Developing a Pathway to Oral Care for Homeless Women

Publication Date

Winter 3-6-2024

Item Type


Executive Summary


The homelessness crisis is sweeping through the nation, impacting large cities and rural areas alike. Seattle’s homelessness rates have been exponentially increasing (Patrick, 2023). Six Seattle Pacific University nursing students partnered with a women’s day center in downtown Seattle. The day center supplies limited overnight beds, meals, activities, and support services for 60-70 women who are experiencing homelessness as well as domestic violence survivors. The nursing students’ initial assessment included a windshield survey, direct observation, and engagement with residents to identify barriers to healthcare services. Oral care emerged as a prevalent need throughout the site. Many obstacles to accessing oral care persist amongst the women related to multifactorial fears secondary to shelterless status as evidenced by clients declining to use resources outside of the shelter, traumas and safety concerns, and a history of adverse dental experiences. The nursing students aim to facilitate the funding for a mobile dental clinic with additional coordination of oral care resources and education.


Oral care has a significant impact on physical health but also has a variety of implications for mental and emotional well-being. Financial concerns and limited knowledge of resources or oral care practices exacerbate these barriers. A study by Hollendrake et. al. determined that the trauma that occurred from domestic violence caused the victim to feel unsafe to reveal private information to a medical provider (2022). This is consistent with the day center residents refraining from seeking medical or dental care. Additionally, homelessness increases the amount of obstacles to obtaining dental care (Paisi, et. al., 2018). As with the residents of this day center, they either do not feel safe to leave the center due to past trauma and/or are limited by their financial resources. Furthermore, it is essential for dental services to provide a safe and comforting environment for patients that would help meet the objectives of Healthy People 2030. A core objective of Healthy People 2030 is to produce socioeconomic environments that promote health and use of the oral healthcare system (CDC, 2020). Stormon, et. al. found that face-to-face engagement increased the number of participants attending dental care for those who are a part of the homeless community (2021). People with adverse childhood experiences have a direct correlation with a lack of dental care (Bahanan & Ayoub, 2023). Holistic care for homeless women should include dental services. According to Doughty, et. al., without dental services, patients can develop sepsis, compromised airway, and gum disease, amongst other medical complications (2020). It is vital for the women at the day center to have access to dental care to promote overall health.


The nursing students established a relationship of trust through initial engagements with the residents using activities such as serving lunch and art therapy. Previous nursing students had implemented a mobile dental clinic van at a relatively close location which proved to be effective; subsequently, the residents expressed interest. The total cost for a mobile dental van per visit was $2,500. The nursing students applied for a grant through a local Chinese church. The dental van would conduct full oral exams over a six-hour period for eight to ten women. The nursing students also organized three slots for the women of the shelter to attend a dental cleaning at a local addiction recovery center. To address knowledge deficits, the nursing students collected information on external dental clinics in the community and created a resource pamphlet for the day center’s clients and staff. Another barrier identified was that several clinics required personal identifiers such as legal names. Many residents are uncomfortable and reluctant to provide such information due to fears of exposure and past domestic violence trauma. The nursing students gathered a list of dental care clinics closest to downtown Seattle and created a table detailing the clinic’s cost, Medicare acceptance, services, personal identifiers required, open hours, and location. This pamphlet allows residents of the shelter to have a resource of dental sites that meet their specific needs. These interventions aim to provide access to information, funding, and resources to combat the specific concerns of the clients.


The interventions put in place by the nursing student group were threefold. One outcome was to provide funding and a pathway to support a mobile dental van on-site at the women’s center. The van costs $2,500 for six hours and appointments for 8-10 women. The students determined that three times yearly would be effective for improving access to dental care to start. The total funds requested, $7,500, was approved through the grant application for three dental van visits. The team has met the outcome of providing access to funding and a clear pathway to connect the women’s center with a mobile dental clinic. The second outcome was to connect the women’s center to a dental clinic at the addiction recovery center. This outcome was met as three appointment slots were filled by the women at the center. The third outcome was to provide a document to help women determine what dental resources are available to them. This outcome was met as the document was submitted to the center. This document will help the women better understand what resources are available for their individual needs.


The clients at this shelter acknowledged their need for dental care but were unable to seek dental care due to safety concerns and financial insecurity. Three interventions were devised to meet the goal of providing a pathway to accessing safe and reliable dental care. The nursing students were able to coordinate with a local addiction recovery center that provides monthly dental care to obtain three spots for the day center’s clients. Additionally, the nursing students constructed a detailed pamphlet with information about dental services in the greater Seattle area. Lastly, the nursing students applied for a grant and received $7500.00 to pay for a dental mobile van to come to the women’s shelter three times. A limitation of this project was time. The ten-week duration of the project was hindered by a COVID outbreak at the site. As a result, the students were unable to witness the full impacts of the interventions. However, all three original objectives were met. The nursing students established a strong foundation for future projects in the community by procuring additional funding for more mobile dental vans to come to the shelter, further building dental care sustainability at the day center. Overall, through engagement with the homeless women population, the nursing students have identified oral care deficits as a barrier to improved quality of life. The interventions seek to empower clients with the tools to improve their oral health by creating accessibility and education of resources.


Bahanan, L. & Ayoub, S. (2023). The association between adverse childhood experiences and oral health: A systematic review. Journal of Public Health Dentistry. 83(2), 169-176.

Center for Disease Control and Prevention. (2020). Healthy people 2030: Oral health objectives.

Doughty, J., Freeman, R., & Mavor, L. (2020) Oral health and homelessness: Guidance for community nurses. The Queen’s Nursing Institute.

Hollingdrake, O., Saadi, N., Cruz, A., & Currie, J. (2022). Qualitative study of the perspectives of women with lived experience of domestic and family violence on accessing healthcare. Journal of Advanced Nursing. 79(4), 1353-1366.

Paisi, M., Kay, E., Plessas, A., Burns, L., Quinn, C., Brennan, N., & White, S. (2019). Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review. Community Dentistry and Oral Epidemiology. 47(2), 103–111.

Patrick, A. (2023, March 27). WA’s homeless population is increasing, new HUD report shows. The Seattle Times.

Stormon, N., Sowa, P. M., Anderson, J., & Ford, P. J. (2020). Facilitating access to dental care for people experiencing homelessness. JDR Clinical & Translational Research. 6(4), 420-429.

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