Active Program
Project SmilesForAll
Preventive Oral Health Access for Unhoused Communities
Mobile preventive oral health services targeting unhoused populations in San Diego County, reducing barriers to care through direct community outreach and RDHAP-led clinical delivery.
Section 01
The Oral Health Crisis Among Unhoused Populations
Individuals experiencing homelessness face significantly higher rates of untreated dental decay, periodontal disease, and oral infections compared to the general population. Barriers to care include lack of transportation, absence of insurance, provider stigma, and competing survival priorities.
Oral health is frequently deprioritized in homeless service systems, yet untreated oral disease contributes to systemic health complications, chronic pain, nutritional deficiency, and reduced employability.
Higher Untreated Decay
Unhoused individuals have markedly higher rates of untreated caries and missing teeth compared to housed populations.
Source: Journal of Health Care for the Poor and Underserved
Periodontal Disease
Elevated rates of moderate to severe periodontal disease are documented among homeless populations in multiple studies.
Source: NIH, National Health Care for the Homeless Council
Access Barriers
Transportation, insurance gaps, provider availability, and stigma create compounding barriers to dental care access.
Source: CDC, National Health Care for the Homeless Council
Section 02
Emergency Department Utilization
Dental-related emergency department visits cost billions of dollars annually across the United States. The vast majority of these visits are for conditions that could have been prevented through routine preventive care — including fluoride application, sealants, and basic oral hygiene interventions.
Uninsured and unhoused populations are disproportionately represented in dental-related ER utilization data. Emergency departments are not equipped to provide definitive dental treatment, resulting in repeat visits, antibiotic prescriptions, and pain management without addressing the underlying disease.
Billions
spent annually on dental-related ER visits in the U.S.
Source: CDC
Majority
of dental ER visits are for preventable conditions
Source: ADA Health Policy Institute
Overrepresented
Uninsured and unhoused populations in dental ER data
Source: CDC
Section 03
Our Prevention Model
Project SmilesForAll delivers mobile preventive oral health services directly to shelters, encampments, and service facilities where unhoused individuals gather.
Mobile Hygiene Services
RDHAP-led portable preventive care delivered on-site at shelters, service centers, and community locations.
Fluoride Varnish
Professional fluoride application to protect against caries progression and strengthen compromised enamel.
Silver Diamine Fluoride
SDF application to arrest active caries without the need for drilling, reducing the burden of untreated decay.
Oral Health Education
Practical education on oral hygiene, nutrition, and available resources tailored to the realities of homelessness.
Referral Coordination
Structured referral pathways connecting individuals to restorative dental care, FQHC dental services, and Medi-Cal enrollment.
Upstream Intervention
We are not replacing comprehensive dental clinics. We are reducing disease burden upstream, before acute care becomes necessary.
“We are not replacing comprehensive dental clinics. We are reducing disease burden upstream.”
Read our analysis on why prevention must be mobile for unhoused communities in San Diego County.
Section 04
Public Health Systems Impact
Preventive outreach targeting unhoused populations produces measurable systems-level benefits beyond individual patient outcomes.
Reduced Acute Infections
Early preventive intervention reduces the progression of caries and periodontal disease to acute infection requiring hospitalization.
Reduced Antibiotic Overuse
Preventing dental infections upstream reduces the reliance on antibiotic prescriptions in emergency settings, supporting antimicrobial stewardship.
Reduced Hospital Burden
Fewer dental-related ER visits free emergency department capacity for true medical emergencies, reducing system strain and costs.
Support Project SmilesForAll
Shelters, service agencies, and funders are invited to partner with us.