Dental fear among transgender individuals - a cross-sectional survey

Unmet Needs for Ancillary Services and Associations with Clinical Outcomes Among Transgender Women with Diagnosed HIV: Medical Monitoring Project, United States, 2015-2020

Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV.

Supporting transgender patients with their personal hygiene

Attending to one's personal hygiene is a private and ritualistic act that is linked to self-expression and is important for one's well-being and self-esteem. Providing effective support with personal hygiene to patients can demonstrate thoughtfulness and sensitivity to their individual needs. Nurses in all fields of nursing may encounter patients who identify as transgender, but many nurses have expressed concerns about their lack of knowledge and confidence in that area of care. This article discusses the use of gender-affirming language and the factors to consider when supporting transgender patients with their personal hygiene as part of personalised, equitable and inclusive nursing care.

Prevalence of dental caries and periodontal disease among transgenders in Belagavi district, Karnataka, India: A cross-sectional study

AIM

To assess the oral health practices and the prevalence of dental caries, and periodontal disease among transgenders.

METHODS AND RESULTS

The study was conducted on a sample of 180 participants from the transgender community in Belagavi district over a course of two months. A trained and calibrated examiners recorded oral health status according to WHO dentition status and treatment needs (1997) and Community Periodontal Index (CPI) under the supervision of the subject expert. Chi-square test, spearman's rank correlation coefficient test, multiple linear regression and logistic regression were applied. The statistical significance was set at p ≤ .05 for all the tests. The prevalence of dental caries and periodontal disease among transgenders was 72.2% and 92.2%, respectively. A positive linear correlation and a significant relationship was found between the oral hygiene practices/deleterious habits and dental caries among the transgenders. Multiple linear regression model revealed that the prevalence of dental caries and periodontal disease was significantly associated with age and oral hygiene practices.

CONCLUSION

The prevalence of dental caries and periodontal diseases among transgenders was high. These results may be of use to promote oral health promotion and establishing a paradigm for dentists to work toward improving oral health.

Barriers to oral health care for transgender and gender nonbinary populations

BACKGROUND

Despite 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.

METHODS

One-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.

RESULTS

One-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.

CONCLUSIONS

Discrepancies 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 IMPLICATIONS

Although 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.

Association between self-reported dental fear and exposure to violence among adolescents-A population-based study

BACKGROUND

The etiology of dental fear (DF) is multifactorial and involves other contributing factors than dental traumatic experiences.

AIM

To study, among adolescents, associations between DF and exposure to child physical abuse (CPA), intimate partner violence (IPV), and bullying.

DESIGN

We extracted data from a population-based survey of 4977 adolescents who were 15-17 years old in 2017. The questionnaire queried socioeconomic background factors, DF, self-perceived oral health, general health, and exposure to child abuse. To estimate associations between DF and exposure to child abuse, we used multivariate logistic regression analysis.

RESULTS

Overall, 8.2% reported DF, girls (10.5%) reported DF significantly more often than boys (5%), and adolescents not identifying themselves as girl or boy reported the highest prevalence of DF (25.5%; p < .001). 15.3% had been exposed to child physical abuse; 11.1%, to IPV; and 11.2%, to bullying. Experiences of IPV and bullying, but not physical abuse, were statistically significantly associated with DF. The odds of developing DF for adolescents exposed to any type of violence was 1.9 times the odds for adolescents with no exposure to child abuse.

CONCLUSION

Exposure to violence is associated with dental fear in adolescents.

"Trans-forming" dental practice norms: Exploring transgender identity and oral health implications

OBJECTIVE

This narrative review explores current research to broaden understanding and awareness of the transgender experience while identifying oral health needs and proposing strategies of inclusivity to optimize oral health outcomes.

METHODS

A comprehensive electronic literature search was conducted in the following online databases: PubMed, Google Scholar, CINAHL, and Education Source. The search yielded 35 articles with a wide range of study designs and methodologies.

RESULTS & DISCUSSION

Several themes emerged from the literature, including psychosocial oral health implications, barriers to oral health care, inclusive dental practice strategies, and cultural competence of oral health providers.

CONCLUSION

The transgender population experiences many social and health disparities that stem from discrimination. Systemic inequalities, coupled with other barriers to care, have significant oral health implications for this population. Implementing inclusivity strategies and gaining awareness of the transgender experience will contribute to better oral health outcomes in this community.

