This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility: For women involved in street sex work who took part in our research, damaged or missing teeth were more than a health problem. They could become visible reminders of lives they were trying to change.
Our study explored the oral health needs, experiences and priorities of 21 street sex workers in Liverpool. We interviewed participants recruited through community support services and worked with them to create artwork reflecting their experiences, which they then helped us interpret and refine. The experiences discussed here are those of women involved in survival-based street sex work.
This means selling sex during acute hardship, when someone has few realistic alternatives for meeting an immediate need, such as obtaining food, drugs or somewhere to stay. At the time of the research, all the women were living in temporary accommodation and using at least one drug, with many using several. Drug use was one part of circumstances that also included insecure housing, violence, mental ill health and earlier experiences of neglect and instability.
Crucially, the damage to their teeth could remain after other parts of their lives had changed. Women described how, even after detoxing from drugs, the appearance of their teeth could lead other people to assume they were still using them. For some, restoring their teeth was closely connected with stopping drug use and street sex work, rebuilding family relationships and showing that their lives had moved on.
Participants described childhoods affected by parental substance use, neglect and instability. Some recalled that brushing their teeth or attending a dentist received little attention because their families were struggling to meet more immediate needs. In adulthood, women linked their deteriorating oral health to overlapping experiences, including drug use, diets high in sugar, vomiting and violence.
Some said heroin made them crave sugar, while others described developing a dry mouth when using crack cocaine or methadone. Brushing could be forgotten or feel unimportant during periods of heavy drug use. Some women who had already lost several teeth felt there was little point in continuing.
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