Dental outreach service to sex workers in Hong Kong

Abstract

Background International oral health studies conducted on sex workers have found a higher-than-average prevalence of oral health problems in this population. These findings have been attributed to work-related engagement in risk factors for oral lesions and barriers to accessing dental treatment. However, there has been no clinical oral health study conducted on sex workers in Hong Kong to date. This project aimed to collect pilot data on the oral health status of sex workers in Hong Kong, whilst bridging a gap in dental treatment access by providing outreach services including oral examinations and oral hygiene education. The findings were analysed and compared to the 2011 Hong Kong Oral Health Survey (OHS) and a past research project surveying the oral health beliefs of sex workers. Methods Current and former sex workers from four NGOs based in Hong Kong were recruited for the project. Participants were invited to complete a sociodemographic questionnaire, which collected data on risk factors for oral mucosal lesions, working practices, oral health behaviours and attitudes towards dental treatment. Participants then attended an oral examination, which involved an extra-oral examination and an intraoral assessment of the oral soft tissues, periodontal status, presence of caries and tooth wear, and existing restorations. Oral health education was provided in the form of informational leaflets and live demonstrations of oral hygiene tools. Participants who were found to require more complex treatment were informed of their conditions and, where appropriate, referred to the Prince Philip Dental Hospital (PPDH) for further care. Results 43 current and former sex workers participated. They were predominantly female, Chinese, aged between 35 and 54 years and currently employed in the sex industry. On the whole, participants were aware of the link between sexually transmitted diseases (STDs) and oral health. The majority did not have regular dental check-up habits due to a lack of perceived need. However, more than three-quarters presented with caries and periodontal disease upon examination, which is significantly greater than the general adult population of Hong Kong. All participants received individualised oral hygiene education and over 90% of participants received fluoride varnish. Oral mucosal lesions were found in two participants, of which one was referred to a specialist. Conclusion The oral health status of sex workers in Hong Kong is far from satisfactory, and greater education and service provision should be made accessible to improve the current situation. The stigma associated with the sex industry in Hong Kong created difficulties in recruiting participants for the study. Due to the limited sample size, statistical significance was not reached for many of the assessed parameters. Further larger-scale studies should be conducted, and the results compared to more recent oral health surveys to determine whether the Hong Kong sex worker population does indeed have a greater oral health burden than the general population. It is hoped that the project has provided the participants with greater oral health awareness and understanding of their own treatment needs.