Objective The aim of this study was to describe the dental services delivered by the Community Dental Service (CDS) of Tower Hamlets (TH) and City and Hackney (CH) for adult homeless people in 2009-2011, to assess if the service met its planned objectives and to report the outcomes of the dental care provided.
Method TH and CH CDS provided a nine tier dental service for homeless people during April 2009 to September 2011, in which the dedicated mobile dental service (MDS) and the dedicated dental clinic (DDS) provided 3,102 dental appointments for homeless people. Data collection from a random sample (n = 350) of record cards of adult patients who were homeless and offered oral care from these services was conducted, in collaboration with an analysis of appointment books, service delivery rotas and day sheets. Patients' oral findings, treatments, challenges as well as feedback received from the service users were recorded and evaluated against the planned objectives.
Results One thousand two hundred and twelve (39.1%) of these appointments went to the 350 patients whose record cards were examined as part of this audit. One of the record cards randomly selected had incomplete date and was excluded from the results, so data was presented on the 349 complete record cards. The age range of these patients was 18-74 years, with a mean age of 38.46 years ± 9.1 standard deviation (SD) with 80% of the patients (n = 281) under 50 years of age. Forty percent of these patients presented in pain with a further 5% complaining of swelling and infection, 99% of people required treatment and only nine people had no decay, three of whom were edentulous. Two hundred and thirteen (61%) patients completed their treatments, which took between 1 to 18 appointments, but only 97 (27.8%) patients did so without any failed or cancelled appointments. Of the 128 (36.7%) patients who were lost after the first appointment, only 15 (11.7%) did not receive any treatment; most had been treated for pain with temporary fillings, extractions, permanent fillings and management of swelling. Sixty-seven band 1, 16 band 1.2 (emergency only), 148 band 2 and 52 band 3 courses of treatment were submitted.
Conclusion This study showed a significant need for services providing oral healthcare for this population and highlighted that flexibly delivered dental services, embedded in local health and social networks, seemed to promote uptake in these clients who normally find it extremely difficult to find dental care services elsewhere.
Improves the evidence base for the effectiveness of targeted service delivery to special care groups.
Provides information for other dental services to consider when developing and assessing special care services.
Describes how increasing accessibility of dental care to homeless people led to a decrease in the loss of clinical time due to failed or cancelled appointments.
Over 2,000 single people per year access the Tower Hamlets (TH) homeless services; 1 in 12 children in TH live in homeless households; in a single year about 350 individuals are contacted by services in TH.1 These numbers grow year on year.
Homeless people are a high-risk group for oral and dental disease but providing them with dental services can be difficult. Unless they are in pain, dental care could be a low priority; seemingly the least of their worries'.
It has been recommended that a combination of both mainstream and dedicated services, such as mobile dental services (MDS), should be used to address this problem. This BDJ paper provides a rare example of evidence for the effectiveness of dedicated service delivery. It shows that targeting special care dental services, though costly, is successful.
Figures in the study reinforce the significant and shocking need for dental care amongst homeless people: 99% seen required treatment and only 6 out of 346 (dentate) homeless patients had no decay.
The evidence in this study certainly leads to high level recommendations about the development of services for homeless people and other special care groups. However, it also contains practical suggestions of how services can be improved on a day-to-day basis. For example they found that a high rate of patients were failing to attend their appointments with the MDS – to help with this one of things they implemented was to simply ring and remind all patients and key workers the day before and a half an hour before the appointment. Every little helps.
To learn more about dental care for homeless people both in community dental services and the general dental service, I recommend you also read the BDA's report: Dental Care for Homeless People (accessible online at http://www.bda.org/Images/homeless_dec20_2003.pdf).
The full paper can be accessed from the BDJ website (www.bdj.co.uk), under 'Research' in the table of contents for Volume 213 issue 7.