Replication Framework for Dental Services Supporting People Experiencing Severe and Multiple Disadvantage
People experiencing homelessness often live with severe and multiple disadvantage, manifesting as complex needs that have a profound impact on their oral health and overall wellbeing. Dental problems such as tooth decay, gum disease, tooth loss, pain, and infection are common, and are frequently left untreated because of barriers to accessing care. Despite having greater needs, many people are unable to receive timely dental treatment, meaning that problems often escalate, leading to reliance on emergency care.
Poor oral health affects much more than the mouth; as well as making eating difficult, it can impact systemic health, disrupt sleep, damage confidence, and worsen mental health, making everyday life harder to manage. Ongoing dental pain may also lead some people to use drugs or alcohol as a way of coping, further harming their health and reinforcing cycles of disadvantage. Timely dental care not only improves health and wellbeing, but can also bring economic benefits by reducing costly emergency visits, improving employability, and supporting pathways out of poverty.
The Community Dental Clinic was established in early 2018 by Peninsula Dental Social Enterprise (PDSE) CIC, the clinical arm of the Peninsula Dental School at the University of Plymouth. Initially providing pro bono dental care in Plymouth, the service has since secured external (ICB) funding and has expanded within Plymouth as well as extending to Exeter. It now supports people experiencing severe and multiple disadvantage through an integrated care model that combines dental treatment with access to wider health, housing, and social support services. It adopts several principles and recommendations made by the NICE guideline (NG214) Integrated health and social care for people experiencing homelessness.
A patient attending this clinic in Plymouth commented: “The staff and treatment were fantastic. Just thank you so much, you’ve changed my life.”
Building on our experience of designing, implementing, and evaluating the Community Dental Clinic in practice, our research team, led by Dr Martha Paisi, has developed a Replication Framework for dental services supporting people experiencing severe and multiple disadvantage. This framework has drawn upon community engagement, research evidence, and input from clinicians. It provides guidance for organisations looking to develop and deliver a similar model of care in their own communities.
None of this work would be possible without the commitment of a dedicated multidisciplinary team. Dentists, Dental Nurses, administrators, and partner organisations all play a vital role in ensuring people can access compassionate, person-centred care. Through clinical care, research, evaluation, community engagement, and service improvement, they have helped build an evidence-informed model that supports people experiencing severe and multiple disadvantage to access compassionate, person-centred care. Their expertise, dedication, and collaborative approach help remove barriers to treatment while supporting individuals to engage with wider health and social care services.
We are also grateful to the people who have used the Community Dental Clinic and shared their experiences, helping us to continually improve and shape our approach. Their insights have been central to the development of both the service and the framework.
If you are interested in delivering a similar service, you can learn more here, or contact pdse.impact@plymouth.ac.uk
You can also explore our research projects here and find further details about our clinical services here.
