After being in and out of homeless shelters over the years, Danna Adair realized she’d been neglecting her teeth.
“I didn’t have any back teeth, so I was using my front teeth to chew, and they were almost gone,” the 60-year-old recalled. “I knew that my teeth were not going to last much longer.”
Dental issues like Adair’s are most prevalent among people experiencing homelessness, who often don’t have the resources to care for their teeth.
While dental care is covered by Medi-Cal, the state’s health insurance program for low-income people, it can be challenging for homeless people to access care for numerous reasons. For example, providers almost always require identification, which many patients lack.
Without reliable access to dental hygiene and care, homeless people can lose more than just their teeth. Dental issues can also cause them to struggle to eat, lead to chronic pain and even make it harder for them to find work.
Poor oral health care can significantly impact people’s overall health and well-being, dentists say. When problems like cavities or gum disease go untreated, they can worsen and have long-term consequences. And homeless adults often have more intensive dental problems.
Poor dental health can also have psychological impacts, including affecting a person’s self-esteem.
Alfretta Kay Hammond can attest to that. Although she’s been sober since 2003, previous drug use had rotted her teeth, and a fear of needles discouraged her from seeking care.
“I had a very horrific-looking mouth, and I was sensitive about it,” she said. “I’d cover my mouth if I laughed.”
It was only years later, while Hammond was homeless after leaving an unhealthy living situation and losing her job, that she sought help at Father Joe’s Villages’ Village Health Center, a free clinic where the nonprofit offers dental and other health care services to homeless San Diegans.
A problem of access
Father Joe’s serves people currently experiencing homelessness as well as those who were recently homeless or are at risk of homelessness, at its center downtown, where much of San Diego’s homeless population is concentrated.
Just last month, downtown’s homeless population reached a record high of 1,609, the nonprofit Downtown San Diego Partnership reported — the most since the organization began conducting its monthly count a decade ago.
Countywide, 8,427 people were experiencing homelessness as of February, according to the annual count by the Regional Task Force on Homelessness — up 10 percent from the last count in 2020. Nearly half were living without shelter.
Many of these people live without regular access to food or water, nor regular access to bathrooms to bathe, wash their hands — or their teeth. Often dental care takes a back seat to other basic needs, like food and shelter.
Staff at Father Joe’s dental clinic say they often hear firsthand from patients their struggles to find a place to regularly use a toothbrush and toothpaste, let alone carry them safely.
Dr. Parissa Baiera, the dental director at Father Joe’s clinic, says that of the patients who come through the center, about 90 percent have had dental problems in the last six months.
At the clinic, staff provides patients with comprehensive care, from cleanings and fillings to extractions and dentures to emergencies, as well as education on good oral hygiene. Patients in need of more advanced care are referred to low-cost specialists.
Over at the UC San Diego Pre-Dental Society, another unique program is also finding ways to provide dental care to homeless people.
The UCSD Student-Run Free Dental Clinic brings together undergraduate students from various colleges to provide free care to underserved communities with the help of dental professionals. It manages and runs dental clinics downtown, in Pacific Beach and in Lemon Grove.
Each provides comprehensive oral care for patients while providing education and training for pre-dental and dental students, who serve as dental assistants and X-ray technicians and help manage the clinic, said Dr. Irvin Silverstein, the program’s director and adviser.
“The volunteer doctors and dentists get the opportunity to give back to their community and to teach the younger generation, the students are learning from these professionals … and the patients get the care they need so badly,” said Donna Kritz-Silverstein, assistant director and adviser for the program.
One smile at a time
While each patient at Father Joe’s clinic is unique, Baiera says one thing is constant: the renewed sense of dignity and self-confidence they feel after the work is done.
When Hammond started class late last year to renew her nursing assistant certification, she had just gotten her dentures. Now, she has recently been hired at Scripps Health, where she hopes to help others in need.
“I was always a confident person, but my new teeth have lifted my self-esteem,” Hammond said.
She says it was Father Joe’s staff who helped her through the frightening process.
“I was the biggest crybaby,” she said. She described how dental assistant Lois Jenkins-Wallace, knowing her fear of needles, would hold her hand while she was getting shots.
“It still hurt, but she made it (bearable),” she said. “They were the kindest. I have never been in a dentist’s office that has such a real concern for their patients.”
For many patients, it takes time for them to build those relationships with the dental team, who often encourage them to stay motivated to get the work done.
“Sometimes it’s a process,” Jenkins-Wallace said. “They don’t trust right away.”
Adair agreed and joked that she’d used her 15-year-old son Randy Payne as a guinea pig, taking him to the clinic for cleanings years ago before seeking care there herself.
Now, nearly a year after getting her new dentures, Adair lives in an apartment with her son and works in the service department at Petco Park.
Adair did everything she could to speed up the process of getting her teeth, taking cancellations and coming into Father Joe’s sometimes multiple times a week. In the meantime, she was grateful the pandemic’s mask requirements helped her hide her toothless mouth while her gums healed.
“’As soon as I’m healed enough, give me some teeth,’” Adair recalled telling the dental team. “I wanted to get it done so I could feel confident before I went back to work.”
The clinic did just that, allowing her to return to work with new dentures just in time for baseball season.
“Your whole face lights up when you get teeth,” Adair said. “It’s amazing.”
