We’re lucky to live at a time where we have a broader range of patients entering the dental chair every day. More people are openly expressing themselves as members of the LGBTQ+ community, which can help clinicians identify potentially unique treatment needs.
With greater awareness of the risks presented to these patients, dentists can devise more effective treatment plans for each individual.
Outside factors
Blanket assumptions cannot be made for every LGBTQ+ patient, and they will have completely different oral health statuses dependent on their daily lives.
Being LGBTQ+ does not predispose you to oral health issues, but coping with stresses in daily life – such as homophobia, transphobia, social stigmas, or social isolation and rejection[i] – may contribute to stress and oral health-related concerns. For example, lesbian, gay and bisexual adults smoke tobacco and drink alcohol at higher rates than their heterosexual peers,[ii] have a higher risk of poor mental health, and have an increased risk of oral disease due to harmful eating behaviours.[iii] Each of these have been established as factors for oral health issues.
Another significant threat displayed in a variety of reports in recent years is that LGBTQ+ people are consistently more likely to use drugs than their heterosexual counterparts. The Crime Survey for England and Wales from 2022 observed around 31% of bisexual people and 30% of gay and lesbian individuals had taken an illicit drug in the previous year. This drops to 8% of heterosexual people, which is nearly four times lower.[iv]
Cannabis was highlighted as being used by around 23% and 28% of gay/lesbian and bisexual individuals respectively.iv With frequent use, patients can expect to experience dry mouth (xerostomia) and periodontal disease.[v] In fact, studies have shown an increased prevalence of gingival disease when a patient smokes cannabis, regardless of tobacco use.[vi] In turn, patients need to maintain an effective oral hygiene routine that can minimise its effects or repair the damage caused.
Talking with a patient about their substance use is often difficult; approaching the topic tactfully is essential and must not be interpreted as accusatory or judgemental. It may only be viable to ask relevant questions after trust has been established between clinician and patient, but the answers could support a better suited solution for each patient.
Holistic approaches
Also within the LGBTQ+ community, transgender patients may present some unique oral health needs as a result of ongoing transitional treatments.
Transgender patients may undergo hormone replacement therapy (HRT) to feel better aligned with their preferred gender identity. Waiting times for referral and treatment are currently very long,[vii] but it is key that dental professionals provide exceptional oral healthcare whilst it is being undertaken.
Hormones change immunological responses which can potentially put patients at an increased risk of infection.[viii] A female-to-male transgender patient may be taking on HRT that increases the production of testosterone, whilst inhibiting oestrogen. An increased immune function has been linked with oestrogen deficiency, meaning patients undergoing this therapy may experience more intense gingival inflammation during periodontitis flare ups.[ix]
On the other hand, male-to-female transgender patients may be having HRT that increases oestrogen, and subdues testosterone production. An excess of oestrogen could also result in inflammation, making the development of periodontitis more likely.viii Not all transgender patients will be undergoing HRT, and they may not feel entirely comfortable disclosing whether they are or not. However, awareness around the topic is helpful when approaching treatment plans, as well as providing excellent care in regular check-ups.
An effective relationship
If these factors are just the tip of the iceberg, what can clinicians do to help? The most important step may be in communication.
Engaging with each patient through an individual approach, expressing a non-judgemental manner and placing pro-LGBTQ+ leaflets or signs around a practice could help patients feel more comfortable and motivate regular dental visits. An effective patient-dentist relationship may also encourage LGBTQ+ patients to open up about personal details such as substance use or HRT experiences.
In each appointment, it is essential to reiterate the need for excellent oral hygiene routines, as improved plaque control can reduce gingival inflammation.[x] As such, patients should brush consistently twice a day with a soft bristled brush and fluoridated toothpaste. Interproximal cleaning is also key, as regular toothbrushing is generally unable to clean these sites effectively.x
A brilliant oral hygiene routine relies upon consistency and the tools used every day. Clinicians could recommend their patients use the Waterpik® Cordless Advanced Water Flosser. A compact solution that eliminates plaque in interdental spaces, the Waterpik® Cordless Advanced is up to 50% more effective than traditional floss[xi] for improving gingival health. By massaging and stimulating the gums, they are kept strong and healthy with improved circulation.
Diving into the unique challenges that face LGBTQ+ patients is essential for every clinician. By understanding the adaptions needed to everyday care, and creating a welcoming and encouraging environment, dental professionals can ensure this community is optimally treated for the coming years.
For more information on Waterpik® Water Flosser products visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.
Join the 3,000+ dental teams who have already benefitted from a professional Waterpik® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/.
Susan Bio:
Susan joined Waterpik as a Professional Educator over 4 years ago. She is passionate about the work she carries out for the company delivering Lunch & Learn educational sessions to dental professionals.
Susan graduated from Eastman Dental Institute School of Dental Hygiene in 1988 and now has over 30 years clinical experience working in Harley Street, specialist and orthodontic practices. Susan has a particular interest in treating periodontal patients and regularly encourages her patients to use the Waterpik water flosser to help maintain their periodontal health.
Susan lives in Buckinghamshire with her husband and 9 year old son. She is a fitness fanatic and keen runner, having completed many marathons and half marathons.
[i] Mind, (2020). LGBTQIA+ mental health. (Online) Available at: https://www.mind.org.uk/information-support/tips-for-everyday-living/lgbtqia-mental-health/about-lgbtqia-mental-health/ [Accessed November 2023]
[ii] Schuler, M. S., & Collins, R. L. (2019). Early alcohol and smoking initiation: a contributor to sexual minority disparities in adult use. American journal of preventive medicine, 57(6), 808-817.
[iii] Tharp, G., Wohlford, M., & Shukla, A. (2022). Reviewing challenges in access to oral health services among the LGBTQ+ community in Indiana and Michigan: A cross-sectional, exploratory study. Plos one, 17(2), e0264271.
[iv] Office for National Statistics, (2022). Drug misuse in England and Wales: year ending June 2022. (Online) Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingjune2022[Accessed November 2023]
[v] Keboa, M. T., Enriquez, N., Martel, M., Nicolau, B., & Macdonald, M. E. (2020). Oral health implications of cannabis smoking: A rapid evidence review. J Can Dent Assoc, 86(k2), 1488-2159.
[vi] Chisini, L. A., Cademartori, M. G., Francia, A., Mederos, M., Grazioli, G., Conde, M. C., & Correa, M. B. (2019). Is the use of Cannabis associated with periodontitis? A systematic review and meta‐analysis. Journal of Periodontal Research, 54(4), 311-317.
[vii] NHS, (2020). Treatment, Gender Dysphoria. (Online) Available at: https://www.nhs.uk/conditions/gender-dysphoria/treatment/[Accessed November 2023]
[viii] Cantwell, E., McClure, D., (2021). The potential effects of hormonal therapy and stress on the oral health of the transitioning population. RDH Magazine. (Online) Available at: https://www.rdhmag.com/patient-care/article/14199655/the-potential-effects-of-hormonal-therapy-and-stress-on-the-oral-health-of-the-transitioning-population [Accessed November 2023]
[ix] Jafri, Z., Bhardwaj, A., Sawai, M., & Sultan, N. (2015). Influence of female sex hormones on periodontium: A case series. Journal of natural science, biology, and medicine, 6(Suppl 1), S146.
[x] Harrison, P., (2017). Plaque control and oral hygiene methods. Irish Dental Association. (Online) Availabale at: https://www.lenus.ie/handle/10147/622539 [Accessed November 2023]
[xi] Rosema NAM et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011; 13(1):2-10.
