Introduction People who experience homelessness have poor oral health and limited access to dental services.
Aim To examine whether 'peer education' could yield improved plaque management among people experiencing homelessness.
Methods A quasi-experimental, one-group pre-test-post-test study was conducted, with follow-up at one and two months. Participants were living in temporary accommodation in Plymouth, UK. Plaque levels were assessed using the simplified oral hygiene index. A questionnaire and the oral health impact profile (OHIP-14) were administered. Patient satisfaction and barriers to dental care were explored by interviews.
Results The baseline sample included 24 people with a mean age of 36.88 ± 10.26 years. The mean OHIP-14 score was 25.08 ± 19.56; finding it uncomfortable to eat and being embarrassed attracted the highest values (2.46 ± 1.53 and 2.33 ± 1.63, respectively). Plaque levels decreased by month one and month two, though the changes were not statistically significant. Positive changes in confidence in toothbrushing at month two were identified (p = 0.01).
Conclusion Experiencing pain and the opportunity to access treatment were key drivers of study participation. The study indicated that it is feasible to conduct oral health promotion projects for people in temporary accommodation. Adequately powered studies examining the impact of peer education on improving homeless people's oral health are warranted.
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Shelter. Far from alone: Homelessness in Britain in 2017. London: Shelter, 2017. Available at https://england.shelter.org.uk/__data/assets/pdf_file/0017/1440053/8112017_Far_From_Alone.pdf (accessed May 2019).
NHS England. Health care & people who are homeless: Commissioning Guidance for London. London: Healthy London Partnership, 2016. Available at https://www.healthylondon.org/wp-content/uploads/2018/01/Commissioning-guidance-for-London-Homeless-health.pdf (accessed May 2019).
Thomas B. Homelessness kills: An analysis of the mortality of homeless people in early twenty-first century England. London: Crisis, 2012. Available at https://www.crisis.org.uk/media/236798/crisis_homelessness_kills2012.pdf (accessed May 2019).
De Palma P, Frithiof L, Persson L, Klinge B, Halldin J, Beijer U. Oral health of homeless adults in Stockholm, Sweden. Acta Odontol Scand 2005; 63: 50-55.
Figueiredo R L, Hwang S W, Quiñonez C. Dental health of homeless adults in Toronto, Canada. J Public Health Dent 2013; 73: 74-78.
Smile4life. The Oral Health of Homeless People across Scotland: Report of the Homeless Oral Health Survey in Scotland, 2008-2009. Dundee: University of Dundee, Dental Health Services Research Unit, 2011. Available at https://dentistry.dundee.ac.uk/sites/dentistry.dundee.ac.uk/files/smile4life_report2011.pdf (accessed May 2019).
Daly B, Newton T, Batchelor P, Jones K. Oral health care needs and oral health-related quality of life (OHIP-14) in homeless people. Community Dent Oral Epidemiol 2010; 38: 136-144.
Hill K B, Rimington D. Investigation of the oral health needs for homeless people in specialist units in London, Cardiff, Glasgow and Birmingham. Prim Health Care Res Dev 2011; 12: 135-144.
Caton S, Greenhalgh F, Goodacre L. Evaluation of a community dental service for homeless and 'hard to reach' people. Br Dent J 2016; 220: 67-70.
Groundswell. Healthy Mouths: A peer-led health audit on the oral health of people experiencing homelessness. London: Groundswell, 2017. Available at http://groundswell.org.uk/wp-content/uploads/2017/10/Groundswell-Healthy-Mouths-Report-Final.pdf (accessed May 2019).
Kay E J, Vascott D, Hocking A, Nield H. Motivational interviewing in general dental practice: A review of the evidence. Br Dent J 2016; 221: 785-791.
Duane B. Psychological approaches to behaviour for improving plaque control. Evid Based Dent 2017; 18: 3-4.
Greene J C, Vermillion J R. The Simplified Oral Hygiene Index. J Am Dent Assoc 1964; 68: 7-13.
Public Health England. Oral health survey of adults attending general dental practices 2017/18. London: Public Health England, 2017. Available at https://www.gov.uk/government/publications/oral-health-survey-of-adults-fieldwork-protocol (accessed May 2019).
O' Sullivan I, Lader D, Beavan-Seymour C, Chenery V, Fuller E, Sadler K. Foundation Report: Adult Dental Health Survey 2009 (Technical information). London: The Health and Social Care Information Centre, 2011. Available at https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-foun-2009-re14.pdf (accessed May 2019).
Slade G D. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997; 25: 284-290.
Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 3rd ed. London: Public Health England, 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed May 2019).
William M R, Rollnick S. Motivational Interviewing. Helping People Change. 3rd ed. New York, NY: Guilford Press, 2012.
Waplington J, Morris J, Bradnock G. The dental needs, demands and attitudes of a group of homeless people with mental health problems. Community Dent Health 2000; 17: 134-137.
Akbar T, Turner S, Themessl-Huber, M, Freeman R. The Evaluation of HMP Shotts' Oral Health Improvement Project. Dundee: University of Dundee, 2012. Available at https://discovery.dundee.ac.uk/ws/portalfiles/portal/3398945 (accessed May 2019).
Beaton L, Coles A, Rodriguez A, Freeman R. Homeless People in Scotland: a process evaluation of a Community-based oral Health intervention - the findings of a pilot study from 4 NHS Boards. Dundee: University of Dundee, 2015. Available at https://dentistry.dundee.ac.uk/sites/dentistry.dundee.ac.uk/files/media/HoPSCOTCH%20Report.pdf (accessed May 2019).
The British Society of Periodontology. Basic Periodontal Examination (BPE). Liverpool: The British Society of Periodontology, 2016. Available at https://www.bsperio.org.uk/publications/downloads/115_090048_bsp-bpe-guidelines-2019.pdf (accessed May 2019).
The authors are extremely thankful to the Oral and Dental Research Trust (GSK Research Award) for providing funding for this study. We also thank the charity Well Connected for providing the goody bags distributed at baseline, and PDSE for providing us with clinical equipment and consumables. Many thanks to Stephan Morrison from Groundswell for leading the focus groups. A very big thank you is due to the dental team and administration staff at PDSE, particularly Christina Worle, for providing care to our participants free of charge. The study would not have been possible without the support of the lead volunteer and our participants.
The authors declare no conflicts of interest. The funders had no role in the analysis or interpretation of data.
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Paisi, M., Witton, R., Burrows, M. et al. Management of plaque in people experiencing homelessness using 'peer education': a pilot study. Br Dent J 226, 860–866 (2019). https://doi.org/10.1038/s41415-019-0361-0
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