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Leading community dental provider, CDS CIC, removes barriers to dental care faced by patients with SMD and/or homelessness

Nicola Milner

Six months into a year long pilot programme delivering dental care to patients with severe multiple disadvantages (SMD) and/or homelessness, Community Dental Services CIC (CDS) has treated over 145 patients and has referred patients on for smoking cessation, drug misuse and alcohol services, also using the sessions to provide information around better oral health and prescribe high fluoride toothpaste at each visit.

  • Health inequalities
  • Person-centred care
  • Primary care

The pilot and patient need

People experiencing SMD and homelessness face many barriers to accessing oral health care and experience higher levels of dental carries and periodontal disease than the general population. Poor oral health is linked to a decreased quality of life among these patients, compounding issues such as poor diet and substance misuse to alleviate pain. They can feel ashamed and embarrassed to attend a dental practice full of people, fearing that they will be judged as well as facing difficulty finding and registering with a dentist without a fixed address. SMD groups have disproportionately high levels of pain, infections, untreated dental disease, and tooth loss. The Groundswell survey in 2017 of over 260 homeless individuals, found that 28% used illegal drugs to help deal with their dental pain.  People also miss out on vital opportunities to screen for oral cancers during dental visits.

Our pilot is a partnership between CDS and the East Midlands Primary Care Team, working on behalf of five Integrated Care Boards in the Midlands; and has been specifically designed around the needs of this patient group. We identified and work with people who support this group of patients, with the mobile dental clinic attending environments they are already familiar with and trust. It follows on from survey work we undertook amongst this patient cohort a few years ago, to understand the need for services and what type of intervention should be commissioned.

Community Dental Services mobile dental clinic
Community Dental Services mobile dental clinic

Our mobile clinics

Our mobile dental clinics contain a fully equipped dental surgery with X-ray facilities, sterilisation equipment, and a hoist to enable the dental team to carry out a full range of dental treatments in an accessible manner. This service provides a positive dental experience for many people who have not experienced this in the past and being on wheels, enables us to get this valuable resource into the heart of those communities who experience barriers to care.

The CDS mobile clinic has been visiting locations in Nottinghamshire, Derbyshire, Leicestershire and Lincolnshire that offer established services for people who are homeless.

Community Dental Services mobile dental clinic – Inside

Positive outcomes

Feedback from patients has been overwhelmingly positive:

I think this service is invaluable to me. I have not been to a dentist for several years. My teeth are a state from years of drug abuse and being beaten up while living rough on the streets. The dentist was very kind and put me at ease while looking at my teeth and guided me through the process/appointments. This is the beginning of the new me. Thank you so much.

I cannot thank the dentist enough for the support they have shown me. The dentist was non-judgemental towards me, as I was living in a tent in Derbyshire for over 2 years. To be honest, my teeth were the last thing on my mind, but looking back, my teeth are one of the first things other people see. I know that I would have never gone to a dentist surgery as I am far too embarrassed.


Nicola graduated as a dentist in 2000, has a Masters Degree in Public Health and a Diploma in Special Care Dentistry. She joined CDS in 2017. Prior to starting her post as Chief Operating Officer, she was the Associate Operations Director in Leicestershire.  

Nicola continues to work clinically, providing comprehensive dental treatment under general anaesthetic for adults with severe learning disability, she also treats patients under inhalation sedation and provides domiciliary care.