Amid the chaotic conditions of homeless life, the issue of dental care is far from a priority.
There never used to be dental services for homeless people, but that started to change two years ago when Dublin's Capuchin Day Centre for Homeless People sought the assistance of dentists and orthodontists to meet the needs of its drop-in community.
"We check all of them for everything – general decay, gum disease, mouth cancer. But, usually, they're coming in with an issue such as toothache, or they want a denture, a lost filling," says Dr Brendan Fanning, as he and colleague Dr Jim Griffin attend to a lengthening queue of visitors.
Others avail of the morning nourishment provided in the nearby canteen.
The dentists take time out of their practices in Wicklow and Dublin, respectively, every two weeks to attend to the needs of these patients.
“A lot of these patients wouldn’t be regular attenders,” says Fanning, “but you get a mix of that in [regular] practice as well.
“They’d be grossly neglected with a lot of problems.
“You can’t really plan a treatment because you don’t know if they’re going to turn up the following week.
“Our time is restricted, and they live a life that they’re hard to nail down.”
In order to properly brush your teeth, Fanning says “you need a sink and running water.
If you’re homeless or in emergency accommodation, that might be hard enough to get.
“We’ve had problems with people losing their dentures because it’s hard to hold onto your belongings with bags being stolen, that sort of thing.”
Increased susceptibility to mouth cancer is one particularly unfortunate consequence of this less attentive approach to oral healthcare.
Poor diet, excessive alcohol consumption and smoking are all contributory factors to the disease, which Fanning describes as “a silent killer”.
The volunteer dentists are eternally vigilant for signs of mouth cancer; Griffin is aware of two diagnoses of the illness in the past two years at the Capuchin centre, which far outstrips the rate of discovery in the wider population.
“That’s one case a year,” he says.
“Most people in normal general practice would see about one case every 20 years.
“The incidence here is really high because their general health is very poor, their nutrition is poor.
“Heavy smoking, heavy alcohol consumption – they all contribute to it.”
Griffin’s observations are timely, given that the issue is being widely publicised ahead of Mouth Cancer Awareness Day on Wednesday, September 21st.
Dentists around the country will offer free screenings, which take about 10 minutes.
The disease can often go unnoticed during its initial phases, so prompt diagnosis is essential for effective treatment.
“What happens is the lining of the mouth undergoes some subtle changes, little red patches or little white patches,” Griffin says.
“They are the very, very early signs, and if they’re picked up the prognosis is excellent. But you can only pick them up if the patient is coming in on a regular basis.
“If the early disease is caught, the survival rate is 75 per cent at the end of five years.
“If the disease has spread, then the prognosis can go down to as little as 5 per cent survival rate at the end of five years.”
Some 300 cases of mouth cancer are diagnosed every year, and an average of two Irish people die from it every week.
Fanning describes a case of mouth cancer he discovered at the Capuchin centre two years ago.
“We saw him about six weeks ago and he’s doing well.
“He’s had surgery, he’s had chemotherapy and radiotherapy . . . he is alive and reasonably well two years down the road, which is positive.”
Although not as serious a case, patient Thomas Stack began to experience severe pain when he chipped a tooth quite recently.
“It was gone right down to the nerve, nearly down into the gum,” describes Stack, a regular user of the services offered by the Capuchin centre.
“I needed fillings, so I got one or two done here. It’s brilliant, one of the best dentists I’ve ever been to.
“You can go to the dentist or to the doctor, but I mainly come down because they give you a breakfast and a dinner.”
According to Griffin “the reason this clinic works is because the problem with these types of cases is getting access to them”.
“The reason we get access is because of the care they get for the meals and for the food parcels,” he adds, alluding to the 800 hot meals handed out by the charity each day.
Through this basic offering, volunteers are then able to funnel visitors into other services such as GP clinics, a chiropodist and an optician.
Alan Bailey, the centre's volunteer co-ordinator, was amazed at the instantaneous demand for the twice-weekly dentist practice when it began in 2014.
“For a lot of our people it’s the first time they’ve ever been with a dentist,” says Bailey.
“It’s hard to believe. We’ve people with huge dental issues who could never afford to see a dentist up to this.
“We couldn’t believe the take-up on the service.
“The one thing we pride ourselves on is we don’t want to know what your background is, what your financial circumstances are.
“If you need us, come in and we’re here for you. All our services are free.
“If you want, come in and you can join the queue and see the doctor, dentist or whatever.”
For more information on Mouth Cancer Awareness Day on September 21st, including a list of participating dentists, visit mouthcancerawareness.ie
