An oral health survey and outreach service for homeless people in Hong Kong

Abstract

Objectives: The aims of our community health project were to investigate the oral health status of homeless people in Hong Kong and to provide an outreach dental service that caters to their needs. Methods: An oral health survey incorporating clinical assessments (oral mucosal conditions, dental caries experience and periodontal health status), subjective oral health status (oral health-related quality of life), and standardized assessment of oral health knowledge, attitude and behaviours were conducted. Variations in clinical and non-clinical outcomes were assessed in bivariate analysis using chi-square test or t-test accordingly. An outreach oral healthcare service was planned based on findings. Results: The response rate to our project was 90.7% (49/54). Approximately 4-in-10 (42.9%, 21) had oral mucosal conditions, with abscess common. All had a dental caries experience with approximately two-thirds having untreated decay (65.3%, 32); the mean decayed teeth (DT) was 4.1 (SD 5.4). Few possessed filled teeth (FT) (22.4%, 11) with a mean of 0.6 (SD 1.6). The vast majority had periodontal pockets, with most (63.4%, 26) having deep periodontal pockets (CPI = 4). Impact of oral health status on quality-of-life score was considerable (impact prevalence 88.9% (44); mean OHIP-14 score 14.0 (SD 12.1)). Oral health knowledge scores were generally poor (mean scores approximating one-third of possible score), oral health attitudes were generally favourable (mean score approximating three-quarters of possible score). Oral health behaviours were less than ideal with poor regular oral hygiene habits (59.2 %, 29 brushing less than twice a day), frequently snacking (28.6%, 14) and typically pain-motivated dental attendance (59.2%, 29). Variations in oral health status, knowledge, attitude and behaviours were apparent. Age was associated with oral health attitude scores (p < 0.05), dental attendance (p < 0.05), prevalence of untreated decayed teeth (p < 0.05), and OHIP-14 scores (p < 0.01). Education attainment was associated with oral hygiene behaviours (p < 0.01) and subjective oral health status (p < 0.05). Unemployment status was associated with oral health knowledge (p < 0.05) and dental attendance (p < 0.01). Receipt of social security was associated with dental attendance (p < 0.01). Length of homelessness was associated with snacking habits (p < 0.05). An outreach oral health service was provided including scaling and arrangement of care pathways in collaboration with non-governmental organizations. Conclusion: Among the homeless population studied, their oral health status was poor in terms of untreated dental decay and periodontal pockets, with few possessing fillings. Furthermore, oral health had considerable impact on their quality of life, particularly their diet. Oral health knowledge was unfavourable and oral health behaviours were less than ideal in terms of oral hygiene practices, snacking, and pain-motivated dental attendance. Sociodemographic variations in oral health and in oral health knowledge, attitude and behaviours existed. An oral healthcare service was provided within the limitations of time and other resources of the project. The findings of the community health project have implications for advocating and promoting oral health among this often socially excluded group.