How has COVID-19 affected dental provision for the homeless?

Robert Witton discusses the impact of COVID-19 on dental provision for vulnerable groups, such as the homelessRobert Witton discusses the impact of COVID-19 on dental provision for vulnerable groups.

The COVID crisis has hit dentistry hard. The British Dental Association (BDA) estimate that tens of millions of dental appointments have been cancelled or lost due to the virus. Reduced capacity in dental practices has created a huge backlog of patients that will take some time to work through.

This could have potentially serious consequences on oral health for generations to come. But the impact on those struggling to access dental care before the pandemic could be catastrophic.

While overall oral health has improved in the UK, across many population groups we are struggling to make the same impact on oral health inequalities. One such example is people experiencing homelessness.

In the UK (prior to COVID), estimations suggest at least 320,000 people lived in temporary accommodation or on the streets. There has also been an increase in the number of young people and families living in temporary or overnight accommodation.

Adverse impact

Poor oral health is one of the most common physical health problems of people experiencing homelessness. It has an adverse impact on people’s quality of life and ability to move on from homelessness.

There are many barriers to accessing dental care if you are homeless. These have only worsened during the COVID crisis. While there are many examples of successful initiatives across the UK, provision of dental services to this group overall is patchy.

There are limits on NHS funding for developing services recognising the complex and diverse needs of people experiencing homelessness. This is short-sighted; the wider healthcare system has to pick up the consequences of not addressing the oral health needs in this group.

This results in displacement into other parts of the healthcare system such as attendances at A&E, GPs or walk-in centres and inappropriate prescription of antibiotics when urgent dental treatment is what is really required.

Doing the right thing

It is vitally important in the recovery of NHS dentistry that we do not forget the most in need during the return of services. People experiencing homelessness is just one example of an at-risk group, but there are many others in a similar predicament.

If dentistry is to meet the challenge of the NHS Long Term Plan, a radical rethink in the way dental services are commissioned for at risk groups is needed. Only then we will make true progress in tackling oral health inequalities.

There needs to be higher prioritisation of vulnerable groups in dental policy. As well as a recognition that a one size fits all model of commissioning excludes at risk groups.

For me, it is about ‘doing the right thing’. And ensuring everyone can enjoy good oral health – whatever their background or personal circumstance. It is the basic principle of having an NHS.

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