The American Institute of Dental Public Health (AIDPH) recently hosted its 3rd annual LGBTQIA+ Oral Health Week by sharing valuable educational resources on social media to help address disparities and oral health needs in this community. In addition to LGBTQIA+ Oral Health Week, the AIDPH has several other initiatives for underserved populations, including veterans, those residing in rural communities, and those with disabilities.1
The goals of these campaigns are to address gaps in infrastructure and improve access to available resources. The AIDPH’s mission is to empower communities and advance oral health care through research, education, and advocacy.1
In support, the American Dental Hygienists’ Association (ADHA) and the Association for Dental Safety (ADS) shared the information on their platforms to ensure dental hygienists had access to this valuable information. Consequently, many of the comments on the ADHA’s social media post were shocking and saddening to see.
Some hygienists claimed they would not renew their membership with the ADHA, or they would immediately cancel their membership. To clarify, the ADHA simply showed support and shared valuable information. Dues were not allocated to the campaign. Therefore, this stance is really confounding.
Additional comments, in part, included:
“How about stay in your lane. I treat all my patients with respect and care regardless of their sexual orientation or gender.”
“This is ridiculous.”
“Not sure how this post is even relevant… aren’t we supposed to treat every patient with standard of care and kindness no matter gender, race, economic status, etc.?”
“Start focusing on things that matter to our profession.”
“And that’s why I quit the ADHA. Pathetic.”
“I’m sorry this is ignorant! Their teeth are no different than anyone else.”
“Disgusting”
These commenters clearly missed the entire point of the post. If these commenters had taken the time to simply click the link in the post, they would have seen resources that described and provided education on the barriers to care, including the fear associated with seeking and receiving care and specific oral health needs for the LGBTQIA+ community. When you see social media posts that give you a visceral response, instead of getting angry, get curious.
Obviously, the ADHA, ADS, and AIDPH determined there was a need for better education regarding the oral health of the LGBTQIA+ community – maybe ask yourself why.
Barriers to Care
Believe it or not, this is not the first year that the AIDPH has recognized LGTBQIA+ Oral Health Week. First established in 2022, the campaign’s mission is to raise awareness and improve knowledge of the oral health needs of a severely underserved population from a health care perspective.2
In 2022, the CareQuest Institute conducted a national survey to determine how the LGTBQIA+ community perceived their oral health, dental care access, and discrimination experiences. The findings are very concerning. When compared to non-LGTBQIA+ individuals, LGTBQIA+ individuals were:3
- 77% more likely to have visited the emergency department for dental care in the past year.
- 58% more likely to say getting care from a dentist would be difficult.
- 45% more likely to say they were self-conscious or embarrassed by their teeth, mouth, or dentures.
Even when LGBTQIA+ individuals received oral health care, 43% reported feeling uncomfortable going to their appointments, and another 34% reported being treated unfairly during their appointments because of sexual orientation or identity.4
These statistics further confirm and support the need for educational training related to the LGBTQIA+ community and the barriers, such as discrimination, judgment, and other disparities they face.4 The barriers to access to care include refusal of care, harassment, violence in a health care setting, and lack of provider knowledge about health care needs.5
Interventions that emphasize the need for inclusive health care environments and improvement in health care outcomes for marginalized populations generally take the form of educational toolkits and continuing education. This is exactly what the AIDPH provided and was shared with the dental hygiene community through social media posts made by the ADHA and ADS.6
Oral Health Care Needs of the LGTBQIA+ Community
The LGBTQIA+ community presents with special needs and considerations for clinical care. They are often at an increased risk for multiple oral diseases and conditions. Additionally, they often experience depression and anxiety that might complicate treatment and/or their ability to maintain proper oral hygiene.6-13
The LGBTQIA+ community faces a higher risk of drug and alcohol abuse, often associated with depression.6 Drug and alcohol use increases the risk of xerostomia, dental caries, erosion, periodontal disease, TMJ disorders, bruxism, oral cancer, and tooth loss.7
Many individuals in the LBGTQIA+ community experience extreme depression with suicidal ideations. Depression that contributes to suicidal ideations is also associated with poor oral health.8 Approximately 45% of LGBTQIA+ youth ages 13 to 24 reported suicidal ideations in the past year. That is a large percentage. Accordingly, understanding and recognizing the depression rate among LGBTQIA+ individuals is exceptionally high may be helpful in providing care and understanding to these patients.9
