Barriers to oral health care for transgender and gender nonbinary populations

Abstract

BackgroundDespite health disparities and barriers to medical care being well documented in the literature, transgender and gender nonbinary (TGNB) people’s experiences and expectations with regard to oral health care remain understudied. The authors examined gender identity–related factors influencing experiences in the dental setting, aspects of subjective oral health, and avoidance of oral health care. MethodsOne-hundred eighteen TGNB people aged 13 through 70 years completed a 32-item questionnaire designed for this study. Data analysis relied on descriptive methods and bivariate comparisons using a conventional P < .05 statistical significance criterion. Qualitative description analysis was used to identify emerging themes from responses to an open-ended question. ResultsOne-third of participants reported misgendering (that is, had been addressed by their incorrect name and pronouns in the dental setting). Although refusal of oral health care was rare in this sample of TGNB participants, more than one-half felt that their usual source of oral health care was not equipped to provide gender-appropriate care. Participants’ avoidance due to gender identity was significantly associated with measures of self-reported suboptimal oral health. Common themes related to participants’ oral health care experiences included gender insensitivity, awkward interactions, avoidance of care, and lack of gender-affirming providers. ConclusionsDiscrepancies between TGNB patients’ expectations and actual experiences suggest that their needs are often unmet in the dental setting, possibly contributing to gender identity–associated dental avoidance and oral health disparities. Practical ImplicationsAlthough these results need to be verified in larger and more diverse samples, they provide actionable information for improvement to this population’s oral health and management.