LGBTQ+ and dental education: Analyzing the present and recommendations for the future

LGBTQ+ populations constitute increasing proportions of children, adolescents, and adults in the United States. Compared to their heterosexual counterparts, this group suffers from health inequities, including oral health. The report "Oral Health: Advances and Challenges" identified the LGBTQ+ community as an underserved population which faces significant barriers in accessing oral health care. Coverage of LGBTQ+ topics in formal education settings in both dental schools and dental hygiene programs is scarce, which contributes to inequities within this group. Increasing curriculum content related to LGBTQ+ populations is of utmost importance to promote optimal patient-provider interactions while improving oral health outcomes. Ensuring equity in oral health care provision will require deliberate, consistent efforts on the part of all stakeholders. Dental and allied dental education programs have made important strides in enhancing equity and inclusion in their institutions by engaging campus groups that support LGBTQ+ populations, creating mentorship programs, and collaborating with non-profit advocacy groups. Such efforts have successfully empowered LGBTQ+ patients, providers, and allies who are committed to further closing the knowledge gap. Most of the research regarding LGBTQ+ inclusion efforts have been done in the medical arena and there is a void in the data available from the dental profession. To fill this void, recommendations are offered that institutions can easily implement to expand LGBTQ+ diversity and inclusion visibility.

Differentiating Gender and Sex in Dental Research: A Narrative Review

While in humans the term “sex” refers to the biological attributes that distinguish subjects as male, female, and intersex, the term “gender” refers to psychological, social, and cultural factors that strongly influence attitudes, behaviors, and relationships of individuals. Recently, it has been emphasized how the integration of these two terms in the design of the research can improve the methodology of the research itself. However, in dental research, the influence of gender has not gained enough consideration and it is often used indiscriminately as a synonym for sex. This narrative review discusses the usefulness of considering gender and sex in dental research, whose guidelines have been provided so far on this topic, and whether the top 20 dental scientific journals promote the analysis of sex and gender in their guidelines. Sex and gender analysis in dental research could be important both for analyzing biological differences such as those in the immune or neuro-immune system, cardiovascular physiology, developmental anomalies or deformities, and psychosocial differences such as lifestyle, pain experience and prevalence of chronic pain, eating behavior, and access to healthcare services. As for the specific policies for sex and gender analysis and reporting, only five out of 20 biomedical journals have included them in their editorial policy, which refers mainly to the correct use of the terms “sex” and “gender.” In conclusion, we found that no specific and differentiated sex and gender analysis and reporting are required in dental journals. Their integration, which is still not routinely applied, may be improved in the future by updating editorial guidelines and developing more specific methodological recommendations.

Self‐reported factors for improving patient's dental care: A pilot study

Objectives

Patient‐centered approach can offer valuable information in improving dental care, but literature is scarce. This study aimed to evaluate self‐reported factors beneficial for attendance in dental care.

Material and Methods

Survey data were collected during the summer of 2020 comprising both structured questionnaires and an open question on factors considered beneficial for dental attendance. Voluntary patients over 15 years of age (n = 196, 98%) agreed to fill the questionnaires, and n = 112 of them (57%) also gave open commentary in an urgent dental care clinic, City of Oulu, Finland, comprising the study population. Dental fear was assessed by Modified Dental Anxiety Scale (MDAS) sum scores (min 5, max 25). All utterances (n = 181) on an open question were evaluated by inductive content analysis to create sub‐ and main categories. Covid‐19 pandemic case counts in Finland were low at the time of the survey, but their effect on seeking dental care was asked. The distribution of patients was evaluated by cross‐tabulation, considering their age, gender, and dental fear status; the significance level was p < .05.

Results

Females dominated slightly the study population (57%). The mean age of the respondents was 44 years. Half (50%) had moderate (MDAS score 10−18), and 10% had severe dental fear (≥19). The open responses could be categorized into four main categories. The largest main category by patient count concerned factors related to personnel (29%), followed by the patient (28%) and treatment (25%) related, and administrative factors (19%). Males chose factors falling into categories of administration and treatment while females chose patient and personnel‐related factors (p = .048). Compared to the rest, fearful persons (MDAS > 9) reported more often factors related to personnel and treatment (p = .03). Of all participants, 17% reported seeking less dental care during the pandemic.

