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Dental nursing on a mobile dental unit supporting people who are homeless
By Anita Woods, Dental Nurse
Community Dental Services CIC (CDS) is an employee-owned social enterprise and a referral only dental service, providing special and paediatric dental care and oral health improvement across much of the East of England and the East Midlands. CDS brings dental care to people who cannot easily be treated in general dental practice; its patients typically have learning disabilities, mental health issues or severe anxiety.
CDS has been piloting a treatment programme for people with Severe Multiple Disadvantage (SMD) and/or homelessness. The pilot is a partnership between CDS and the East Midlands Primary Care Team, working on behalf of five Integrated Care Boards in the Midlands.
The CDS Mobile Dental Clinic has been visiting locations in Nottinghamshire, Derbyshire, Leicestershire and Lincolnshire that offer established services for people who are homeless. Patients are supported to attend appointments in an environment they are familiar with for check-ups and follow-up treatment.
Here, we catch up with Anita Woods, a Dental Nurse of 46 years, who works for CDS in Leicestershire and is involved with the pilot.
“I began working in a dental practice when I was 16. I attended college part time to do my dental nurse qualification, which I completed aged 19, passing the NEBDN examination and became a Registered Dental Nurse. I started work in the Maxillofacial unit at the Leicester Royal infirmary and then in 2002, I began working for the community dental services in Leicester and since joining CDS have undertaken my inhalation sedation training.
I always wanted to work in a health setting and was drawn to the community dental service as it was an area of dentistry I had not worked in before and I felt that working with its patient group would be very rewarding. I also knew it would offer me the variety of working in different areas of dentistry and the opportunity to improve my skills. I enjoy working with my team members in CDS Leicestershire. We have so many lovely, highly skilled, hardworking employees, who I enjoy learning from every day. The care we give to our patients makes me proud and I like the excellent training that CDS prioritises, as well as the many extended support services they offer employees.
Because we provide such a wide variety of services, every day can be different. From assisting the clinicians in the surgery to visiting schools as part of the epidemiology survey team and working on the mobile unit out and about in the community.
I was excited when I received an email about this project and that the mobile unit was going to be doing some sessions in Leicester city and Leicestershire supporting people who are homeless. It was a service that I had not worked in before and was very interested, so I put my name forward to nurse on the mobile unit. Once successful, we all had a thorough induction on the mobile unit to make sure we were familiar with the clinic environment.
People experiencing homelessness face many barriers to accessing oral health care and experience higher levels of dental carries and periodontal disease than the general population. Poor oral health is linked to a decreased quality of life among these patients, and people who are homeless can often feel ashamed and embarrassed to attend a dental practice full of people, fearing that they will be judged as well as facing difficulty finding and registering with a dentist without a fixed address. I wanted to be a part of CDS’s pilot, designed specifically around the needs of this patient group, with the mobile dental clinic attending places they are already familiar with and trust.
CDS mobile unit
We have not used a mobile clinic to treat people who are homeless in Leicestershire before, and I think it is a very worthwhile and much needed service that enables people, who have difficulty in accessing mainstream dental surgeries for a variety of reasons, the opportunity to receive the dental care they need to progress with their lives.
The dental nurse on the mobile unit plays a vital role. The nurse and dentist work as a team to deliver treatment to people who have no other way of accessing a dentist. The unit is very well equipped, and we are able to provide most dental treatments. The biggest difference between working in clinic and on the mobile unit, is that we are working in a much smaller confined space! The dental nurse and dentist must be able to multitask as there are just the two of us on the session, so, as the nurse, I do all the admin and decontamination of instruments as well as assisting chairside and even mopping the floor at the end of the day!
We are welcoming to all patients that attend the sessions. We are kind and caring and put them at ease. We offer a translation service if they need it. We also give them the opportunity to ask questions about the treatment that we are providing. At the end of the appointment, we ensure that clear after care instructions are given and we provide them with emergency out of hours contact numbers and oral health advice. I find it extremely rewarding, especially as the patients are so appreciative of the dental treatment they are receiving.
Some of the challenges I face whilst working on the homeless dental unit are language and literacy barriers and extreme behaviour. We are required to obtain a full medical history and because English is not the first language for a lot of patients that we see, we use LanguageLine on most of our sessions. The overall process can be time consuming, meaning we can then run late. Many of the patients we see are not able to read or write and they are usually unaccompanied. We overcome this by asking them the questions and filling out the medical history form for them. Very occasionally patients could be intoxicated due to alcohol or drug use and their behaviour can be erratic and even aggressive. However, the skills I have developed through my many years of dental nursing with a variety of people in different settings – including good communication skills; calmness in pressured situations; kindness and empathy; adaptability; positive attitude and a good sense of humour (!) come into play, and the patient care we provide remains excellent and no different from our clinic setting.
I very much enjoy working with the Leicestershire mobile unit team. It is a small team that consists of the driver, Anna the dentist, Tracy who is also a dental nurse and me. We all bring a wide range of experience to the service. Although we have only been working together for a short time, we work and communicate well as a team to provide positive outcomes for all the patients that attend.
I have been proud to be part of the mobile unit team working on this project as we are providing a much-needed, vital and worthwhile service here in Leicestershire and I hope it will continue a long time into the future.”
So far, the mobile clinic has seen over 145 patients at twice weekly sessions which are also an opportunity to signpost to other services, such as smoking cessation and drug and alcohol support. The mobile clinic is equipped to provide a full range of dental treatment.
Feedback from patients has been overwhelmingly positive:
“I think this service is invaluable to me. I have not been to a dentist for several years. My teeth are a state from years of drug abuse and being beaten up while living rough on the streets. The dentist was very kind and put me at ease while looking at my teeth and guided me through the process/appointments. This is the beginning of the new me. Thank you so much.”
“I cannot thank the dentist enough for the support they have shown me. The dentist was non-judgemental towards me, as I was living in a tent in Derbyshire for over two years. To be honest, my teeth were the last thing on my mind, but looking back, my teeth are one of the first things other people see. I know that I would have never gone to a dentist surgery as I am far too embarrassed.”
The one-year pilot is set to continue until June 2024.
Anita Woods
