Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • General
  • Published:

Community engagement and equity-oriented research are prerequisites for designing inclusive oral health services for people experiencing homelessness

British Dental Journal volume 240, pages 173–178 (2026)Cite this article

Abstract

Oral health is a vital aspect of overall health and wellbeing, yet individuals experiencing homelessness often bear a disproportionate burden of poor oral health and its consequences. This paper explores how community engagement and equity-oriented research can be powerful and complementary tools to inform and enhance evidence-based service design for these patients. We present illustrative examples from both the United Kingdom and international contexts. Community engagement captures a genuine, patient-centred understanding of current realities, while research builds on this foundation to identify and address priority needs. This targeted approach increases the likelihood of impactful interventions that move from ‘what is' to ‘what could be'. The ongoing cycle of inquiry and collaboration fosters a dynamic synergy, laying the groundwork for inclusive, responsive and sustainable oral healthcare. We call on policymakers, service providers, researchers and educators to continue advancing these community-partnered approaches. When care is designed following the principle that ‘nothing about us is done without us', oral health services for people experiencing homelessness can become truly accessible, effective and transformative, for individuals and for society as a whole.

Key points

  • People experiencing homelessness face severe oral health inequalities that mirror their broader social marginalisation.

  • Effective dental care for people experiencing homelessness depends on meaningful community engagement and equity-focused research.

  • Designing services with the principle of ‘nothing about us without us', makes oral healthcare more accessible and impactful, benefiting both individuals and the broader community.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Groundswell. Healthy Mouths: A Peer-Led Audit on the Oral Health of People Experiencing Homelessness. London: Groundswell, 2017.

  2. Smile4life. The Oral Health of Homeless People Across Scotland. Dundee: University of Dundee, 2011.

  3. Blackmore T, Williams S A, Prendergast M J, Pope J E. The dental health of single male hostel dwellers in Leeds. Community Dent Health 1995; 12: 104–109.

  4. Seirawan H, Elizondo L K, Nathason N, Mulligan R. The oral health conditions of the homeless in downtown Los Angeles. J Calif Dent Assoc 2010; 38: 681–688.

  5. Daly B, Newton T, Batchelor P, Jones K. Oral health care needs and oral health-related quality of life (OHIP-14) in homeless people. Community Dent Oral Epidemiol 2010; 38: 136–144.

  6. Musa A, Booth J, Wheat H, Witton R, Paisi M. Factors affecting the integration of dental services into health and social care for people with complex needs. Health Expect 2025; DOI: 10.1111/hex.70243.

  7. Watt R G, Daly B, Allison P et al. Ending the neglect of global oral health: time for radical action. Lancet 2019; 394: 261–272.

  8. Watt R G, Venturelli R, Daly B. Understanding and tackling oral health inequalities in vulnerable adult populations: from the margins to the mainstream. Br Dent J 2019; 227: 49–54.

  9. Witton R, Paisi M. Dental care for homeless persons: time for National Health Service reform. Public Health Pract 2021; 2: 100194.

  10. British Dental Association. Dental Care for Homeless People. London: British Dental Association, 2003.

  11. Peres M A, Macpherson L M D, Weyant R J et al. Oral diseases: a global public health challenge. Lancet 2019; 394: 249–260.

  12. Nunez E, Gibson G, Jones J A, Schinka J A. Evaluating the impact of dental care on housing intervention program outcomes among homeless veterans. Am J Public Health 2013; 103(Suppl2): 368–373.

  13. 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 2020; 23: 1289–1299.

  14. Conte M, Broder H L, Jenkins G, Reed R, Janal M N. Oral health, related behaviors and oral health impacts among homeless adults. J Public Health Dent 2006; 66: 276–278.

  15. Public Health England. Evidence Review: Adults with Complex Needs (With a Particular Focus on Street Begging and Street Sleeping). London: Public Health England, 2018.

  16. Paisi M, Withers L, Anderson R et al. Developing oral health services for people experiencing severe and multiple disadvantage: a case study from Southwest England. Front Oral Health 2024; 5: 1283861.

  17. World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. 2022. Available at https://www.who.int/publications/i/item/9789240061484 (accessed 5 August 2025).

  18. World Health Organization. Community engagement: a health promotion guide for universal health coverage in the hands of the people. 2020. Available at https://www.who.int/publications/i/item/9789240010529 (accessed 5 August 2025).

  19. World Health Organization. Framework on integrated, people-centred health services. 2016. Available at https://apps.who.int/gb/ebwha/pdf_files/wha69/a69_39-en.pdf (accessed 5 August 2025).

  20. World Health Organization. WHO framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. Available at https://www.who.int/publications/i/item/9789240073074 (accessed 5 August 2025).

  21. Lebrun-Harris L A, Baggett T P, Jenkins D M et al. Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey. Health Serv Res 2013; 48: 992–1017.

  22. Freitas D J, Kaplan L M, Tieu L, Ponath C, Guzman D, Kushel M. Oral health and access to dental care among older homeless adults: results from the HOPE HOME study. J Public Health Dent 2019; 79: 3–9.

