Developing dental services for homeless people in East London

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.

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.

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.

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.