The National Institute on Minority Health and Health Disparities identifies the LGBTQ+ community as a “health disparity population” due to lowered access to health care. Clinical research is showing that sexual and gender minorities who live in communities with high levels of prejudice die sooner than those living in more accepting communities. And, according to a recent Gallup Poll, 5.6% of U.S. adults identify as LGBTQ+ — up from 4.5% in Gallup's previous update based on 2017 data. Gallup also notes that younger generations are far more likely to consider themselves to be something other than heterosexual, with one in six adult members of Generation Z (aged 18 to 23 in 2020) saying this.

Given these facts, it is important that the oral health community not only understands these disparities, but acquires the skills necessary to provide fair and equal care to all — including the LGBTQ+ community.

As we celebrate Pride this month, DentaQuest talked with two providers with unique expertise in this area to learn about how the oral health community can catch up to LGBTQ+ equality.

Dr. Luis Sanchez is one provider who has a lot of experience with this. As Regional Dental Director at Community Dental Care in East Dallas, Texas, he works with the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program, which provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people with HIV.

The experience of being a gay dentist and working with many patients who have faced discrimination inspired Dr. Alex Barrera a general dentist at Avenue 360 Health & Wellness in Houston, and colleagues to create the Houston Equality Dental Network (HEDN), an organized dentistry group specifically for LGBTQ+ dental professionals and patients. The organization reflects a very real need in our communities.

Here’s what they had to say.

In what ways do LGBTQ+ people face inequality in oral health care? What keeps patients away from dental appointments?

Dr. Barrera: Unfortunately, much of this comes down to LGBTQ+ patients avoiding medical treatment due to past discrimination and fear of stigma. When LGBTQ+ people belong to other marginalized groups, such as being a person of color or having a disability, it becomes even more difficult to find accessible, nonbiased care.

Dr. Sanchez: In my experience, besides accessibility and finances, LGBTQ+ patients stay away from dental appointments due to the general fear of the dentist in combination with the fear of mistreatment and discrimination LGBTQ+ folks experience. Another challenge is a lack of conversation to educate oral health care professionals to be mindful and consider gender identity whenever performing procedures that affect, change or reconstruct aesthetics directly related to their identity.

Are LGBTQ+ people at greater risk for oral health issues? How does this connect with other areas of health?

Dr. Barrera: LGBTQ+ individuals, specifically those of lower socioeconomic status, have higher incidences of alcohol, tobacco, and drug use and are much more likely to experience mental health issues such as depression, anxiety, body dysmorphia and eating disorders — all of this leading to higher incidences of oral health problems.

Dr. Sanchez: Our patients living with HIV have a more challenging time dealing with oral health problems. Since their immune system is debilitated, it makes it harder to fight off infection. Every day, we find more and more evidence of the oral health and well-being connection. For example, the management of heart conditions, diabetes, premature and low birth weight, and even the effectiveness of retroviral drugs, to name a few, are linked to good oral health.

The last year was tough for so many. What impact did COVID-19 have on your network and your patients?

Dr. Barrera: Throughout history, the LGBTQ+ community has always been disproportionately affected during changes in public policies, structures, and in times of crisis because of our specific needs; the COVID-19 pandemic is proving to be no different.

As a community, LGBTQ+ people are at higher risk of acquiring COVID-19 and the potential to have more severe symptoms as the illness progresses. Research shows that LGBTQ+ individuals use tobacco at rates that are 50% higher than the general population. Higher rates of HIV and oral cancer among LGBTQ+ people mean that a greater number of us are immunocompromised, leaving us more vulnerable to the virus.

Dr. Sanchez: Certainly, fear of infection impacted access to services for many of our patients, who are already dealing with so much.

How can dentists be allies for one another, their patients and the community?

Dr. Barrera: As health care and dentistry continue to make progress, the only way we can have true equality is through the allyship of our heterosexual colleagues and those in leadership positions. I encourage all dental professionals to take the time to question their own subconscious biases and to also include LGBTQ+ topics when seeking out continuing education and training for themselves and their staff members. It is only with continued awareness, education, and celebration, can we come together to ensure that the world is a safer and happier place for all.

Dr. Sanchez: There has absolutely been a lack of conversation and education among oral health care professionals about how to be mindful and consider gender identity, for example whenever performing procedures that affect, change or reconstruct aesthetics directly related to their identity.

But the bottom line is LGBTQ+ patients and patients with HIV deserve the same respect, compassion and empathy as everyone else.

Recently, a patient that came in for a complete oral exam that kept referring to herself as "Being HIV." At one point in our conversation, I stopped her and reminded her that she was not "HIV" that she was "Living with HIV.” She teared up and thanked me for treating her like a human being.

Most of us in the health community swore an oath to do no harm; add our mission statement to “Improve the oral health of all”; we must not forget that the LGBTQ+ community is part of that "All."

Learn More:

• Read Dr. Barrera’s List of Five Things Dentists Can do to help LGBTQ People Feel Open to Care.
• Understand how to use inclusive language with LGBTQ+ Glossary (Courtesy of It Gets Better)
• LGBT/GAP offers an introductory mini-course in LGBT health and mental health for trainees and practitioners in any field. (Hosted by the Association of Gay and Lesbian Psychiatrists.)
• Progress toward Healthy People 2020 Objectives (graphic from HealthyPeople.gov)
• Follow Houston Dental Equity Network on Instagram to learn about webinar and CE opportunities.