The Intersection of Housing, Homelessness, and Oral Health 

Authored by McAllister Castelaz, DMD, MS and Alaina Boyer, PhD from National Health Care for the Homeless Council (NHCHC)

Housing is more than shelter; it is a foundational determinant of health. For individuals experiencing homelessness or housing instability, oral health is often an invisible crisis compounded by systemic barriers, stigma, and structural neglect. Stable housing plays a critical role in maintaining oral health. It enables homecare routines many of us take for granted, such as brushing and flossing, as well as the ability to schedule and regularly attend dental appointments for both preventive as well as urgent care. Without stable housing, people face cascading challenges: lack of access to clean water or hygiene supplies, difficulty storing medications or dentures, and reduced ability to prioritize dental visits over pressing needs like food, safety, and shelter.

The barriers are well documented: limited or no insurance, transportation hurdles, inflexible appointment systems, and documentation requirements all compound to make dental care inaccessible (1,2). For those living without housing, the experience is often marked by discrimination or inadequate provider understanding of their circumstances (3,4).

Yet, the impacts of poor oral health are severe. Pain, infections, and broken teeth drive emergency room visits (5). Untreated oral disease worsens chronic conditions like diabetes and heart disease. Malnutrition, low self-esteem, and limited employment opportunities follow. The consequences are both clinical and deeply personal.

Despite these challenges, innovative models are emerging to close the gap (3,6). Low-barrier mobile programs, like the Worcester substance use disorder (SUD) mobile unit, integrate oral health into street outreach. Community health workers (CHWs) trained in oral health deliver hygiene kits, provide tailored education, and help clients navigate care, offering transportation, appointment reminders, and even onsite fluoride varnish applications.

Co-located care in shelters is another promising approach. Embedding dental care into medical visits through routine screenings, case management, and partnerships with local dentists and dental schools helps normalize and sustain access. These models also support trauma-informed care and contingency management strategies, which meet individuals where they are, with compassion and flexibility.

Housing is more than shelter, it is a foundational determinant for oral health. Without, basic routines such as brushing, flossing, and attending dental appointments become nearly impossible. Instability leads to limited access to clean water, hygiene supplies, and safe storage for dentures or medications, forcing survival to take priority over prevention. Fortunately, innovative models are showing promise, mobile outreach programs and CHW-led navigation efforts are bringing oral care directly to people where they are. Co-locating dental services in shelters and medical clinics normalizes access and supports continuity of care. These approaches emphasize flexibility, dignity, and trauma-informed practice. 

Recommendations:

  • Advocate for housing as a health intervention: elevate the role of housing in oral health through public statements, op-eds, and policy briefs. Encourage local and national leaders to integrate oral health into housing first models.

  • Support Medicaid expansion and benefit reform: champion policies that expand adult dental coverage under Medicaid and reimburse for preventive services delivered in non-traditional settings.

  • Advance provider education: promote and develop continuing education on trauma-informed, culturally responsive care that addresses the unique needs of people experiencing homelessness or housing insecurity.

  • Integrate oral health into homeless service systems: partner with shelters, transitional housing programs, and street medicine teams to co-locate or embed dental care services.

  • Train and deploy community health workers (CHWs): advocate for funding CHW-led models that deliver hygiene kits, provide education, navigate care access, and apply preventive treatments such as fluoride varnish.

  • Build cross-sector collaboration: facilitate partnerships between dental schools, public health agencies, behavioral health services, and housing organizations to create comprehensive, wraparound care models. 

  • Conduct and share applied research: evaluate innovative low-barrier programs and publish findings to inform best practices and influence policy at local, state, and national levels.

References

  1. Northridge ME, Kumar A, Kaur R. Disparities in Access to Oral Health Care. Annual review of public health. 2020;41:513–35. 
  2. Fellows JL, Atchison KA, Chaffin J, Chávez EM, Tinanoff N. Oral Health in America. J Am Dent Assoc. 2022 Jul;153(7):601–9. 
  3. Paisi M, Baines R, Worle C, Withers L, Witton R. Evaluation of a community dental clinic providing care to people experiencing homelessness: A mixed methods approach. Health Expect Int J Public Particip Health Care Health Policy. 2020 Oct;23(5):1289–99. 
  4. Paisi M, Kay E, Plessas A, Burns L, Quinn C, Brennan N, et al. Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review. Community Dent Oral Epidemiol. 2019 Apr;47(2):103–11. 
  5. Lee HH, Lewis CW, Saltzman B, Starks H. Visiting the Emergency Department for Dental Problems: Trends in Utilization, 2001 to 2008. Am J Public Health. 2012 Nov;102(11):e77–83. 
  6. Stormon N, Sowa PM, Anderson J, Ford PJ. Facilitating Access to Dental Care for People Experiencing Homelessness. JDR Clin Transl Res. 2021 Oct;6(4):420–9.