Preventive Oral Health and Homelessness in San Diego County: A Public Health Framework

Oral health disparities are among the most visible — and preventable — consequences of housing instability. In San Diego County, one foundational component of health is frequently overlooked: preventive oral health.

National research consistently shows that individuals experiencing homelessness have significantly worse oral health outcomes than the general population. Studies document higher rates of untreated dental decay, increased periodontal disease, greater prevalence of missing teeth, and limited access to routine preventive care.

Traditional dental delivery systems assume stable housing and predictable scheduling. For unhoused individuals, those assumptions often fail. When preventive access is inconsistent, disease progression becomes predictable.

If preventive services are only available in fixed-site dental offices, participation among unhoused populations will remain limited. Mobile and community-based oral health delivery models bring services directly to outreach sites, temporary housing facilities, and supportive housing programs.

Silver Diamine Fluoride is particularly impactful in community settings. Research supported by the National Institutes of Health demonstrates that SDF can arrest active decay without invasive procedures. Fluoride varnish reduces the likelihood of new decay. Education improves long-term hygiene practices.

Oral health does not exist in isolation. Research highlights connections between oral inflammation and broader systemic health outcomes including diabetes management challenges, cardiovascular disease associations, and nutritional instability.

A prevention-based framework includes mobile delivery of preventive services, evidence-based interventions, clear referral pathways for restorative care, partnership with housing and outreach organizations, data-informed targeting, and alignment with public health goals.

The state of oral health among unhoused communities reflects both challenge and opportunity. Oral health is public health. Prevention is cost-effective. Mobile delivery reduces inequity. Integration strengthens systems.