Date of Award

Summer 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

James E. Hixson, PHD

Second Advisor

Ezinne I. Ogbureke, BDS, DMD

Third Advisor

Craig L. Hanis, PHD

Abstract

Background: Dental care resources for the homeless population are scarce, underfunded and generally inadequate to meet their oral health needs. While poor oral health is clearly an added burden for people who struggle daily to survive under miserable living conditions, little is known about their views on dental health, their perceived needs and their attitudes towards dental care. The purpose of this study was to determine the most common oral health needs of homeless patients and to identify their participation in receiving comprehensive care. Methods: The study was a cross sectional analysis where data were collected retrospectively using the records of patients who visited the dental clinic at Healthcare for Homeless for the first time from August 31st, 2017 to August 31st, 2018. Information on their chief complaint, pattern of visits, emergency management, smoking history and mental health history were recorded. Oral hygiene status and dental caries status were summarized using the Periodontal Index and Decayed, Missing and Filled Teeth Index, respectively. Statistical analyses were conducted to estimate the common dental needs and their oral health status. Results: The sample included 352 patients with a mean age of 43.2 (SD+- 17.6) with 38.6% women and 61.1% men. The majority of patients were African Americans (51.7%) followed by Caucasians (26.4%). About 49.4% were current smokers and 49% had diagnosed psychotic diseases. The most common dental need identified in this cohort was pain (38.1%) followed by routine care (23.6%). Other needs identified were cavities, broken teeth, missing teeth and cleaning. About 71% of the patients discontinued treatment after their initial visit. Analyzing the stages at which the treatment was discontinued, we found that 38% discontinued treatment with initial visit and 12% with emergency management. Univariate and multivariate analysis of treatment stages with continued participation resulted in a significant association with the patients receiving care at the outreach clinics and patients discontinuing treatment in between procedures. Further analyses were conducted to assess the association between periodontal health and the dental caries status and conducted t-test with 95% CI (p<0.001) which showed statistically significant associations between the two diseases. A linear regression model reported individuals who discontinued treatment had higher prevalence of dental caries. There were no significant associations for the predictors in periodontal assessment. Conclusion: This study identifies and informs the oral health needs common to the homeless population. Identification of levels of detachment from comprehensive treatment is unique to this study. This could facilitate further research to identify the barriers and propose an intervention model to improve the oral health in the homeless community.

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