  23. Marmot M, Bell R. Social determinants and dental health. Adv Dent Res 2011; 23: 201–206.

  24. Davidson C. Vision and oral health among individuals experiencing homelessness. 2015. Available at https://nhchc.org/wp-content/uploads/2019/08/in-focus_vision-oral-and-homelessness_june20153.pdf (accessed 1 January 2026).

  25. DiMarco M A, Luington S M, Menke E M. Access to and utilization of oral health care by homeless children/families. J Health Care Poor Underserved 2010; 21(Suppl): 67–81.

  26. Paisi M, Kay E, Plessas A et al. Barriers and enablers to accessing dental services for people experiencing homelessness: a systematic review. Community Dent Oral Epidemiol 2019; 47: 103–111.

  27. Yusuf H, Golkari A, Kaddour S. Oral health of people experiencing homelessness in London: a mixed methods study. BMC Public Health 2023; 23: 1701.

  28. Paisi M, Witton R, Burrows M et al. Management of plaque in people experiencing homelessness using ‘peer education': a pilot study. Br Dent J 2019; 226: 860–866.

  29. Vargas C, Whelan J, Brimblecombe J, Allender S. Co-creation, co-design, co-production for public health – a perspective on definitions and distinctions. Public Health Res Pract 2022; 32: 3222211.

  30. Grindell C, Coates E, Croot L, O'Cathain A. The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res 2022; 22: 877.

  31. Lee D, Feiertag P, Unger L. Co-production, co-creation or co-design of public space? A systematic review. Cities 2024; 154: 105372.

  32. Muirhead V, El Tantawi M, Rodriguez A. Editorial: Co-designing and evaluating oral health promotion interventions for vulnerable groups. Front Oral Health 2025; 6: 1587771.

  33. Buch K, Harden S. The impact of a service-learning project on student awareness of homelessness, civic attitudes, and stereotypes toward the homeless. J Higher Educ Outreach Engagement 2011; 15: 45–61.

  34. Zeien J, Hanna J, Puracan J et al. Improving health professionals' and learners' attitudes towards homeless individuals through street-based outreach. Health Educ J 2021; 80: 961–973.

  35. Webb L, Sandhu S, Morton L et al. A dental student view on learning gained through Inter-Professional Engagement with people experiencing homelessness. Educ Prim Care 2019; 30: 319–321.

  36. Cairns D, Rodriguez A. A stakeholder co-design approach to designing a dental service for adults experiencing homelessness. Front Oral Health 2024; 5: 1355429.

  37. Beaton L, Humphris G, Rodriguez A, Freeman R. Community-based oral health interventions for people experiencing homelessness: a scoping review. Community Dent Health 2020; 37: 150–160.

  38. Beaton L, Humphris G, Rodriguez A, Freeman R. Implementing the Smile4life intervention for people experiencing homelessness: a path analytical evaluation. BMC Oral Health 2021; 21: 383.

  39. Simmonds A. People experiencing homelessness. Br Dent J 2025; 238: 77.

  40. Mago A, Brondani M A, MacEntee M I, Frankish C J. A model pathway to oral health care for homeless people. J Can Dent Assoc 2018; 84: 10.

  41. Scottish Government. Health and social care integration. Available at https://www.gov.scot/policies/social-care/health-and-social-care-integration (accessed 25 May 2025).

  42. Rodriguez A, Shambhunath S, Wijesiri T I D, Biazus-Dalcin C, Mc Goldrick N. Co-design of health educational materials with people experiencing homelessness and support workers: a scoping review. Front Oral Health 2024; 5: 1355349.

  43. Rodriguez A, Biazus-Dalcin C, Marshall J, Gorman R. Smile4life: a Co-Designed Educational and Training Resource Guide. Dundee: University of Dundee, 2022.

Download references

Author information

Authors and Affiliations

  1. Peninsula Dental School, University of Plymouth, Plymouth, UK; School of Nursing and Midwifery, University of Plymouth, Plymouth, UK

    Martha Paisi

  2. School of Dentistry, University of Dundee, Dundee, UK

    Andrea Rodriguez

  3. Community Research Partner, Plymouth, UK

    Lyndsey Withers

Authors
  1. Martha Paisi
    View author publications

    Search author on:PubMed Google Scholar

  2. Andrea Rodriguez
    View author publications

    Search author on:PubMed Google Scholar

  3. Lyndsey Withers
    View author publications

    Search author on:PubMed Google Scholar

Contributions

MP: conceptualisation, writing-original draft, final approval of the article. AR: review and editing, final approval of the article. LW: review and editing, final approval of the article.

Corresponding author

Correspondence to Martha Paisi.

Ethics declarations

The authors declare no conflicts of interest.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paisi, M., Rodriguez, A. & Withers, L. Community engagement and equity-oriented research are prerequisites for designing inclusive oral health services for people experiencing homelessness. Br Dent J 240, 173–178 (2026). https://doi.org/10.1038/s41415-025-9251-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41415-025-9251-9

Search

Advanced search

Quick links