Dental care needs and treatment priorities in a homeless population in Rome: an observational study

Objectives: This study aimed to identify the oral health conditions of homeless individuals in Rome, the most frequently required dental treatments, and to describe a standardized, replicable clinical protocol tailored to the specific needs and access barriers of this vulnera- ble population. Methods: Five hundred homeless individuals received comprehensive den- tal examinations at the Primary Care Services of the Dicastery for the Charity Services (Vat- ican City) between September 2023 and January 2026. Clinical assessments included oral hygiene status, periodontal health, caries prevalence, and degree of edentulism. Treatment interventions were programmed by scheduling subsequent appointments. For patients requiring prosthetic rehabilitation, treatment was sequenced into distinct steps: preparatory treatments (hygiene, extractions, conservative procedures), impression taking, prosthesis try-in, and delivery. Results: Oral health assessment revealed poor or absent hygiene (85.4%), high DMFT scores (63.0%), and root residues (22.4%). Periodontal disease affected 94.0% of participants (gingivitis 73.0%, periodontitis 21.0%). Tooth loss patterns included partial edentulism (12.0%) and complete edentulism (24.0%). A total of 440 appointments were scheduled, with an attendance rate of 78.4%. Prosthetic rehabilitation was com- pleted in 150 patients: 50 received partial dentures (33.3%) and 100 complete dentures (66.7%). Conclusions: The examined homeless individuals experienced severe oral health deterioration characterized by extensive tooth loss and advanced periodontal disease. A substantial prosthetic rehabilitation was needed in this sample. The proposed sequential treatment protocol demonstrated high feasibility and patient adherence in this vulnerable population. Comprehensive dental services that address both immediate emergency needs and long-term rehabilitative care are crucial for improving oral health-related quality of life and facilitating social reintegration. Patient-reported outcomes indicated meaningful improvements in digestive function, aesthetic satisfaction, and employment opportunities following prosthetic rehabilitation.