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

A scoping review about LGBTQIAP+ people in oral health research

Oral health personnel must acknowledge the health needs of sexual and gender minorities. They should consult scientific literature to deepen their knowledge about sexuality, gender identity, general and oral health status, and treatment disparities among LGBTQIA+ people. The aim of this scoping review was to portray the development and current stage of internationally indexed literature approaching the oral health of this population. In this study, the search strategy used consisted of combinations of subject descriptors (MeSH terms), in two concept blocks: LGBTQIAP+ people and oral health. Global literature was searched through Medline (PUBMED), Web of Science, Embase, Lilacs, and Scopus electronic databases, with no language or date restrictions. Records were selected and evaluated by two independent reviewers, under the supervision of three senior reviewers and the inclusion criteria resulted in 189 eligible papers. Since the first study was published in 1974, numbers increased over the decades, reaching 67 (35.4%) in 2010-2019. The most frequently studied populations were North American (42.9%) and European (19.0%) and the most frequent language of publication was English (99.0%). There were 38 open access papers (20.1%). Medical (57.7%) and dental journals (20.1%) predominated. Cross-sectional studies were found more frequently (65.1%), followed by the cohort type (11.1%). Oral manifestation of STI (58.7%) was the topic most frequently addressed. The search for literature approaching the oral health of LGBTQIAP+ people showed evidence of the need to encourage research reported in papers made easily available, with more robust scientific evidence, and on a broader scope of topics, including oral health needs and treatment, and planning of oral health services.

Cost-related avoidance of oral health service utilization among lesbian, gay, and bisexual individuals in Canada

OBJECTIVES

This study estimates the frequency of cost-related oral health service avoidance (CROHSA) among lesbian, gay, and bisexual (LGB) individuals in Canada relative to heterosexual persons.

METHODS

Heterosexual and sexual minority individuals in Canada were compared using the national probability-based Canadian Community Health Survey 2017-2018. Logistic regression was used to quantify associations between LGB status and CROHSA. Mediators were tested following Andersen's behavioral model of health service utilization and included partnership status, oral health status, presence of dental pain, educational attainment, insurance status, smoking status, general health status, and personal income.

RESULTS

From our sample of 103,216 individuals, 34.8% of LGB individuals reported avoiding oral health care due to cost compared to 22.7% of heterosexual persons. Disparities were most pronounced among bisexual individuals (odds ratio [OR] 2.29 95% confidence interval [CI] 1.42, 3.49). Disparities persisted despite adjustment for confounding using age, gender/sex, and ethnicity (OR 2.23 95% CI 1.42, 3.49). Disparities were fully mediated by eight hypothesized mediators namely, educational attainment, smoking status, partnership status, income, insurance status, oral health status, and the presence of dental pain (OR 1.69 95% CI 0.94, 3.03). In contrast, lesbian/gay individuals did not have elevated odds of experiencing CROHSA compared to heterosexual individuals (OR 1.27 95% CI 0.84, 1.92).

CONCLUSION

CROHSA is elevated for bisexual individuals relative to heterosexual individuals. Targeted interventions should be explored to improve oral healthcare access among this population. Future research should assess the role of minority stress and social safety on oral health inequities among sexual minority groups.

Health insurance is associated with dental care use among university students in Washington State

BACKGROUND

The goal of this study was to examine the association of health insurance and preventive dental care use among university students.

METHODS

This secondary analysis of cross-sectional data focused on students at University of Washington in Washington state (WA) who completed a health insurance survey in 2017 (n = 3768). The exposure was health insurance (private insurance in WA [reference group], not insured, Medicaid or Medicare [public insurance], university insurance, private insurance not in WA, other) and the outcome was receiving a dental cleaning in the past 6 months. Logistic regression was used to generate odds ratios and 95% confidence intervals (CI) adjusted for confounders.

RESULTS

About 5% of university students did not have health insurance and 37% did not have a dental cleaning in the past 6 months. Compared to students with private health insurance based in WA, the odds of not receiving a dental cleaning were 3.90 times greater for university students with no health insurance (95% CI 2.74, 5.55; p < .001) and 3.08 times greater for publicly-insured university students (95% CI 2.52, 3.76; p < .001).

CONCLUSIONS

University students are at risk for poor oral health behaviors. Those without health insurance and those with public insurance face barriers to preventive dental care. Efforts should be made to connect uninsured university students with insurance, dental services, and other oral health promotion activities.

Knowledge, attitudes, and willingness of oral health professionals to treat transgender patients

Background

Lack of knowledge about transgender patients often correlates with increased stigma and an unwillingness to provide care to this population. This study examined the knowledge, attitudes, and willingness of oral health care providers with regard to treating transgender patients.

Methods

Dentists, mid-level providers, and dental hygienists in the United States and Canada accessed an online survey (N = 315) focused on assessing knowledge, attitudes, and willingness to provide care and/or seek additional education on treating transgender individuals. Descriptive statistical, correlational, and regression analyses were conducted.

Results

The survey completion rate was 85% (n = 268). Respondents correctly answered an average of 70% of the knowledge questions, with 56% of participants unable to define "gender" and 66% unable to define "sex identity". Almost 1 in 4 respondents incorrectly defined a trans male or trans female, or misidentified particular health disparities experienced by transgender individuals. A lack of willingness to seek additional information on providing culturally competent care, having lower levels of knowledge, and identifying with specific religions correlated with higher levels of stigma (p < 0.001). While US providers exhibited low stigma overall, Canadian providers, survey respondents with higher levels of knowledge, and those with transgender friends and/or family demonstrated lower levels of stigma (p < 0.001).

Discussion and conclusions

Transgender individuals face disparities in medical and oral health care. Based on the findings of this survey, it will be important to address factors associated with higher levels of stigma and educate oral health professionals on providing culturally competent care for transgender individuals.