The Perceptions of Homeless People in Stockholm Concerning Oral Health and Consequences of Dental Treatment: A Qualitative Study

Abstract

This study investigated the perceptions of Swedish homeless people concerning their oral health and perceived consequences of dental treatment. Candid, tape-recorded interviews were conducted in a conversational style. A phenomenological-hermeneutical method was used to analyze the subjects' stories. New participants were recruited into the study, until the interviews provided no additional new information, which occurred after eight interviews. All narratives revealed expressions of loss as well as recovery in the informants' life. Both aspects highlighted the fact that homelessness equated to "loss" not only of a permanent residence but also of many values. Similarly, oral health was described and interpreted in terms of loss and recovery. During periods of drug abuse, study participants ranked oral health as a low priority and generally received only emergency dental attention. In more rehabilitative phases of life, however, they perceived oral health and dental treatment as a function to restore their human dignity and as a key to their holistic recovery of total body health.

Homelessness & Health in Canada

“…Overall, they show that homelessness has a direct association with poor oral health Clarke et al 1996;Conte et al 2006;De Palma and Nordenram 2005;De Palma 2007;Dogan et al 2006;Gaetz and Lee 1995;Gelberg, Lin and Rosenberg 1988;Gibson et al 2003;Han, Wells and Taylor 2003;Jago, Sterberg and Westerman 1984;Kaste and Bolden 1995;Lee, Gaetz and Goettler 1994;Luo and McGrath 2006;Pizem et al 1994). Homeless persons have poor oral health, such as missing and decayed teeth, oral pain, gum disease and related conditions in need of urgent attention (Allukian 1995;City of Toronto 2000;Clarke et al 1996;Collins and Freeman 2007;Hwang , 2002King and Gibson 2003).…”

“…Consequently, dentistry is rarely a priority until a problem surfaces in or around the mouth. Competing priorities are often interpreted as general apathy or a lack of motivation rather than a sign of adaptation to unpleasantness and chaos (Daiski 2007;De Palma and Nordenram 2005;Gelberg, Lin and Rosenberg 1988). Yet this adaptation is usually a source of social embarrassment sufficient to inhibit the search for care.…”

“…Studies of homelessness and oral health (Table 8-1) are few and usually limited to small sample sizes (Blackmore et al 1995;Chi and Milgrom 2008;Collins and Freeman 2007;Conte et al 2006;Daly, Newton and Batchelor 2009;De Palma and Nordenram 2005;De Palma 2007;Gibson et al 2008;Jago, Sterberg and Westerman 1984;Kahabuka and Mbawalla 2006;Kaste and Bolden 1995;Lee, Gaetz and Goettler 1994;Luo and McGrath 2006;Pizem et al 1994;Waplington, Morris and Bradnock 2000). Overall, they show that homelessness has a direct association with poor oral health Clarke et al 1996;Conte et al 2006;De Palma and Nordenram 2005;De Palma 2007;Dogan et al 2006;Gaetz and Lee 1995;Gelberg, Lin and Rosenberg 1988;Gibson et al 2003;Han, Wells and Taylor 2003;Jago, Sterberg and Westerman 1984;Kaste and Bolden 1995;Lee, Gaetz and Goettler 1994;Luo and McGrath 2006;Pizem et al 1994).…”

“…Patients with mental health or substance use problems can be unpredictable and socially disruptive (Muirhead et al 2009) and, consequently, tend to be shunned by dentists (Allukian 1995;Clarke et al 1996;De Palma and Nordenram 2005;Falvo 2009;Lee, Gaetz and Goettler 1994;McCormack and MacIntosh 2001;Pizem et al 1994). …”

“…However, there are strong opinions that charity offers little more than a 'band-aid solution' to a complicated set of social problems (Crall 2006;De Palma and Nordenram 2005;Hwang , 2002Moore, Gerdtz and Manias 2007;Mouradian 2006). The British Dental Association (2003), for example, states that charitable dentistry by unpaid volunteers "is clearly no substitute for a coherent and properly-funded dental access strategy for homeless people", and adds "that homeless people, just as much as any other section of the community, are entitled to adequate and accessible dental care as a right, and should not be forced to rely on charity" (37).…”