Helping homeless people smile again

WORKING in west London, it’s hard not to notice the increasing numbers of people sleeping rough on the streets. I struggled to think of a meaningful way to help them until I finally had a eureka moment. The answer was right there in front of me – I could use my clinical skills to try to address a major gap in dental services.

That was when I reached out to the key players in my story – amazing people who were either making, or willing to make a difference in the community.

Together we would set up a voluntary initiative providing free dental care to the homeless community from our base at Acton Town Dental Practice. And I’m pleased to say that, two years on, it is going from strength to strength.

So how did it all begin?

Barriers to care

People experiencing homelessness often find it difficult to access general dental services and are instead much more likely to go to hospital emergency departments for urgent care. There are lots of reasons for this pattern of attendance, including chaotic lifestyles, having to meet more urgent needs such as finding accommodation, dental anxiety, safety concerns, financial restrictions, not having an address, and uncertainty about available dental services.

The structure of the NHS dental health system can also make it difficult for homeless populations to access dental care. Some of these include cost, inflexibility of appointments, limited collaboration between services, lack of training/skill development and staff concerns about treating homeless patients.

All the research I’ve read suggests that a key part of improving access is having health services take into account homeless people’s needs and tailoring resources to meet them. Considering that the vast majority (over 80 per cent) of dental care is delivered via general dental practices in the UK, there is scope for providing services to individuals facing homelessness.

Assembling the team

I knew I would need a lot of help turning my idea into reality. And so our first hero in this saga is Ian Breen, the manager of Acton Homeless Concern. He works tirelessly helping the homeless community, as well as others in need, with their day-to-day affairs. I sold him the vision of a comprehensive free dental service for people who either could not access the NHS or did not have the skills to do so.

He helped me create a network of homeless charity managers whose role would be to highlight and vet the people at most need, as well as assisting in the management and smooth running of the service.

Our next shining star was a charismatic Italian dental technician, by the name of Angelo Zuccari Plini. I remember the day I called him asking for his services – he made me feel that I was doing him the favour. Angelo makes anything from dentures to bridges to the high-end private standard he is accustomed to; he doesn't take a penny for his services or for any materials.

Along with my manager Madalina Pirlog, a Romanian hurricane with a big heart, the key players in the team were assembled.

A comprehensive service

We have successfully been running a daily comprehensive dental service alongside our private practice for the past two years for patients who are:

• homeless
• refugees
• receiving benefits or lacking skills to access NHS services.

We started off providing a few appointments until the service grew and grew to around 60 to 80 patients a month. We have also held monthly events, where we have four surgeries running, a hot food service, hairdressers providing free cuts, performances from local musicians and even a mobile Italian coffee shop.

Everyone involved in the project works for free and we now have more than 70 people across three practices all pitching in.

We have no catchment area for the service, but the majority of patients are referred from local boroughs in London.

During a patient's first appointment, we carry out a dental examination, ask about their priorities and preferences for treatment, and a treatment plan is agreed. All comprehensive dental care needed to maintain oral health and function is available to our homeless patients. These include:

• oral health promotion
• fillings
• extractions
• hygiene/periodontal treatment
• crowns, dentures etc.

More advanced treatments such as bridges and implants are also available for patients who are considered high priority, especially if there is an aesthetic necessity regarding the patient's recovery from their homeless journey. As a result, dental care has become part of the overall rehabilitation and recovery of patients during their journeys out of homelessness.

Key lessons learned

Reflecting on the past two years, we have encountered many obstacles and have managed them as best we can. Some of these issues included:

ATTENDANCE. Particularly bad in this community, understandably due to their lifestyle and all the factors mentioned above. We partially countered this by maintaining good communication with the charity managers. We also booked appointments for the service at the end of sessions, meaning staff could take an early finish if a patient failed to turn up.

CRITERIA. It was sometimes difficult to clarify to the referring managers exactly who was eligible for this service and who was not. On many occasions, people would turn up for a routine appointment purely because they did not have an NHS dentist at the time. This problem was improved upon by asking the referrer to double check eligibility with the practice if they were in any doubt.

SUNDAYS. These sessions required a lot of preparation by many people who were willing to voluntarily provide their services (clinicians as well as others such as caterers, hairdressers, musicians). However, turnout was unpredictable – sometimes we would have 20 patients, other days over 100, regardless of what the day list would say. As a result, we decided to focus on improving daily access to our dental services. So now, we only hold these Sunday sessions occasionally.

The patients we see are not only emergency dental cases, some need to regain their smile and confidence. They want to begin a new chapter in their lives, be it starting a new job, or a new relationship. So if we can be a couple of pages in their new chapter, and maybe get them smiling again, then that's good enough for me.

Dr Ghassan Radi is a principal dentist at Acton Town Dental Practice

Find out more

• Developing a voluntary initiative for homeless populations in general dental practice - BDJ

PHOTO: From left, Ghassan Radi with a patient and caterer Sam