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June 22, 2023
When patients fill out a form at a dentist’s or doctor’s office, do they see themselves represented? For individuals who are lesbian, gay, bisexual, transgender, queer, or have other sexual orientations or gender identities (LGBTQ+), the answer can sometimes be a hard “no.”
And it’s an example of a larger problem in oral health: Structural bias and stigma around gender, gender expression, and sexual orientation can deepen LGBTQ+ oral health inequity.
New research from CareQuest Institute, drawn from the newest State of Oral Health Equity in American survey data, affirms the persistence of LGBTQ+ disparities in oral health.
What does that mean for anyone working in a dental setting? No matter your role — dentist, hygienist, assistant, manager, technician, therapist — you can reduce disparities by showing up as an ally, offering meaningful support to shift policy and culture.
A Snapshot of LGBTQ+ Oral Health
Annually for the last three years, CareQuest Institute has conducted the State of Oral Health Equity in America survey to identify current gaps in oral health and inform solutions. Surveying more than 5,000 adults in the United States, it is the largest nationally representative survey focused exclusively on adults’ knowledge, attitudes, experiences, and behaviors related to oral health.
Findings, which will be released in reports in the coming weeks, illustrate that the LGBTQ+ community continues to experience greater levels of dental disease. For example:
- Nearly 3 in 5 LGBTQ+ people say they had one or more oral health symptoms this year, compared to just under 1 in 5 non-LGBTQ+ individuals.
- More than 1 in 3 LGBTQ+ adults say they have fair or poor oral health, compared to about 1 in 4 of their non-LGBTQ+ peers.
Dental pain can interfere with employment and academic success. Untreated symptoms can eventually turn into a crisis, when services often cost more. Over the long term, financial hardship can be greater if you lack dental coverage. Data show, too, that these consequences fall harder on those who identify as LGBTQ+:
- LGBTQ+ adults are nearly twice as likely to say they lost dental insurance in the past year, compared to their non-LGBTQ+ peers.
- At 12.2%, more LGBTQ+ individuals say they missed school or work due to an unexpected dental appointment than 7.4% of non-LGBTQ+ people.
Anti-LGBTQ+ Bias Can Push Care Out of Reach
Individuals who identify as LGBTQ+ have long faced discrimination in health care and other sectors. Studies show experiencing bigotry acts as a roadblock to care, leading LGBTQ+ people to delay needed services in the future.
Data from the State of Oral Health Equity survey underscore that reality. In short, the data reveal LGBTQ+ gaps in access to dental care. More specifically:
- Almost 3 in 10 LGBTQ+ patients say they don’t have a regular source of dental care, compared to just under 2 in 10 of non-LGBTQ+ people.
- More than 2 in 5 LGBTQ+ people say their last dental appointment was more than a year ago. Less than 1 in 3 of their non-LGBTQ+ peers say the same.
- People who are LGBTQ+ are nearly twice as likely as non-LGBTQ people to say they don’t plan to see a dental provider in the next year for a checkup or preventive care.
Unique Systems of Oppression Hurt LGBTQ+ People
In a 2022 CareQuest Institute webinar, Alex Barrera, DDS, addressed some of the social structures that uphold anti-LGBTQ+ bias. Barrera is president of Houston Equality Dental Network and a community health dentist at Legacy Community Health.
“The major reason that discrimination against the queer community exists is because of heteronormativity,” explains Barrera (using “queer” as an accepted term encompassing all LGBTQ+ people). “It’s the assumption that everyone is heterosexual and that heterosexuality is superior to all other sexualities.”
It functions as a system of oppression against LGBTQ+ people, he said.
“What it’s all about is control,” says Barrera. “It’s very easy to control people when there are only two boxes they can fill.”
Five Ways to Be an Ally to LGBTQ+ Patients
Toward the end of his presentation, Barrera offered five strategies for oral health providers to make dental care experiences more inclusive for LGBTQ+ patients.
- Recognize your privilege and use it for good.
If you are not LGBTQ+, reflect on how you may benefit from heteronormativity. Are there assumptions people make about you that you don’t have to correct? Consider how this belief system appears in your practice. Interrupt discrimination when you see it and encourage colleagues to do the same.
- Learn and use inclusive language.
There are a range of terms LGBTQ+ people use to describe aspects of their identity. Some have evolved over time. For example, many people today prefer “gay” over “homosexual.” Talk with LGBTQ+ patients and respect the language they use. - Create a safe space for patients.
Providers can affirm LGBTQ+ people with policy and cultural shifts. Enact nondiscrimination policies protecting LGBTQ+ patients and colleagues. Celebrate Pride Month. Advertise your practice on queer websites. Share your pronouns with patients and ask for theirs. Consider making them visible, such as on name tags.
- Update intake forms and electronic dental records.
Create space on forms and records for patients to share their pronouns and gender identity, including options not to list a gender. Ask patients about their correct name — and use it. This is especially important to support transgender patients, who may not use their legal name.
- Don’t minimize anyone’s queerness.
Allow patients to talk about who they are. Be open to hearing about their friends, family, and identities, which may look different from yours.
These actions can start creating safer environments for LGBTQ+ people, lowering barriers to care, and advancing oral health equity.