Anxiety rates among LGBTQIA+ youth are exceptionally high as well. Of LGBTQIA+ youth surveyed, 73% reported experiencing symptoms of anxiety. This can clearly play a role in their decision to seek or avoid dental care.9
Some of the oral health impacts associated with depression include:8
- Neglect of oral hygiene which leads to an increased risk of dental caries and periodontal disease
- Poor nutrition which contributes to an increased risk of dental caries and periodontal disease
- Drug-induced xerostomia
- Avoidance of necessary dental care
Furthermore, the LGBTQIA+ community is also disproportionately affected by HIV and HPV.10,11
An estimated 55% of gay and bisexual men are living with HIV in the United States. That means one in six gay or bisexual men will be diagnosed with HIV in their lifetime. Transgender women are also at a higher risk of acquiring HIV, with an estimated 49 times higher odds compared to the general population.10
Anti-LGBTQIA+ biases contribute to the spread of HIV by discouraging many in the LGBTQIA+ community from getting tested and treated. A critical factor in reducing the spread of HIV is accessing the proper medications to reduce the amount of HIV in the blood to undetectable levels. Many LGBTQIA+ individuals have expressed they do not feel comfortable discussing their sexual behaviors with health care providers due to these biases.10
HIV-related oral manifestations may include:12
- Oral candidiasis
- Erythematous candidiasis
- Angular cheilitis
- Periodontal disease
- Linear gingival erythema
- Necrotizing gingivitis
- Necrotizing periodontitis
- Xerostomia
- Kaposi’s sarcoma
- Recurrent aphthous ulcers
- Oral hairy leukoplakia
- Oral hyperpigmentation
- Oral herpes
- Oral warts
- Dental caries
While there is no inherent link between sexual orientation or gender identification and oral cancer, there are contributing factors that increase the risk for the LGBTQIA+ community. Compounding risk factors such as tobacco and alcohol use paired with a higher incidence of HPV infections contribute to the increased risk of oral cancer. Increased drug, alcohol, and tobacco use is associated with increased stress, stigma, and discrimination among the LGBTQIA+ community.13
To effectively manage the oral health needs of the LGBTQIA+ community, it is imperative to direct advocacy efforts to oral health care providers.12 The efforts of the ADHA, ADS, and AIDPH on social media were an example of an effort to better inform dental professionals and mitigate disparities in the LGBTQIA+ community. Unfortunately, it was not received well by many and likely utilized by even fewer.
Implicit Bias
Implicit bias was on full display in the comments section of the ADHA’s social media post, solidifying the previously discussed feelings of discomfort and unfair treatment among the LGBTQIA+ community reported in the CareQuest Institute national survey. The implicit bias seen was both glaring and embarrassing. I believe this is why the ADHA turned off the comments section. Nonetheless, let’s talk about implicit bias.
Implicit biases are “subconscious associations between two disparate attributes that can result in inequitable decisions.”14 Implicit bias is often hidden and difficult to recognize in oneself. Becoming aware of one’s own implicit bias is often the first step toward change.14,15 If you had a visceral response to the ADHA’s post regarding LGBTQIA+ Oral Health Week, you might have implicit biases you need to recognize.
Some states require implicit bias training for health care professionals. Thirteen states require it in their Medical Practice Act. However, very few states require implicit bias training for dental professionals.14,16 Accordingly, it is important that dental professionals seek continuing education courses and resources to better understand the discrimination and disparities experienced in dental settings by the LGBTQIA+ community.
In Closing
According to the Patient’s Bill of Rights, all patients have a right to be treated with dignity and respect. Published literature indicates this is not happening for many individuals in the LGBTQIA+ community as they seek health care. I implore you to be the change we need to better serve these patients.17
Fellow dental professionals, I challenge you to take the Harvard Implicit Association Test. You may be surprised that you have implicit biases that may interfere with your ability to treat your patients fairly. Be honest and reflect on the results you receive.
As you move forward in your career as a dental health care provider, continue to seek out knowledge and recognize you may need to improve your understanding of the different health care needs of specific communities.
When we know better, we can do better. It is time for us to challenge ourselves and each other to be better clinicians through evidence-based and individualized care. By acknowledging that all patients are not the “same” regarding barriers, disparities, and oral health needs, we can provide individualized care in a way that helps patients feel safe in our care.
