By: Ms. 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 of 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. What if you’ve 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 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 that 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 antiandrogens 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 to work together and hold 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 in 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.

Alisha Prince is currently a dental student in the International Dentists Program at the University of Colorado School of Dental Medicine. After getting her dental degree in India, she worked as an associate dentist for three years before moving to the U.S. She received her Master’s in Biological Sciences at Wichita State University and worked as a dental assistant, research associate and adjunct faculty member before going back to dental school to pursue her US dental license.