A study of 21 women in Liverpool who engage in survival-based street sex work has highlighted how poor oral health can worsen stigma and disadvantage. The research explored their oral health needs, experiences, and priorities, focusing on women living in temporary housing and using at least one drug, with many using multiple substances. Many of the women shared that their childhoods were marked by parental drug use, neglect, and instability. In their families, basic needs like food and shelter often took precedence over dental care, and brushing teeth or visiting a dentist was often overlooked. In adulthood, the women linked their worsening oral health to a range of overlapping issues, including drug use, diets high in sugar, vomiting, and exposure to violence. Some reported that heroin increased their cravings for sugary foods, while others described dry mouth as a side effect of using crack cocaine or methadone. During periods of heavy drug use, brushing teeth was often forgotten or considered unimportant. Women who had lost several teeth felt that continuing to care for them was pointless. These experiences align with broader research showing that people with substance-use disorders often suffer from higher rates of tooth decay and gum disease. The women described severe dental problems, including broken, crumbling, or missing teeth, along with abscesses and constant pain. One participant said she had found a tooth in her hand, while another used a nail file to smooth a sharp, broken tooth that was cutting her tongue. Poor dental appearance, they said, often led others to assume they were using drugs or involved in sex work, reinforcing the stigma associated with both. A 2024 clinical study comparing 40 female sex workers with 40 others of similar age and sex found that sex workers had significantly more missing teeth and tooth decay. However, these studies do not prove that sex work itself caused the differences—rather, they suggest that oral health issues often result from overlapping disadvantages, disrupted care, and experiences that feed into each other. Almost all the women described major barriers to accessing dental care, including long waiting lists, high costs, travel distances, and fear of treatment. Some lost access to a dentist after missing appointments during personal crises. When dental pain became severe, some turned to drugs for relief, while others tried to treat the problem themselves. Some had access to services like Dentaid’s mobile dental bus or dental care in prison, which they valued. However, these services often focused on emergency treatment rather than repairing or replacing damaged teeth. Women in hostels reported that dentures could be lost or stolen, which further complicated their ability to maintain their dental health. These challenges explain why oral health problems often persist even after women stop using drugs or leave street sex work. While emergency care can ease immediate pain, long-term solutions require multiple appointments and ongoing treatment, which remain difficult to access. The study highlights the need for outreach, drop-in clinics, and mobile dental services that partner with community organizations women already trust. These services should provide clear pathways to continued treatment, allowing women to repair or replace damaged teeth. Practical support, such as help with appointments and travel, can also make it easier for people to access care. Previous research in the UK suggests that flexible services and partnerships with trusted organizations are more effective in meeting the healthcare needs of street sex workers. Dental professionals can play a role by offering non-judgmental care and recognizing that trauma can make treatment frightening. A review of trauma-informed dental care outlines ways to help patients feel safer and more in control, though more research is needed to determine the most effective approaches. The women in the study wanted dental care that would allow them to eat, speak, and live without pain, and to reflect the positive changes they were making in their lives, rather than being defined by their past.