The approach that one “treats all patients to the standard of care with kindness and respect” may not fully encompass individualized needs, which, when addressed, brings better patient outcomes. Providing individualized care for every patient requires a better understanding of the patient’s culture and specific needs. If you were resistant and dismissive of the resources provided by the AIDPH and shared by the ADHA and ADS, perhaps ask yourself these questions:
- How does a clinician know they are providing the standard of care if the oral health needs and implications of a certain population are not understood?
- How does a clinician know they are treating someone with kindness and respect if they do not understand what culturally responsive care and considerations look like for specific populations?
Again, when we know better, we can do better.
Lastly, thank you to the AIDPH for providing resources for dental hygienists to become better health care providers to a marginalized community that deserves much better from the general population, but most especially from their health care providers.
Author’s note: Thank you to Daniel Jeremy Lopez, RDH, CDHC, for consulting with me on this article and bringing attention to the need for better understanding when caring for the LGBTQIA+ community. Your input was invaluable.
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References
- Focus Areas. (n.d.). American Institute of Dental Public Health. https://aidph.org/focus-areas/
- Laying the Foundation: Addressing LGBTQIA+ Oral Health Disparities and the Need for Inclusivity in Dental Care and Education. (2024, October 16). American Institute of Dental Public Health. https://aidph.org/2024-lgbtqia-oral-health-week-foundations-inclusive-education/
- Oral Health and the LGBTQ+ Community: A Snapshot of Disparities and Discrimination. (2022, June 28). CareQuest Institute for Oral Health. https://www.carequest.org/resource-library/oral-health-and-lgbtq-community-snapshot-disparities-and-discrimination
- Tharp, G., Wohlford, M., Shukla, A. Reviewing Challenges in Access to Oral Health Services Among the LGBTQ+ Community in Indiana and Michigan: A Cross-Sectional, Exploratory Study. PLoS One. 2022; 17(2): e0264271. https://pmc.ncbi.nlm.nih.gov/articles/PMC8880834/
- National Transgender Discrimination Survey Report on Health and Health Care. (2010, October). National Center for Transgender Equality and National Gay and Lesbian Task Force. https://cancer-network.org/wp-content/uploads/2017/02/National_Transgender_Discrimination_Survey_Report_on_health_and_health_care.pdf
- LGBTQIA+ Oral Health Week. (2024). American Institute of Dental Public Health. https://aidph.org/lgbtqia-oh-week/
- Impact of Drug Use on Oral Health: Drugs That Cause Dental Problems. (2024, October 8). American Addiction Centers. https://americanaddictioncenters.org/health-complications-addiction/dental-health
- Oral Health Fact Sheet for Dental Professionals: Adults with Depression. (n.d.). University of Washington School of Dentistry. https://dental.washington.edu/wp-content/media/sp_need_pdfs/Depression-Adult.pdf
- 2022 National Survey on LGBTQ Youth Mental Health. (n.d.). The Trevor Project. https://www.thetrevorproject.org/survey-2022/
- How HIV Impacts LGBTQ+ People. (2017, February). Human Rights Campaign. https://www.hrc.org/resources/hrc-issue-brief-hiv-aids-and-the-lgbt-community
- HPV and Cancer. (n.d.). National LGBT Cancer Network. https://cancer-network.org/cancer-information/hpv-and-cancer/
- Lomelí-Martínez, S.M., González-Hernández, L.A., Ruiz-Anaya, A.J., et al. Oral Manifestations Associated With HIV/AIDS Patients. Medicina (Kaunas). 2022; 58(9): 1214. https://pmc.ncbi.nlm.nih.gov/articles/PMC9504409/
- Rengasamy, G., Veeraraghavan, V.P. Promoting Oral Cancer Awareness in LGBTQ+ Communities – Diversity in Oral Health. Oral Oncology Reports. 2024; 11: 100549. https://www.sciencedirect.com/science/article/pii/S2772906024003959
- Shah, H.S., Bohlen, J. (2023, March 4). Implicit Bias. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK589697/
- Sabin, J.A. Tackling Implicit Bias in Health Care. N Engl J Med. 2022; 387(2): 105-107. doi:10.1056/NEJMp2201180. https://www.nejm.org/doi/full/10.1056/NEJMp2201180
- Implicit Bias Training Options for AAO Members. (2023, March 21). American Association of Orthodontists. https://www2.aaoinfo.org/implicit-bias-training-options-for-aao-members/
- Patient Bill of Rights and Responsibilities. (n.d.). Bureau of Medical Services. https://www.state.gov/patient-bill-of-rights-and-responsibilities/
