Wiltshire Council: Mobile dental outreach clinics to improve access to oral health care

The 2021 adult oral health survey for England indicated that 66 per cent of adults reported they had very good or good oral health and 63 per cent of adults reported regularly attending their dentist for check-ups. However, significant health inequalities persist in both oral health outcomes and access to dental care across the UK (OHID, 2024).

For example, dental services are often more concentrated in urban areas, while rural communities frequently face shortages of NHS dentists. Additionally, individuals living in the most deprived areas are more likely to experience poor oral health (Baird and Chikwira, 2023). Given Wiltshire’s rural geography, these disparities are particularly relevant.

Vulnerable populations also face additional barriers to accessing dental care and are disproportionately affected by poor oral health. For instance, individuals who use substances tend to have more severe dental issues and periodontal disease than the general population yet are less likely to receive dental care (Baghaie et al., 2017). Similarly, people experiencing homelessness often have high levels of unmet oral health needs which significantly impact their oral health-related quality of life (Yusuf, Golkari and Kaddour, 2023).

These challenges—limited access to NHS dental care, the link between substance use and poor oral health, and the difficulty of maintaining dental hygiene while rough sleeping—provided the rationale for commissioning mobile dental outreach clinics in Wiltshire. The project aimed to:

• 1. Increase access to dental services for vulnerable Wiltshire residents who are managing complex circumstances, such as substance use, rough sleeping, or being at risk of homelessness.
• 2. Increase patients’ knowledge around oral health hygiene and promote healthier behaviours.
• 3. Deliver a reliable and well-attended mobile dentistry service tailored to the needs of socially excluded populations in Wiltshire.

Wiltshire Council Public Health Team commissioned a dental provider to deliver a pilot programme of 18 mobile dental outreach clinics throughout 2024. During the clinics, a range of treatments were offered, including:

• Oral assessment
• Cancer screening
• Oral health instruction
• X-rays • Fillings
• Tooth extraction
• Fissure sealant
• Fluoride varnish
• Scale and polish
• Referral to onward care.

The 18 clinics were delivered across supported accommodation sites in Trowbridge, Chippenham and Salisbury, with six clinics held in each location. These locations were chosen as the supported accommodation sites house individuals who are at risk of homelessness and also offer drop-in sessions for individuals rough sleeping. Therefore, they were suitable locations to help increase access to dental services for vulnerable Wiltshire residents who are managing complex circumstances, such as substance use, rough sleeping, or being at risk of homelessness, as per objective 1.

A point of contact was identified at each location who took on the responsibility of promoting the clinics and organising list of patients to be seen on the day. This approach worked well as the workers at the supported accommodation had existing relationships with many individuals, helping to allay any fears about attending the clinics. Across the 18 clinics, a total of 117 patients were seen.

All patients received an oral assessment, cancer screening, and oral health instruction as standard. Clinicians reported that they saw an improvement in oral health in patients who attended multiple clinics in Salisbury, Chippenham and Trowbridge. All clinics were well attended, and demand consistently exceeded capacity.

Qualitative feedback was obtained from patients and a support worker:

“The dentist was warm, friendly and gentle. The music was perfect. He explained everything. He treated me with respect and dignity. Sleeping rough and keeping my mouth clean was a challenge. They knew this and acknowledged my efforts. I disclosed how vital it is for my mental health to have a way to clean my teeth every day. My sense of self-worth rose from fairly near rock bottom to almost glowing, by the end of the day.” (Client quote)

“It was helpful that they come out to us rather than trying to get out using public transport to get to an emergency dentist” (Client quote)

“[I’m] an extremely anxious patient, everyone made me feel comfortable…[I’m] extremely happy with all help and support available” (Client quote)

“I spoke to several of the clients after treatment and the relief was clear to be seen. Pain subsiding immediately which in turn would combat the additional use of drugs and alcohol to block out the pain. The clients were made to feel valued and comforted throughout and long may this service continue.” (Quote from support worker)

This indicates that the three core objectives of the programme were met: improving access, increasing oral health knowledge, and delivering a reliable service for vulnerable populations.

Due to the success of the pilot programme, the Wiltshire Council Public Health Team are keen to continue to work with system partners to reduce oral health inequalities and improve access to dental services.

• Baghaie, H., Kisely, S., Forbes, M., Sawyer, E. and Siskind, D.J., 2017. A systematic review and meta‐analysis of the association between poor oral health and substance abuse. Addiction, 112(5), pp.765-779.
• Baird, B., Chikwira, L., 2023. Dentistry in England explained. The Kings Fund.
• OHID (Office for Health Improvement and Disparities), 2024. Adult oral health survey 2021: report summary
• Yusuf, H., Golkari, A. and Kaddour, S., 2023. Oral health of people experiencing homelessness in London: a mixed methods study. BMC public health, 23(1), p.1701.

Lizzie Shea – Public Health Specialist – Substance Use 

Kelly Fry -Public Health Principal – Building Resilience