Homeless adults' access to dental services and strategies to improve their oral health: a systematic literature review

Abstract

Homeless people have poor oral health and high treatment needs, yet tend to make problem-based dental visits. This review aimed to determine how and where homeless adults receive oral health care, the barriers that prevent homeless adults accessing dental care and find strategies to promote oral health to homeless adults. The databases MEDLINE via OvidSP, PubMed, CINAHL and Scopus were searched using the keywords: homeless, roofless, houseless, rough sleeper, couch surfer, shelter, hostel, dental and oral health. The inclusion criteria were: participants over the age of 17 years, studies written in English, based in developed countries and published after 2003. Selected articles were assessed using the Mixed Methods Appraisal Tool and data extracted were thematically analysed. Twenty-two studies met the inclusion criteria. Five main themes were found: how homeless people accessed dental care; factors affecting the uptake of care; strategies used to improve access to care; the effect of non-dental staff on dental care; and challenges with providing care to homeless people. Dental care for homeless adults was affected by numerous factors. Improving their access to dental services requires collaboration between support service providers, dental care to be near homeless populations and flexibility by dental services.

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

“…However, that review only focused on the characteristics of the population acting as barriers to care and thus bias towards the structural components of access could have been introduced. A recent systematic review which included studies published in developed countries identified similar population and system level factors affecting homeless people's access to dental care . Lack of inclusion of grey literature appears to explain why some elements captured in our review were not identified in others (ie, confusion on how benefit eligibility affects right to care and language difficulties acting as barriers to care; support to register and attend services as an enabler).…”

“…A recent systematic review which included studies published in developed countries identified similar population and system level factors affecting homeless people's access to dental care. 55 Lack of inclusion of grey literature appears to explain why some elements captured in our review were not identified in others 55 (ie, confusion on how benefit eligibility affects right to care and language difficulties acting as barriers to care; support to register and attend services as an enabler). Peer advocates can be an important source of support for people experiencing homelessness to register and attend services.…”

“…The current review focused on access of homeless people to dental services in the UK. However, it appears that many of the barriers identified are applicable to homeless populations in other countries (eg, cost, availability, complexity) . Furthermore, they seem to have cross‐healthcare system relevance (eg, specialist primary healthcare services and mental health services) .…”

“…However, it appears that many of the barriers identified are applicable to homeless populations in other countries (eg, cost, availability, complexity). 54,55 Furthermore, they seem to have cross-healthcare system relevance (eg, specialist primary healthcare services and mental health services). 9 This may well be explained by the fact that barriers and enablers for people who are homeless are conceptually similar regardless of the country or healthcare setting.…”

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

“…Individuals who are homeless (those without a fixed, regular, and adequate night-time residence) had higher mortality rates and experience the dual burdens of DPs, CDs compared to the general population [4,5,14] due to structural and system-level barriers (e.g., lack of affordable housing, shrinking safety nets, health care systems models, health services affordability, lack of accessibility to health and social services) [15][16][17][18][19], social exclusion [18]. People experiencing homelessness frequently suffer serious mental disorders (e.g., psychotic disorders, mood and personality disorders, substance and alcohol use disorders) [20,21] and modifiable risk factors (e.g., diet, smoking) [22,23], which also contribute to poor health profiles and premature mortality [5,21].…”