Models of Dental Care for People Experiencing Homelessness in the United Kingdom - A Systematic Review of the Literature.

Abstract Background People who experience homelessness have poor oral health and face significant barriers to accessing care. Recommendations have been outlined for health services to address their needs - termed Inclusion Health. The Smile4Life report recommended dentistry for this group should have three ‘tiers’ of service: emergencies, ad hoc treatments and routine care. In primary care, other medical services have developed into two models of care. They are either mainstream practices that offer care with enhanced services for people who experience homelessness, or an integrated model where specialist services bridge the gap between primary and secondary care. There is little understanding of how Inclusion Oral Health recommendations have been implemented across dental settings; particularly across different geographies and within the different stages of homelessness. Aims Describe and compare dental services that exist for people who experience homelessness in the UK. Methods Two medline searches were performed in October 2020 to assess the models of dental care for people who experience homelessness in the UK, including rough sleepers, the hidden homeless, travellers, sex workers and vulnerable migrants. Results The search resulted in nine dental services which were dedicated to treating people who experience homelessness. The majority did not explore the specific definitions of homelessness and only one service cared for gypsies and travellers. There were a mixture of models of care, including using blended approaches such as different sites and appointment types to flex to the needs of their population. Conclusion Many services that are dedicated to treat people who experience homelessness in the UK are based in the Community Dental Services which allows for flexible models of care due to sporadic patient attendance, high treatment requirements and complex needs. More research is required to determine how other settings can accommodate these patients as well as understanding how more rural populations access dental care.