Opening doors to oral health: reimagining care for those without access
Oral health is often overlooked in conversations about homelessness. For people experiencing homelessness (PEH), untreated dental issues can affect far more than physical health, they can damage self-worth, confidence, and deepen social exclusion. Yet for many, access to care remains out of reach – hindered by cost, stigma, complex systems, and fear.
A research team from the School of Dentistry has been documenting the barriers faced by PEH. They have been evidencing the impact that partnership working between patients, frontline services, and commissioners can have when removing structural and social barriers that prevent PEH from accessing dental care.
Their goal? To uncover the impact of dental care on wellbeing and the value that dental care gives to people experiencing homelessness.
Video summary
Impact
- Interdisciplinary, community collaboration: developed a city-wide network involving NHS staff, voluntary organisations, commissioners, and those with lived experience
- Health impact: improving dental, physical, and mental health for those experiencing homelessness.
Key information
- Major funders: Health Innovation Yorkshire & Humber
- Partners and collaborators: NHS England
- Disciplines: dentistry
- Investigators: Dr Karen Vinall-Collier, Dr Julia Csikar.
When access to care isn't equal
People experiencing homelessness suffer from worse oral health and lower life expectancy than the general population. Chronic pain, untreated infections, and missing teeth are common, whilst drug and alcohol misuse can further complicate care. Despite this, limited trust in mainstream services and a history of exclusion mean PEH often rely on emergency treatment and self-care, rather than preventative support.
Recognising this urgent unmet need, the Leeds-based research team partnered with stakeholders across the health and voluntary sectors to ask a fundamental question: how should dental services be designed to meet the needs of people experiencing homelessness?
Building change with, not for
Evidence gathering began with simple tools – graphics, post-its, and workshops – grounded in a clear ethos: design with, not for. Through open conversations, the team invited people with lived experience of homelessness to articulate their needs and reimagine how dental services could better support them.
These early engagements revealed critical insights: lack of trust, the emotional weight of dental neglect, logistical hurdles, and an urgent need for trauma-informed care. Just as importantly, they have developed a city-wide Patient and Public Involvement and Engagement (PPIE) network – a multi-sector alliance involving NHS staff, voluntary organisations, commissioners, and those with lived experience.
Together, this group has influenced the design of a new model of dental care that was guided by empathy, flexibility, and dignity. In 2022, this work led to NHS England commissioning two bespoke dental services in Leeds. Charities that support PEH are ensuring their clients can get the dental care they need. They help PEH with paperwork, support them at their appointments (as phobia and anxiety are very high in this group), provide transport, and accompany them to care. This creates a more inclusive pathway that removes many of the traditional barriers.
The human impact of this initiative was clear. One man, once held back by low self-confidence, now works with local charities helping others access care. Dental teams describe a renewed sense of purpose, knowing their efforts are reaching those who need it most. As one practitioner put it: “This work is showing that dentistry is about much more than just teeth.”
Success inspires new work
While the initial outcomes were encouraging, there was a lack of formal evaluation. With funding from Health Innovation Yorkshire & Humber, the team expanded their engagement activities to understand the network and service’s impact in more detail.
Using a socioecological model, they gathered insights from patients, dental staff, and charity partners, exploring outcomes at individual, interpersonal, and community levels. The findings were striking. Patients described improved self-esteem, mental health, and employability. Many reported a greater sense of connection to their communities.
Impact so far
The work has already led to measurable change. It played a key role in shaping NICE’s ‘Integrated health and social care for people experiencing homelessness’ (NG214) report, where it was positively recognised. Insights from the research have informed the commissioning and design of two bespoke dental services in Leeds, which tailor care to the specific needs of people experiencing homelessness (PEH).
Beyond direct service impact, the work has helped establish a cross-sector research network grounded in co-production with PEH, laying a strong foundation for future research. It has supported doctoral study into peer-led dental health promotion, delivered by undergraduate dental students—further embedding a collaborative, inclusive approach to oral health.
Dr Karen Vinall-Collier said: “Our research is showing that this dental service is empowering people to take control of their health and feel benefits not just orally, but also in their personal confidence and the confidence in the care and advice they receive.
“It is important to note that support services struggle to get dental care for their clients, so this is a much-needed service. Commissioners are using underspent dental money and reinvesting in service gaps.
“It also evidences that investment in such services could reduce the pressure elsewhere in the system and entice other commissioning boards to consider the use of underspent monies for the most in-need in our communities.”
Internationally, the research has gained attention and funding, with Dr Vinall-Collier and Dr Julia Csikar sharing their findings in Brazil, building global collaborations focused on improving access to oral healthcare. The project’s success was recognised at the University of Leeds’ Research Impact and Engagement Awards 2024, where it won a prize for ‘emerging health impact’.
Crucially, the work is contributing to a shift in how dentistry is understood and practised, helping to foster a culture that sees oral health as an essential part of overall wellbeing, particularly for marginalised communities.
From local pilots to national practice and beyond
The team’s ambition remains clear: to generate evidence that not only protects existing services but scales them. They continue to push forward in redefining how success in dental care is measured – moving beyond standard clinical outcomes to encompass recovery, resilience, and social inclusion.
Building on its roots in lived experience and co-production, the project will attempt to identify new metrics of success. The team is embedding its learning into dental teaching, ensuring that future practitioners are equipped with the empathy, insight, and skills needed to serve vulnerable groups. With a committed, diverse network, strong local momentum, and increasing national interest, the project challenges assumptions about who dental care is for, and the difference it can make for vulnerable communities.