Dental issues associated with homelessness are wide and varied. We share a building with a medical clinic that operates a homeless service. Many of this clinic’s patients were presenting serious oral health issues and advanced dental disease. Our local CCG awarded us a small contract to pilot a service for these hard to reach patients. First of all we worked just with homeless patients. Our service grew to cover a variety of other vulnerable groups in Manchester. We work with Manchester Action on Street Health. We provide support to sex workers, mental health charities, asylum seekers and refugee groups. All of these people may find it difficult to get treatment in a standard dental practice.
Oral hygiene training
To build up trust we visit ten local charity bases delivering oral hygiene training and giving out simple oral health packs. Once trust has been established we encourage patients to come to our clinics. Here we can assess their oral health and plan treatments. We fund and support our dental nurses in their training as oral health educators. This is really essential as they are the ones to deliver those vital oral health messages to patients.
Building relationships with homeless people
Building trust with homeless patients can be very challenging. Getting them to come to appointments, which may be quite far away from where they are living is also difficult, especially when there is often no way of contacting them. You really have to change your approach – even how we dress can have an impact. We have found that dressing more informally makes us seem less intimidating. Besides that, we also have to be prepared to be very strict in case patients attend under the influence of drink or drugs.
We would urge any practices considering running a homeless dental service to get in touch with local services that already work with vulnerable groups. Working closely with local public health agencies and CCG partners will also ensure you are offering the best value to the widest patient base. No matter the size of your local area, you will probably be surprised by the number of vulnerable people who need help.
It is important to remember how easy it is for people to become homeless. You never know the back story of any patient you meet. The clinics themselves and levels of patient attendance are very different from standard dental practice. You have to be prepared to be really flexible. As failure rates are higher you need to be prepared to persevere. Hard-to-reach groups often have very low expectations so being involved with reinstating their pride and dignity is hugely rewarding.