Housing instability exposes structural weaknesses in healthcare delivery. When someone loses stable housing, they do not lose their need for preventive care. They lose the infrastructure that makes accessing it straightforward.
Oral health is one of the first areas where this breakdown becomes visible. Tooth decay progresses quietly. Gum disease advances slowly. Without preventive care, oral health conditions worsen until pain forces action.
The U.S. Surgeon General's report on oral health emphasized that oral health is integral to overall well-being. For individuals experiencing housing instability, oral health often reflects cumulative disadvantage: limited access to preventive services, intermittent insurance coverage, nutritional instability, chronic stress, and reduced continuity of care.
Episodic care — short-term interventions disconnected from broader systems — provides temporary relief but limited long-term impact. Prevention requires consistency. Fluoride varnish must be applied periodically. Oral hygiene education requires reinforcement. Disease monitoring requires follow-up.
San Diego County has a network of housing support programs, temporary shelter systems, behavioral health providers, community-based outreach teams, and public health agencies. Integrating oral health prevention into these systems creates sustainability.
Evidence-based preventive interventions suitable for community integration include fluoride varnish application, Silver Diamine Fluoride for caries arrest, oral hygiene education, risk-based screenings, and clear referral coordination.
Oral health affects more than physical comfort. Missing or visibly damaged teeth can influence self-confidence, social interaction, employment opportunities, and willingness to engage with services. Prevention reduces avoidable deterioration that can compound social barriers.
Health equity does not emerge organically. It requires intentional infrastructure that reduces barriers. When prevention is embedded within community health systems that already serve unhoused populations, equity advances.