Do LGBT+ people face inequality in oral healthcare?

Although the Centers For Disease Control says oral health disparities among minorities are “profound in the United States,” the issue has barely been studied in relation to the LGBT+ community (folks who are lesbian, gay, bisexual, transgender, etc.). A 2018 article in The Journal of the American Dental Association called, “Should Dental Make A Transition?” questioned whether dentists adequately meet the concerns of transgender patients when performing procedures that impact the masculine or feminine aesthetic of their smile, teeth size, and facial profile. It got us wondering: Are there differences in the state of oral health for LGBT+ people and other communities? It turns out the answer is complicated.

LGBT+ patients feel less positive about their oral health.

While the LGBT+ population is understudied in dental research, one recent report published by the American Association of Public Health Dentistry found notable differences in self-reported oral health measures: “Bisexual and homosexully experienced individuals reported a substantially higher proportion of fair/poor oral health compared to heterosexual individuals.” But researchers found no clinical basis for this disparity in self-reported health.

Although this is one study — and there are many known barriers and disparities in general healthcare among minorities — and it may seem odd, the findings point to the idea that oral health outcomes aren’t the ultimate measure of equality in oral healthcare.

LGBT+ people may visit the dentist less than average.

One survey found that the fear of discrimination and maltreatment at the dental office “were significantly associated with the level of dental fear” among transgender individuals. Although research is lacking, this may also be the case for lesbian, gay or bisexual individuals who perceive their oral health to be worse off than average. A survey of LGBT+ people in Cleveland that found only 10 percent of transgender people report visiting the dentist regularly furthers the notion that perceived discrimination might be to blame for why LGBT+ people are less likely to visit the dentist. This likely comes from a history of discrimination not only based on identity, but also from the dark history of HIV stigma in healthcare that has disproportionately impacted this community.

While most providers are not likely to be discriminatory and generally follow the rule of “universal precaution,” which includes consistency of treatment precautions for all people, the field itself is lacking in sensitivity literature for professionals to reference while providing care for LGBT+ people. According to the American Dental Hygienists’ Association, “increasing the knowledge and demystifying sexual minority issues can enhance the confidence and attitudes of healthcare workers when treating LGBT individuals.” However, the Commission on Dental Accreditation doesn’t currently require diversity training beyond gender disparities. Dental professionals and academics have noted the gap in dental education on dealing with a diverse group of patients, with some folks creating seminars for dental students on sensitivity when providing care for LGBT+ people.

With more discussion and visibility, we can bring more equity to oral health.

Simply by bringing attention to this conversation, the oral health of LGBT+ people is made more visible and salient to dental school curriculums and policy makers (like at the Commission on Dental Accreditation), and helps LGBT+ people themselves become more conscious of potential disparities. Dr. Jeremy Krell, DMD (and Director of Dental at quip) says, “Support can come from many different places and healthcare professionals should be on the forefront of implementing social sensitivity protocols to create a welcoming environment for all.” At the end of the day, everyone has a mouth, and we should be working to ensure everyone has access to quality oral healthcare to keep themselves healthy — so they can smile with pride every day.