Quality Oral Health for the LGBTQ+ Population

Three ways that providers can support equal access to care

Oral health is a fundamental component of overall well-being; however, disparities persist among marginalized populations, including the LGBTQ+ community. Many LGBTQ+ individuals face health disparities linked to societal stigma and discrimination that equate to a denial of their civil and human rights. Identified as a "health disparity population," this community faces reduced access to healthcare and a higher burden of certain diseases, such as depression, cancer, and HIV/AIDS. LGBTQ+ individuals also face higher rates of dental anxiety, self-reported oral health problems,¹ and unmet oral health needs. According to research from the CareQuest Institute for Oral Health, nearly three in five people who identified as LGBTQ+ reported that they had experienced one or more oral health symptoms this year, compared with just under one in five non-LGBTQ+ individuals.² LGBTQ+ individuals were also 53% more likely than non-LGBTQ+ individuals to report having high levels of anxiety about receiving dental care and often have lower levels of trust and respect for, as well as comfortability with, their oral healthcare providers.³

This oral health data is not entirely surprising considering that LGBTQ+ people also experience higher rates of chronic medical and mental health conditions, substance abuse, and inadequate access to healthcare.⁴ Because stigma, discrimination, and other social determinants of health contribute to these disparities, it is critical to address these root causes. Advancing oral health equity for the LGBTQ+ population requires a comprehensive approach that includes cultural responsiveness, trauma-informed care, and advocacy.

The first component, cultural responsiveness, is critical in advancing oral health equity for the LGBTQ+ population. Research has shown that when healthcare providers are more knowledgeable about LGBTQ+ terminology, health disparities, and cultural nuances, they are able offer more patient-centered care.⁵ For example, one study demonstrated that when transgender health content was added to a course, students reported a nearly 70% decrease in discomfort with providing care to transgender individuals.⁶ By acquiring this knowledge, dental professionals can offer patient-centered care that is respectful, inclusive, and responsive to the diverse needs of LGBTQ+ individuals. For example, after taking a CareQuest Institute continuing education classon creating an inclusive environment for LGBTQ+ patients, attendees reported having a better understanding of both the appropriate terminology to use and the fear of discrimination that contributed to dental anxiety in some LGBTQ+ patients.⁷

The second component involves practicing trauma-informed care. Many LGBTQ+ individuals have experienced various forms of trauma, such as emotional abuse and physical violence, which can lead to dental anxiety and avoidance of care. Dental healthcare providers should undergo comprehensive training, such as self-paced continuing education programs,on trauma-informed care in order to be able to best address the unique needs of LGBTQ+ patients and create a safe and supportive environment.⁸ In addition, dental professionals should be skilled in recognizing signs of trauma and providing appropriate support or referrals when needed.

The third component, advocacy, is also critical in advancing oral health equity. People with lived experience should not only be part of the conversation but also inform policy changes meant to improve their experience of oral and overall health outcomes. Allies are also essential advocates who can play important roles in getting policymakers to prioritize LGBTQ+ health issues, allocate resources, and develop comprehensive health programs that address the unique needs of the LGBTQ+ population. The Oral Health Progress and Equity Network (OPEN) has organized a learning collaborative to bring together oral health and health advocates, identify opportunities to support LGBTQ+ health equity, and take collective action.

By integrating cultural responsiveness, trauma-informed care, and advocacy into their work as healthcare providers, dental professionals can contribute to a future where all individuals, have equal access to quality oral healthcare, regardless of their sexual orientation or gender identity.

About the Author

Kaz Rafia, DDS, MBA, MPH, is the chief health equity officer at the CareQuest Institute for Oral Health.

References

1. Schwartz SB, Sanders AE, Lee JY, Divaris K. Sexual orientation-related oral health disparities in the United States. J Public Health Dent. 2019;79(1):18-24.

2. Oral health and the LGBTQ+ community: a snapshot of disparities and discrimination. CareQuest Insitute for Oral Health website. https://www.carequest.org/resource-library/oral-health-and-lgbtq-community-snapshot-disparities-and-discrimination. Published June 2022. Accessed October 17, 2023.

3. Oral Health in America: Advances and Challenges. Bethesda, MD: US Dept of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021.

4. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, et al. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health. 2013. 103(10):1802-1809.

5. Eckstrand K, Ehrenfeld JM, eds. Lesbian, Gay, Bisexual, and Transgender Healthcare. Springer; 2016.

6. Safer JD, Pearce EN. A simple curriculum content change increased medical student comfort with transgender medicine. Endocr Pract.2013;19(4):633-637.

7. Becoming an ally: creating an inclusive environment for LGBTQ+ patients. CareQuest Institute for Oral Health website. https://www.carequest.org/education/webinars/becoming-ally-creating-inclusive-environment-lgbtq-patients. Presented June 30, 2022. Accessed October 17, 2023.

8. Understanding and providing trauma-informed oral health care. CareQuest Institute for Oral Health website. https://www.carequest.org/education/course/understanding-and-providing-trauma-informed-oral-health-care/overview. Published April 13, 2023. Accessed October 17, 2023.