Ann Arbor, MI, USA

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  • UJPH Executive Board

Ann Arbor Homelessness and Oral Health

Elizabeth (Lit) Kurtz, an uninsured Groundcover News vendor, needed to receive a root canal, but could not find many affordable options to choose from. Lit was forced to compromise the quality of care she received in order to get treated accordingly. Poor quality of care eventually forced Lit to pay high out-of-pocket medical expenses to treat postoperative negative health outcomes. It is evident that our nation’s most vulnerable populations experience a heightened burden of oral health disease.[1] Specifically, individuals experiencing homelessness face major health disparities that range from malnutrition due to their inability to eat fresh, nutrient-rich foods, to low self-esteem of their smiles[2] . As a pre-dental student, it is truly noteworthy to see how many individuals experiencing homelessness have not been able to receive preventative dental care or oral health treatments. This is largely due to the circumstances many of these guests experience, including facing expensive payments for preventative oral care and dental procedures, and having no form of consistent income or lack of insurance coverage. This leads to serious oral health disease that require immediate treatment.[3] Many of these individuals have no choice but to receive care from teaching clinics where procedures have lower costs, but the quality of care is compromised. [4]


After graduating[5] from Eastern Michigan University, Lit started out as a substitute teacher and eventually became an English teacher in Detroit[6] . Everything changed when Lit found herself as one of the many teachers that were part of a mass teacher layoff in 2012. Shortly after losing her job, Lit lost her home, her savings, and eventually all of her belongings. Now, as a Groundcover News[7] vendor Lit exclaims that she takes it day by day to ensure she has enough to provide for her immediate needs. Lit, like many other Ann Arbor residents who experience poverty, is unable to think about her medical and health care costs in advance since she is preoccupied about providing herself with food and shelter for that day.


Lit told me about a time[8] when she visited the University of Michigan Dental School to receive a root canal. She chose to go to U of M because the clinic did not require any insurance coverage and its student clinic had the lowest out-of-pocket fees in the nearby area. This low fee is available because patients are practiced on by current dental student who are still in training. This system is allowed since these students are supervised by the school’s licensed faculty dentists. Lit was confident in receiving her procedure since not only was the student clinic the most affordable option but U of M also boasts a world class dental program. However, when asked about her overall experience, Lit described it as exhausting. Lit exclaims that following her procedure she developed a pustule in her mouth. At first, Lit did not take it seriously as she was under the impression that the swelling and pain would go away after a few days. Instead, however, the pustule slowly grew into a larger abscess in her mouth and developed an infection. In order to treat the infection, Lit needed antibiotics and proper treatment so that the infection would not spread through her bloodstream and case further health complications. Lit had no choice but to rush to the University of Michigan Hospital Emergency Room where she had to pay hundreds of dollars in out-of-pocket fees.

The 2020[9] Michigan State Oral Health Plan identifies three main areas of focus: professional integration, health literacy, and increased access to oral health care[10] . Michiganders have yet to experience optimal oral health, as disparities continue to exist for individuals with lower socioeconomic status and among minority and ethnic populations. According to the 2014 Michigan Behavioral Risk Factor Survey, persons with low household income and less than a high school education were more likely to have had no dental visit during the past year and 6 or more teeth missing. Among Michiganders with a household income of less than $20,000, 55.3% did not have a dental visit during the past year, compared with only 13.7% among those who had a household income of $75,000 or more. [11]


Marginalized populations experience a disproportionate burden of oral health disease due to a slew of factors. Some determinants include inadequate access to dental care, systemic discrimination, and lack of affordable specialized health services. In addition, other factors include limited transportation services, employment that offers no dental coverage, a shortage of dentists who practice in low-income communities, and a shortage of dentists who accept public insurance like Medicaid. Lit later expressed that she is still unable to make frequent visits to the dentist for checkups and screenings. She says that many of her friends who are in similar situations as her try to prioritize oral health and hygiene, but find it extremely difficult to do so. Lit exclaims that although lower costs dental clinics exist, the quality of care is not present, and existing health problems become exacerbated when not properly treated.


Lit’s situation is an example of a cycle of preventable health expenditures that individuals who experience homelessness face every day. [12] Recognizing the stories about those who experience homelessness and how it impacts their oral care and overall health is very important in understanding what systemic changes need to take place. I hope that college students will be more cognizant of the health determinants that low income individuals face. Moreover, I hope that university policy and programs will continue to encourage helping the local community with free health resources and opportunities for preventative medicine for those who need it most. [13]

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