The Surgeon General called dental caries the silent epidemic, suffered disproportionately by the poor. Homeless mothers/children are especially vulnerable as they lack access to dental care. This prospective study elucidated predictors of access, oral health, and the effectiveness of shelter-based care. A convenience sample of 120 homeless families (children n=236) provided predictor factors at intake and one month later. Nearly half the children (n=98) had dental caries. Ten independent variables explained 33% of the variance of access barriers; the most influential were mental health (B=-.426), oral health beliefs (B=.243), and victimization (B=.185). Ten independent variables explained 24.3% of the variance of oral health: mother's age (B5.351), number of children at the shelter (B=.337), and race (B=.154) had the most influence. Shelter-based care was effective in improving access: 43% of families secured dental appointments and perceived access barriers decreased after shelter-based care (t=4.695; p=<.001).