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Providing Dental Care to the Homeless

A Success Story

Homelessness continues to be one of our nation’s greatest tragedies, with an estimated 700,000 homeless people on any given night and two million people who experience homelessness during one year in the United States.1 An additional struggle for this population is their exclusion from healthcare services, a privilege for most Americans. The prevalence for disease is much higher in the homeless population than in the general population due to many factors, such as limited or no access to healthcare providers, and lack of transportation and resources to obtain care. Although collecting information on the characteristics and needs of this population is a challenge, statistical data is not impossible to obtain.

The Health Care for the Homeless Program (HCHP) was established in 1987 by Title VI of the McKinney Act as a federal program to supplement community-based health programs to help access health care for the homeless. This program has helped to provide statistical data to track the usage of services for this population. Their health problems extend into dental disease, and the severity and impact on their general health and well-being are well documented in the literature.2 Homeless adults often attempt to find health care services due to dental problems.3 Consequentially, homeless persons tend to seek out emergency rooms for their health care, where services tend to be triage in nature rather than preventive. A study of Homeless Veterans showed dental care was the third ranked need behind long-term permanent housing and childcare.4

The Union Rescue Mission (URM), a homeless shelter in Wichita, Kansas, aided in meeting the oral health needs of homeless people in the area. This particular shelter works specifically with homeless men, which makes up the largest segment group of the homeless population.5 This group of participants was identified by being selected into a rehabilitation effort by the URM. A main goal of this program was to incorporate these men back into society with the hope of finding jobs. Restoring oral health was a key factor in accomplishing this goal. This project was successful in that all the men had their comprehensive dental care needs met, including restorative and prophylactic care by volunteer efforts.

Union Rescue Mission

It is estimated that there are 526 homeless individuals in Wichita, Kansas. The Union Rescue Mission houses 200 beds—currently occupied by 166 people—where the homeless can retreat at night with a meal and shelter. The URM provides not only shelter and meals, but many different resources such as transportation, spiritual guidance, and a variety of programs to the residents. Residents without a high school diploma are sent through a program to earn their GED. They are analyzed for learning disabilities, given access to tutors and counselors, evaluated for mental illness, and provided medication if necessary. They are expected to keep up on their weekly schedules and tasks. The men seem to view living in the mission as a privilege and are eager to make themselves useful. Classes are designed to be beneficial for them and to help them successfully integrate themselves back into society. Some examples of classes available through the URM include: Understanding and Respecting Boundaries, Smoking Cessation, Anger Management, Computer Skills, and classes on how to manage money. Participants are assisted in identifying and becoming aware of their unique strengths and interests in hopes of finding a job that is suitable to their personalities, enjoyable, and will give them a sense of accomplishment or satisfaction. The URM has a high success rate as compared to other institutions and accesses a low percentage of government funding. It offers the residents an honest chance at regaining their footing. The men are encouraged to stay at the mission after securing a job to help them save money, continue accessing the benefits at URM, and to stay in a familiar environment while making a transition into society. The URM focuses on building independence rather than dependence, which is something many government programs seem to struggle to achieve.

Volunteer Efforts for Dental Care

A group of 15 homeless men at URM were identified to participate in this program based on their motivation to succeed. These men were selected by the URM because they had demonstrated consistent self improvement, a strong desire to become independent, and were the most likely to integrate successfully back into society. The primary objective was to give them a better chance in gaining employment, as well as improve poor oral health, which could have prevented them from finding work or adversely affected their health and continuing success. Of this group of men, 82% were successfully integrated back into the work force and have overcome their challenges. Two of the men are currently enrolled in college and maintain contact with URM.

Once these men were identified, recruitment for dental hygienists, dentists, and lab resources were made by URM. A group of five dental hygienists from Wichita State University performed the initial screenings. They gathered health histories and assessed their oral health using the screening tool of decayed, missing, and filled teeth (DMFT). Each patient was assigned an identification number to track their progress. The hygienists charted the number of teeth missing, number of teeth decayed, total number of filled surfaces, and for each patient recommended a prophylaxis and further dental evaluation for restorative work or extractions (Table).

Once the screenings were performed and needs assessment was made, five dentists and five dental hygienists graciously gave time to provide restorative care and prophylaxis on two successive afternoons. The restorative dental care took place at Grace Medical Clinic, which provides medical and oral health care to the indigent population. This facility provided all equipment and supplies at no cost. The dentures used were also gratuitously provided by a local dental laboratory.

