Dental Care for the LGBT+ Community: Alisha Prince

Mr. Smith told his dentist that his spouse will call to confirm his next appointments. The well-meaning dentist reassured him that his wife can call the office anytime to confirm the appointment. Mr. Smith has been married to his husband for over ten years.

People on the LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, and more) spectrum face situations like this almost every day. These interactions can range from awkward assumptions to micro-aggressions, and even full-fledged discrimination. A recent Gallup poll concluded that 7.1% of the population self-identified as being on the LGBT spectrum (Jones, 2022). Yet, there are very few studies that adequately address their barriers to dental care.

Gay, lesbian, and bisexual individuals are more likely to rate their oral health as poor (Schwartz, Sanders, Lee, & Divaris, 2019). They are less likely to get routine exams and have an established dental home as it is hard to find LGBT competent dental providers and offices. Most of the dental textbooks, intake forms, and courses are conventionally heteronormative. This directly affects the care our patients receive. Here are a few ways we can start to make dental offices more welcoming and supportive to the LGBT community.

Using a patient’s preferred name and pronouns:

It is imperative to not make assumptions about a person’s gender based on how they may present themselves. By clearly stating your pronouns and asking new patients what their preferred pronouns are, we can start to avoid misgendering them. Practice using pronouns like they/them to refer to a person. Accidentally used the wrong pronoun? Apologize, move on with the conversation and try to do better next time. Call a patient by the name they prefer, rather than what shows up on our electronic health records. Using the name that they don’t use anymore, (referred to as their “dead name”), is problematic as it can out a person’s sex without their consent.

Being gender competent:

Sex is what people are assigned at birth. Gender is how they identify. Many dental practices are moving away from the dated “Sex: Male/ Female/ Other” health history form formats and are asking about a patient’s gender instead. Patients will feel more welcome if we have a space for them to mention their gender identities. People who are transgender or non-binary also have trouble filling out sections which are titled “Female only”. A transman who was assigned female at birth may still go through the menstrual cycle, experience menopause, pregnancy, and breastfeeding, or be on birth control.

Knowing about hormones and their oral effects:

People undergoing gender transitions are usually prescribed hormones to aid in the process. During male-to-female transitions, patients take estrogen and anti-androgens like spironolactone, finasteride, leuprolide, and progestin. In female-to-male transitions, patients take testosterone. Most people are unaware of the side effects these hormones can have on dental care (Macdonald, Grossoehme, Mazzola, Pestian, & Schwartz, 2022). Beyond the systemic risks of osteoporosis, hyperkalemia, liver toxicity, and diabetes, patients on hormone replacement therapies are also at an increased risk of chronic periodontitis and oral infections (Weinstein, 2019). Therefore, we must create a safe space where our patients can disclose this information.

LGBT+ people have experienced stigma and discrimination their whole lives. Creating a dental office where everyone feels safe, accepted, and free from judgment, requires everyone working together and holding each other accountable. Step in when you hear a colleague or friend say something offensive. Hire a team that’s informed about these issues. Representation matters. Incorporate various family configurations on lectures, marketing materials and websites. We need more LGBT+ competent providers who can understand and break down healthcare barriers. Everyone deserves to smile with Pride.

References:

Jones, J. M. (2022). LGBT Identification in U.S. Ticks Up to 7.1%. Retrieved from https://news.gallup.com/poll/389792/lgbt-identification-ticks-up.aspx

Macdonald, D. W., Grossoehme, D. H., Mazzola, A., Pestian, T., & Schwartz, S. B. (2022). Transgender youth and oral health: a qualitative study. Journal of LGBT Youth, 19(1), 92-106.

Schwartz, S. B., Sanders, A. E., Lee, J. Y., & Divaris, K. (2019). Sexual orientation-related oral health disparities in the United States. Journal of Public Health Dentistry, 79(1), 18-24. doi:https://doi.org/10.1111/jphd.12290

Weinstein, G. (2019). Dental Care of Transgenders on Long-Termhormone Therapy. J Oral Biol, 6(2), 3.