Conclusions

Patients value dental personnel and treatment‐related factors, specifically those with fear.

Reviewing challenges in access to oral health services among the LGBTQ+ community in Indiana and Michigan: A cross-sectional, exploratory study

Objective

In healthcare settings, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations often experience discrimination, leading to decreased healthcare services utilization. In this study we have tried to identify oral healthcare providers (OHP)’s perceptions toward LGBTQ+ patients, perceived barriers for LGBTQ+ patients in accessing oral health services, and whether they were open to inclusive oral healthcare practices. In addition, the experiences of LGBTQ+ patients in oral healthcare settings including their oral healthcare seeking behaviors and beliefs were also explored.

Methods

Descriptive, quantitative surveys were administered to OHPs and LGBTQ+ patients within Indiana and Michigan. Surveys contained questions about participant demographics, including gender and sexual minority status, and the presence of inclusive healthcare practices within the oral healthcare settings. Descriptive analyses and regression modeling were used to explore the distribution of participant responses and to identify predictors associated with patient comfort and OHP’s attitudes toward LGBTQ+ patients.

Results

Overall, 71% of LGBTQ+ patients reported regularly attending dental appointments; however, 43% reported feeling uncomfortable going to appointments and 34% reported being treated unfairly during appointments because of sexual orientation. Among OHPs, 84% reported that the healthcare settings where they practiced were welcoming for LGBTQ+ populations and 84% reported willingness to improve LGBTQ+ care. The presence of inclusive healthcare practices predicted comfort for LGBTQ+ patients (P < 0.10). Additionally, OHPs who either identified as an ally or as having a family member or close friend in the LGBTQ+ community had higher odds of feeling responsible to treat LGBTQ+ patients.

Conclusion

Many LGBTQ+ patients often experience discomfort in oral healthcare settings. While OHPs were largely unaware of this, evidence suggests the need for cultural competency training for OHPs.

Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States

Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the odds of unmet healthcare needs among transgender people with disabilities compared to cisgender people with disabilities. The rates of disability type were similar between transgender and cisgender participants with two significant differences. Fewer transgender participants identified physical or mobility disability as their main disability compared to cisgender participants (12.31%/8 vs. 27.68/581, p < 0.01), and more transgender participants selected developmental disability as their main disability compared to cisgender participants (13.85%/9 vs. 3.67%/77, p < 0.001). After adjusting for sociodemographic characteristics, the odds of disabled transgender participants reporting an unmet need were higher for every unmet need except for preventative services.

Understanding and Caring for LGBTQ+ Youth by the Oral Health Care Provider

With growing visibility, there is an increasing prevalence of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth who feel empowered to own their true identity. Members of the oral health team frequently do not receive sufficient education in their training to recognize the nuance that treating this population may require. Although the tooth-level treatment does not materially change, a deeper appreciation of development of sexuality and gender identity, transgender medicine, and the health disparities LGBTQ+ youth face can promote more meaningful, trusting clinical relationships with this vulnerable population. This article aims to provide members of the oral health team with the requisite knowledge to deliver culturally competent care to LGBTQ+ youth.

Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9

Anxiety and fear are determinants of acute and chronic pain. Effectively measuring fear associated with pain is critical for identifying individuals’ vulnerable to pain. This study aimed to assess fear of pain among students and evaluate factors associated with pain-related fear. We used the Fear of Pain Questionnaire-9 to measure this fear. We searched for factors associated with fear of pain: gender, size of the city where the subjects lived, subject of academic study, year of study, the greatest extent of experienced pain, frequency of painkiller use, presence of chronic or mental illness, and past hospitalization. We enrolled 717 participants. Median fear of minor pain was 5 (4–7) fear of medical pain 7 (5–9), fear of severe pain 10 (8–12), and overall fear of pain 22 (19–26). Fear of pain was associated with gender, frequency of painkiller use, and previously experienced pain intensity. We found a correlation between the greatest pain the participant can remember and fear of minor pain (r = 0.112), fear of medical pain (r = 0.116), and overall fear of pain (r = 0.133). Participants studying medicine had the lowest fear of minor pain while stomatology students had the lowest fear of medical pain. As students advanced in their studies, their fear of medical pain lowered. Addressing fear of pain according to sex of the patient, frequency of painkiller use, and greatest extent of experienced pain could ameliorate medical training and improve the quality of pain management in patients.