Discussion

There were 15 males in the project whose ages ranged from late thirties to early sixties. It was necessary to extract all remaining teeth from five of the 15 men and make them full sets of dentures. Four out of the 15 men had their upper teeth extracted to facilitate a full upper denture. On average, 7.4 teeth were missing prior to treatment; the presence of decay was noted on 19.2 tooth surfaces, on 6.8 teeth; and 9.73 fillings were placed. Eight of the men received periodontal debridement as well as restorative care. The number of decayed teeth (6.8) closely resembled other studies that have tracked data on homeless populations.6,7 Most of the men seemed to have similar pasts involving one or more of the following: dysfunctional family life, some form of abuse, undiagnosed and/or untreated mental illness, and/or a history of substance abuse.

Almost all the men were enthusiastic to share their stories and experiences. All were pleased with the high quality of care and attention they received. This experience, however, has also left the men seemingly disgruntled with the lack of dental treatment options they now face for their future. The impact the dental treatment had on the men and their self perceptions and health was immediate. Prior to the treatment, they were constantly sick; as a result of treatment, they have not had dental pain or abscesses. There was a noticeable rise in their self esteem and they felt that their options in finding employment have also increased. Everyone involved in this project would like to see it blossom into something more, and as a new group of men are identified for this program, they are hopefully anticipating the chance for the restorative care the first group received.

Conclusion

The challenge of providing dental care for this population continues to be a balancing act between medical, dental, and social services. This project targeted a group of individuals who were committed to success through a rehabilitation effort and proved to be successful. This was due to many variables that came together such as the volunteer efforts, coordination of the men with the URM administration, and the men’s overall motivation to make something of their lives.

There are many charitable events, such as this one, that provide valuable services that enrich the lives of this indigent population. Hopefully, they will prove beneficial in both providing the service and motivating the patient to make their oral health care a priority. Perhaps the ultimate goal is to provide services that would benefit this population for not only immediate care, but preventive care as well.

 

*Assistant Professor, Department of Dental Hygiene, Wichita State University, Wichita, Kansas.

†Senior Clinical Educator, Department of Dental Hygiene, Wichita State University, Wichita, Kansas.

‡Dental hygienist, Vancouver, Washington.

References

  1. National Law Center on Homelessness and Poverty. Out of sight-out of mind? A report on anti-homeless laws, litigation, and alternatives in 50 United States cities. Washington, DC: National Law Center on Homelessness and Poverty; 1999.
  2. Gelberg L, Linn LS, Rosenberg DJ. Dental health of homeless adults. Spec Care Dent 1988;8(4):167-172.
  3. Han B, Wells B, Taylor AM. Use of the Health Care for the Homeless Program services and other health care services by homeless adults. J Health Care Poor Underserved 2003;(1):87-99.
  4. King TB, Gibson G. Oral health needs and access to dental care of the homeless adults in the United States: A review. Spec Care Dent 2003;23(4):143-147.
  5. National Coalition for the Homeless. People Need Health Care. 2007. Available at: http://www.nationalhomeless.org/publications/facts/health.html. Accessed October 13, 2008.
  6. Allukian M Jr. Oral health: An essential service for the homeless. J Public Health Dent 1995;55(1):8-9.
  7. Kaste LM, Bodlen AJ. Dental caries in homeless adults in Boston. J Public Health Dent 1995;55(1):34-36.

Tables

Table 1: Initial Screening Data of Union Rescue Mission Men

Patient

# of teeth missing

# teeth decayed

# decayed surfaces

# teeth filled

Total of number of surfaces filled

Cleaning recommended

1

6

1

1

10

16

X

2

2

0

0

5

5

SRP

3

4

2

10

0

0

 

4

2

0

0

2

10

SRP

5

13

14

41

2

2

 

6

6

1

2

6

7

X

7

5

26

91

1

3

SRP

8

7

11

25

11

31

SRP

9

10

5

10

6

12

SRP

10

7

15

50

7

12

X

11

13

11

28

3

3

X

12

13

10

18

0

0

SRP

13

0

1

3

0

0

SRP

14

15

2

2

10

19

X

15

8

3

7

7

26

SRP

Average

7.4

6.8

19.2

4.67

9.73

 

Based upon: 32/dentition    5 surfaces/tooth    SRP = periodontal debridement

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