Damaged Teeth Trap Women in Cycle of Stigma After Street Sex Work

For some women trying to leave street sex work, one of the last visible signs of their past was in their mouth.

A study of 21 women involved in survival-based street sex work in Liverpool found that dental damage caused by drug use, poor nutrition, and years of neglect became a lasting marker that others used to make assumptions about their lives, even after those lives had changed, according to a report by Phys.org.

Survival-based street sex work refers to selling sex during acute hardship, when someone has few realistic alternatives for meeting an immediate need such as food, drugs, or shelter. At the time of the research, all of the women were living in temporary accommodation and using at least one drug, with many using several. Their circumstances also included insecure housing, violence, and mental ill health.

Researchers interviewed participants recruited through community support services in Liverpool and worked with them to create artwork reflecting their experiences. The women then helped the researchers interpret and refine that artwork.

The women described how their teeth became damaged across their lifetimes. Many recalled childhoods shaped by parental substance use, neglect, and instability, where brushing teeth or visiting a dentist received little attention because families were focused on meeting more immediate needs. In adulthood, they linked further dental deterioration to drug use, high-sugar diets, vomiting, and violence.

Some said heroin made them crave sugar. Others described developing dry mouth while using crack cocaine or methadone. During periods of heavy drug use, brushing was sometimes forgotten or felt unimportant. Some women who had already lost several teeth said they felt little reason to continue caring for the ones that remained.

The physical descriptions were severe. Women described teeth breaking, crumbling, or falling out. One said teeth had fallen into her hand. Another filed down a sharp, broken tooth with a nail file because it was cutting her tongue. Abscesses and persistent pain were common.

The study found that this damage did not disappear when other parts of the women's lives improved. Even after detoxing from drugs, the appearance of their teeth led other people to assume they were still using. The stigma attached to their dental appearance followed them.

For several women, restoring their teeth was not just a medical goal. It was connected to stopping drug use and street sex work, rebuilding family relationships, and demonstrating to others that their lives had moved on. The appearance of their teeth had become tied to their identity and to how others perceived their progress.

The researchers noted that these experiences were consistent with broader evidence. People with substance-use disorders show higher rates of tooth decay and gum disease. Repeated vomiting associated with some eating disorders can erode tooth enamel. Higher sugar consumption increases the risk of decay.