Oral Health and Homelessness in San Diego County: A Prevention-Based Response

Oral health disparities are often most visible among communities experiencing homelessness. In San Diego County, unhoused individuals face significant structural barriers to accessing preventive dental care. The result is predictable: higher rates of untreated dental decay, increased periodontal disease, unmanaged pain, and disproportionate reliance on emergency services.

National research consistently shows that individuals experiencing homelessness have substantially worse oral health outcomes compared to the general population. Studies published in the Journal of Health Care for the Poor and Underserved and reports from the National Health Care for the Homeless Council document elevated rates of untreated dental decay, missing teeth, and periodontal disease.

Barriers to care are multifaceted: lack of transportation, competing survival priorities, limited insurance coverage or benefit navigation, difficulty storing hygiene supplies, stigma within healthcare settings, and fragmented referral systems.

Dental-related emergency department visits cost billions annually across the United States. Emergency departments are not designed to function as preventive dental care systems. When prevention is unavailable, downstream costs increase — both financially and in human suffering.

Prevention-based mobile oral health programs focus on oral health screenings, fluoride varnish application, Silver Diamine Fluoride (SDF) to arrest active decay, oral hygiene education, and referral coordination for restorative needs.

Silver Diamine Fluoride can arrest active caries without drilling. For populations facing access barriers, stabilizing disease progression reduces infection risk and buys time for comprehensive treatment when available.

San Diego County has a network of community organizations, healthcare providers, and public health infrastructure capable of supporting preventive oral health outreach. Community-based preventive programs serve as entry points into care, stabilization mechanisms, education platforms, and referral bridges.

Prevention works. Access matters. Systems can adapt. Oral health equity requires intentional design.