink and drugs to deal with dental pain.

Behind the problem was a set of complex and interlinked factors; lack of self-care often driven by drug and alcohol misuse and mental health issues was a big problem. However, we also found that poor diet and other lifestyle factors like tobacco smoking and access to dental products like toothbrushes 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 was interviewing 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 as an undocumented migrant he was too scared to register with the dentist for the fear of being found out and getting deported.

However, the issues around access to dentistry were apparent for everyone no matter where they were from. Attendance at the dentist was far lower than the general population and this 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 people didn’t care about their teeth. What struck me was how resourceful people were when they had 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 resourceful people can be when they faced with hard times.

An interesting finding was that levels of dental anxiety and phobia were not dissimilar to the general population. It might also come as a shock that people really cared about their teeth – they just need the opportunity to do something about it. However, the impact of social stigma and bad experiences of treatment meant that people were often only likely to attend a dentist when issues got really bad.

It’s through the 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. It just goes to show that offering a flexible service that meets people where they are is really key to improving oral health of homeless people.

This is how we can make a difference to people’s life by taking the time to understand what challenges individuals face and working with them to take back control.

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.

You can read the full report here