Gender incongruence/dysphoria in children and adolescents: overview and implications for dentistry

Introduction Over the past 10 to 15 years, there has been growing recognition that the traditional spectrum of gender-defined dichotomised roles does not necessarily, or accurately, fit within a certain subsection of the population. A condition associated with gender incongruity that dental practitioners must be aware of is gender dysphoria.Aims Our role as dental and oral healthcare professionals necessitates us to provide safe and effective dental healthcare to all members of the population; as such, it is essential for dental healthcare professionals to undertake appropriate professional development to increase their knowledge of gender dysphoria.Overview of gender dysphoria While gender incongruity is not considered a disorder on its own merit, when it is associated with significant distress or disability, the term 'gender dysphoria' is applied. The aetiological factors that underpin gender dysphoria are still yet to be fully understood; however, it is generally accepted that it arises from a combination of biological and psychosocial factors. In the UK, all paediatric and adolescent gender incongruence referrals are managed by specialist clinicians working within multidisciplinary clinics.Implications for dentistry Our focus in this paper is to highlight and aid the dental team in the management of patients with gender dysphoria alongside providing clinical tips in the clinical management of these patients by dental clinicians.Conclusion It is important that dental healthcare professionals familiarise themselves with the aetiology, diagnosis and treatment pathway of this important subset of the population.

Considerations in the management of trans patients

It is essential to raise awareness of the health and social needs of trans individuals. This article presents the barriers that trans people may encounter when accessing healthcare services and offers practical recommendations on how holistic care may be achieved.

Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research

RATIONALE

A growing body of transgender (trans) health research has explored the relationship between stigma and health; yet, studies have conceptualized and operationalized anti-trans stigma in multiple ways.

OBJECTIVE

This scoping review aims to critically analyze quantitative measures of anti-trans stigma in the U.S. using a socioecological framework.

METHOD

We organized and appraised measures from 126 included articles according to socioecological level: structural, interpersonal, or individual.

RESULTS

Of the identified articles, 36 measured anti-trans stigma at the structural level (i.e., institutional structures and policies), 102 measured anti-trans at the interpersonal level (i.e., community interactions), and 44 measured anti-trans stigma at the individual level (i.e., internalized or anticipated stigma). Definitions of anti-trans stigma varied substantially across articles. Most measures were adapted from measures developed for other populations (i.e., sexual minorities) and were not previously validated for trans samples.

CONCLUSIONS

Studies analyzing anti-trans stigma should concretely define anti-trans stigma. There is a need to develop measures of anti-trans stigma at all socioecological levels informed by the lived experiences of trans people.

Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy

This study seeks to evaluate the long-term effects of pharmacologic therapy on the bone markers and bone mineral density of transgender patients and to provide a basis for understanding its potential implications on therapies involving implant procedures. Following the referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and well-defined PICOT (Problem/Patient/Population, Intervention, Comparison, Outcome, Time) questionnaires, a literature search was completed for articles in English language, with more than a 3 year follow-up reporting the long-term effects of the cross-sex pharmacotherapy on the bones of adult transgender patients. Transgender demographics, time under treatment, and treatment received were recorded. In addition, bone marker levels (calcium, phosphate, alkaline phosphatase, and osteocalcin), bone mineral density (BMD), and bone turnover markers (Serum Procollagen type I N-Terminal pro-peptide (PINP), and Serum Collagen type I crosslinked C-telopeptide (CTX)) before and after the treatment were also recorded. The considerable variability between studies did not allow a meta-analysis. All the studies were completed in European countries. Transwomen (921 men to female) were more frequent than transmen (719 female to male). Transwomen's treatments were based in antiandrogens, estrogens, new drugs, and sex reassignment surgery, meanwhile transmen's surgeries were based in the administration of several forms of testosterone and sex reassignment. Calcium, phosphate, alkaline phosphatase, and osteocalcin levels remained stable. PINP increased in transwomen and transmen meanwhile, CTX showed contradictory values in transwomen and transmen. Finally, reduced BMD was observed in transwomen patients receiving long-term cross-sex pharmacotherapy. Considering the limitations of this systematic review, it was concluded that long-term cross-sex pharmacotherapy for transwomen and transmen transgender patients does not alter the calcium, phosphate, alkaline phosphatase, and osteocalcin levels, and will slightly increase the bone formation in both transwomen and transmen patients. Furthermore, long-term pharmacotherapy reduces the BMD in transwomen patients.

