Oral Health and Drug Use Among People Experiencing Homelessness: A Community-Based Cross-Sectional Study

The health vulnerability that homeless individuals encounter, in which poor nutrition, irregular hygiene behaviours, social exclusion, and limited access to preventive dental care converge with high rates of substance use, is a major factor in the acceleration of oral disease progression. Xerostomia, bruxism, poor diet, delayed care-seeking, and trauma are other ways that drug use exacerbates oral health issues, but the extent to which these interactions occur in the homeless population is not well quantified in low- and middle-income countries.

The aim of this study was to use outreach-based sampling to describe oral health conditions and drug-use patterns among people experiencing homelessness and to examine the relationship between substance use and oral health outcomes.

The study involved a community-based, cross-sectional study of homeless persons living on the roads and in public places in Lucknow city. Caries experience was recorded as Decayed, Missing, and Filled Teeth (DMFT), and Plaque Index and Gingival Index scores were recorded as means of the teeth/surfaces examined. The examiner examined the oral mucosa for the presence of common oral lesions and their location. The data were entered into a spreadsheet and analysed using standard statistical software. The chi-square test or Fisher's exact test was used to test associations for categorical data and the t-test or Wilcoxon rank-sum test for continuous data.

A total of 300 homeless people (PEH) were assessed, and 246 (82.0%) reported drug use (including any tobacco use), while 186 (62.0%) reported any alcohol use, 138 (46.0%) of whom reported hazardous alcohol use. Higher untreated decay was associated with increased risk for substance use. Lesions were more common among opioid users, 22/66 (33.3%), than non-users, 35/234 (15.0%). The results of this study indicate that the oral disease burden experienced by people who are homeless was high, with a high prevalence of untreated caries, tooth loss, periodontitis, and reported pain, as well as a high prevalence of substance use and tobacco use in this population. Untreated caries was strongly correlated with high-risk substance use, tobacco use with periodontitis, and hazardous alcohol use with poorer plaque control, with a clear protective gradient for more frequent toothbrushing.