Filling a gap for the homeless and toothless: In a church crypt in central London, a dentist is providing care and advice for down-and-outs. Alan Jabez talks to her about the work

Monday afternoon, and the queue outside Blanaid Daly's dental clinic is growing ever longer. Many of the patients have been watching the lunchtime television programmes while others have come off the street to grab a hot cup of tea.

The waiting area is a room deep below the ground containing a couple of old chairs, while the clinic doubles as an office and doctor's surgery at other times. The only medical equipment is an old chiropodist's chair; a wobbly table lamp provides the illumination.

Once a week Ms Daly establishes a temporary dental clinic here in the crypt beneath St Martin-in-the-Fields church in Trafalgar Square, London. She provides basic treatment to many homeless people who have not visited a dental surgery in years, and whose teeth are often in appalling condition.

The first patient is Bob, a fit-looking man in his fifties who used to be a boxer. Most of his front teeth are either missing or have been badly smashed, and he has come to pick up a new set of dentures.

Ms Daly, who does not wear a white coat so as not to create barriers between her and the patients, talks to him about his general condition, as well as asking whether he has found a job and a place to stay. As he has been to the surgery before, he feels he can trust Ms Daly, and appreciates her concern and advice.

Unfortunately, the new dentures do not quite fit, so Ms Daly says she will take them home, make a few alterations, and then make a special journey back to St Martin's the following day.

Such commitment has earned her the respect of her patients. Many complain that the rest of society largely ignores them or treats them with extreme caution. Ms Daly feels that providing support and giving extra time to patients should be the priority of every health worker, irrespective of whether they are being paid.

She moved to London from Dublin a couple of years ago, eager to pursue her interest in community health. She receives a grant from the homelessness charity Crisis, which is best known for organising a massive 'open Christmas' for homeless people in a disused warehouse in central London each year, but is increasingly providing support services for the homeless throughout the year.

Each week Ms Daly visits a number of local community centres where homeless people go, offering whatever dental care she can. Most places are even more basic than the St Martin's clinic, she says: 'I'll usually have to clear away coffee cups and cigarette ends before I can

begin.'

She feels that many of her growing number of patients prefer the basic facilities. 'As they are in a territory they are familiar with, it often helps to de-stigmatise their perception of a typical surgery,' she says.

Before establishing the mobile clinic - she carries all her supplies and instruments on the underground - she visited many community centres in London to gain a better understanding of the problems and conditions of homeless people, of whom there are now many thousand throughout the capital. 'I felt it was very important to get to know them first and also to gain their trust,' she says.

The idea seems to have worked. These days, a little over a year since she began, she is finding that people are coming back for return visits, and many are keen to open up and talk about all their problems.

She is well aware that for some lonely homeless people, the chance of having an ordinary conversation can be as valuable as the relief of a minor toothache. She also finds herself offering advice about housing or how to fill in forms and pay important bills.

As she does not have a dental nurse, Ms Daly has to perform a range of duties. When she sees new patients, she dictates their dental condition into a cassette recorder and transcribes the tape at home. She also has to sterilise her instruments at home.

At all the community centres she displays notices telling people the days and times she will be in attendance. She then operates a queuing system, as well as making appointments - aiming to use the time as well as possible.

The vast majority of her patients are men, their ages ranging from the early twenties to the late seventies. Many have teeth in such bad condition - usually caused by dietery problems or a complete lack of care - that they have become afraid of visiting a normal surgery.

Most have teeth broken or missing and many also have excessive plaque, tartar and broken fillings. Another typical problem is dentures that are either badly fitted or broken, resulting in the person having difficulty speaking or eating. Some people she has seen have managed to survive with no dentures at all, accepting an unhealthy mouth as one of the hazards of life on the street.

No matter how bad any person's teeth, she never insists on specific action. 'I make recommendations and then let the individuals decide what action they want to take themselves,' she says.

Her reasoning is that as most homeless people have so many other physical and emotional problems to deal with, spending time getting their teeth sorted out often comes low down on their list of priorities.

The St Martin's clinic is the one where Ms Daly has become best known. There is usually a rush of patients to see her. In the waiting room, a scuffle breaks out between men vying to be next in line. Some are slightly drunk, while others are unshaven and poorly dressed.

One man pushes his way to the front but is removed by one of the permanent staff - always on the look-out to make sure Ms Daly is all right. There is a panic button in the surgery, but she has never had to use it. She feels confident that her relaxed style and Irish banter will get her out of any tight situation.

When she is unable to carry out treatment, she makes an appointment with a local dentist who has a fully equipped clinic and is sympathetic to her efforts.

Initially, the general response from other dentists was that they did not want hordes of unkempt men hanging around their waiting rooms. But gradually she has found a more favourable attitude, and an increasing number of dentists are now keen to offer their services - especially if the patients have been sent by Ms Daly.

Rather than 'dropping' their NHS patients, as many dentists are currently threatening to do, Ms Daly would like them to increase their NHS workloads and welcome homeless people to their practices.

She opposes the idea of establishing special services for the homeless, unless they have acute mental or medical problems, believing that such action would alienate them further from the rest of society.

She would like to see the Crisis project expanded across Britain. Her ultimate aim is to ensure that homeless people everywhere can receive the same dental care that the rest of us take for granted.

Sadly, in today's profit-hungry health world her goal seems increasingly idealistic.

(Photograph omitted)