Providing Dental Care to Homeless Residents
By Ginger Hall Carnes
Since 2011, School of Dentistry faculty, dental students and residents, and dental hygiene students have provided dental care at the San Antonio Christian Dental Clinic at Haven for Hope to two populations: homeless individuals residing at the Transformational Campus and to low-income residents who lack dental insurance and the money needed to go to private dental offices.
Single men, women and families with children who reside at the Transformational Campus receive short-term residential housing while participating in intensive services such as substance abuse and mental health treatment, educational programs, employment assistance and job training.
Methodist Healthcare Ministries, a partner with the San Antonio Christian Dental Clinic and the School of Dentistry, requested the dental school’s assistance in providing free dental care to a third group—homeless individuals who are guests of the Courtyard at Haven for Hope, which is hailed nationally for its efforts to address homelessness. Men and women who are not ready to adhere to the requirements, including remaining sober or entering a 90-day treatment program, of the Transformational Campus can sleep in the Courtyard, an outdoor, safe sleeping space with access to showers, restrooms, laundry services, hot meals and outreach services.
Through an innovative program named the Street Medicine Initiative, dental faculty, students and residents since July 2017 have been providing dental screenings, cleanings and treatment to individuals who sleep in the Courtyard. The Street Medicine Initiative is funded through Methodist Healthcare Ministries.
Vidal G. Balderas, D.D.S, M.P.H., director of the school’s Primary Dental Care Program Rotation for the Homeless, said, “These people are on the margins. They are still living on the streets, and they need the most help. We are meeting them where they are.”
The Street Medicine clinic begins every Monday morning. As students and faculty arrive in their scrubs, men and women approach them and yell, “Where are you all coming from?” The students say, “Dental,” and they say, “Can you see me?” A dental staff member signs in patients and gets basic information. At the Monday screenings, dental faculty and students evaluate patients and then schedule appointments later that week. The cleanings and dental treatment are performed in the Mobile Dental Clinic which is parked on the Haven for Hope campus.
“These high-risk patients have urgent dental care needs: infections, broken teeth, cavities to the nerve, and teeth with only root tips. They are often in a lot of pain. If left untreated, they end up in the emergency room,” said Dr. Balderas, associate professor of comprehensive dentistry.
As part of the Street Medicine Initiative, “we address the need before it becomes an ER issue. We actually treat the dental problem so they can heal. For example, we will remove the tooth that is decayed and causing other health issues.”
Working with this population has its challenges, said Dr. Balderas, a former migrant worker who has a master’s degree in public health. Some forget their appointments because they have no address or phone to get reminders. Others might be under the influence with a substance that masks the pain that morning so the tooth doesn’t bother them, but they come back when it flares up. “I have a lot of sympathy and empathy for individuals who are suffering.”
Dental faculty and students see the results of their hard work. Many of the guests gain self-esteem because they are proud of their teeth and are comfortable smiling again. Their new smiles can lead to changes in their lives. “If they get some teeth, maybe they’ll feel better about themselves and enroll in the rehab program at the Transformational Campus. This dental care may be a contributing reason in deciding to try to change their lives,” Dr. Balderas said.
Dental hygiene students spend one day a week at the Street Ministry Initiative because all patients are required to have a cleaning and be educated on oral hygiene.
“The biggest priority for patients is, ‘Can I get these teeth replaced?’ and we tell them, ‘Let’s get everything cleared up by relieving pain, treating the infection, etc. We value your whole mouth’,” Dr. Balderas shared. Dental hygiene students and dental students both contribute to the prevention aspect of care through cleanings, and they explain to the patients that oral health is tied to overall health and well-being.
Fourth-year dental students are required to do a one-week clinical rotation at the San Antonio Christian Dental Clinic and the Street Medicine Initiative. In addition, residents provide advanced specialty care.
Juanita Lozano-Pineda, D.D.S., M.P.H., associate dean for external affairs and associate professor of comprehensive dentistry, said this unique clinical training allows students “to care for special needs patients in a community-based setting.” These patients can’t come to the School of Dentistry’s Center for Oral Health Care & Research where students gain clinical practice experience. They don’t have the resources to travel to the school’s dental practice.
“The experience helps the students understand the social determinants of health,” said Dr. Lozano-Pineda. “They see firsthand that certain factors–like poverty and lack of access to medical care–affect your overall health.”
Reflecting on his experiences at Haven for Hope, fourth-year dental student Valay Desai said, “I feel a good smile can do a lot to improve self-confidence which most homeless people do not possess.”
Some students enter the clinical rotation with pre-conceived notions that these individuals are homeless because of bad choices they made. “I always used to think people are responsible for their actions and end up homeless, but now I realize that sometimes they do not have a choice and gradually become homeless.” He learned that many lost their jobs, were the victims of domestic assault, or were caught up in sex trafficking.
“I learned a lot about being homeless–the difficulties they face, the insults they receive, the root cause of homelessness, and the way we should care for them as a community,” said Desai.