My preferred pronoun is she: Understanding transgender identity and oral health care needs

Objective

This literature review summarizes current research and evidence regarding transgender persons and oral health.

Methods

A search of the literature was conducted in the following databases: PubMed, Google Scholar, EBSCO Host, Science Direct, and Wiley Online Library using the keywords "transgender identity, gender non-conforming, discrimination, transition, binary systems, transgender oral cavity, transgender, transgender oral health, transgender dental health." Articles published from 2000 to 2017 in both peer-reviewed and non-peer reviewed journals, which reported information regarding the oral health status of transgender populations, were selected for review.

Results

The search revealed 18 articles, only 7 of which pertained to the oral health status of transgender client populations. Five other articles were eliminated due to either poor quality or irrelevance.

Discussion

The 13 articles included in the review revealed a need for oral health care professionals to be aware that gender is not binary, nor is it a mental health disorder. Transgender people face heightened risk of discrimination, violence, anxiety, depression, suicidality, substance abuse, and sexually transmitted diseases, as well as significant barriers to health care of which oral health professionals should be made aware.

Conclusions

Transgender people have the same rights as everyone else to oral health care. Oral health care providers are responsible for ensuring that transgender clients receive care that aligns with their needs and for providing that care in a culturally competent manner. This requires an understanding of the basics of gender nonconformance and its impact on oral-systemic health. Additional research is needed to increase the scientific knowledge base to facilitate improved health outcomes for this client population.

Are dental care providers in Saudi Arabia prepared to treat patients with special needs?

Background: Equity in services accessibility is one of the major components of good quality healthcare. However, patients with special needs have limited access to dental care services, which could be due to the lack of training and experience of the dental care providers that might effect on their preparedness and willingness when it comes to caring for the patients with special needs.

Objectives: The main objective of this study is to determine the factors influencing the preparedness and willingness of dental care providers at different Saudi Arabian universities to provide treatment to patients with special needs.

Methods: A Cross-sectional study design targeting all dental care providers such as interns, residents, specialists, consultants, dental nurses and students from universities around Saudi Arabia. Two scales were adapted to determine the dental care providers’ perceived preparedness and willingness to treat patients with special needs.

Results: A total of 243 participants from dental colleges around Saudi universities were included in the study. Males appeared to be more prepared and willing to treat patients with special needs compared to females. Dental care providers from King Saud University perceived more preparedness compared to other universities in the study. While graduates from King Abdulaziz University exhibit more preparedness to treat patients with special needs compared to graduates from other universities in the study. Also, dental care providers who have treated a patient with special needs perceived more preparedness to treat them again.

Conclusion: When a dental care provider have treated a patient with special needs or just dealt with them in a daily life, this experience procured high preparedness score, however, did not influence on their willingness score in the treatment of these individuals. Good dental education programs are important to provide equity of dental care services to all parts of the community equally.

Sexual orientation-related oral health disparities in the United States

OBJECTIVE

Recent reports have documented health disparities according to sexual orientation and used the minority stress model as a framework for understanding their origins. To date, however, sexual orientation-related disparities in the oral health domain have not been evaluated. Accordingly, this study sought to investigate potential health disparities in objectively-assessed and subjective reports of oral heath among lesbian, gay, and bisexual adults relative to the heterosexual community-dwelling US population.

METHODS

We used three consecutive cycles (2009-2014) of National Health and Nutrition Examination Survey (NHANES) data for men and women aged 18-59 years. We examined clinical measures of dental caries, tooth loss, chronic periodontitis, and oral human papillomavirus (HPV) as well as subjective reports of oral health status and use of dental services.

RESULTS

Clinical measures of oral disease did not differ according to sexual orientation; however, bisexual adults were more likely to rate their oral health unfavorably (41%) than heterosexual adults (27%). Gay men reported "bone loss around teeth" more frequently (35%) than heterosexual (11%) and bisexual (10%) men. Bisexual individuals were more likely to confront barriers to accessing dental care (30%) versus heterosexual adults (19%).

CONCLUSIONS

While clinical measures of oral health did not substantially differ between sexual orientation strata, subjective measures of oral health were worse among gay, lesbian, and bisexual adults versus heterosexual adults. Further study of the psychosocial construction of oral health among sexual minorities is warranted.