BACKGROUND
Oral health is an integral aspect of overall well-being and quality of life. Population groups such as two-spirit, lesbian, gay, bisexual, transgender, and queer, including other sexual and gender minorities (2SLGBTQ+), have reported poor oral health outcomes. Therefore, the aim of this review was to investigate the extent and scope of the literature describing 2SLGBTQ+ oral health outcomes, including unmet oral health needs and patterns of oral health care service utilization, as well as the risk factors affecting both.


METHODS
A comprehensive search strategy was developed to review the scope of the literature pertinent to unmet oral health needs and factors affecting access to oral health care among 2SLGBTQ+ members, globally. In total, 6 databases were searched with a combination of keywords relevant to 2SLGBTQ+ oral health status and oral health care utilization.


RESULTS
Our review identified 10 studies that met the eligibility criteria. Five out of 10 studies were based in India, 4 in the United States, and 1 in Brazil. Two studies reported poorer oral health outcomes among transgender people as compared with cisgender people, while 2 studies reported similar patterns of dental service utilization between their transgender and cisgender participants. Five studies explored the personal and structural risk factors associated with poor oral health outcomes, including financial affordability and income level and perceived discrimination, including instances of misgendering in health care settings. However, further comprehensive studies must be conducted to validate the trends and findings reported by the studies in the review and to generate data from diverse regional contexts.


CONCLUSIONS
Our review identified that the extent of the literature in this research area is sparse and scarce. The evidence indicates poorer oral health status among 2SLGBTQ+ communities. Wider studies with diverse, representative samples are required to gain a comprehensive understanding of 2SLGBTQ+ oral health outcomes.


KNOWLEDGE TRANSFER STATEMENT
The results of this review will undoubtedly be important for many years to come as 2SLGBTQ+ oral health equity is prioritized by experts in public health dentistry. This review will allow other researchers to understand and fill literature gaps regarding 2SLGBTQ+ oral health outcomes, furthering this area of research.

A Scoping Review of Oral Health Outcomes and Oral Health Service Utilization of 2SLGBTQ+ People.

The aim of this cross-sectional study was to investigate the associations between oral health-related quality of life (OHRQoL) and socioeconomic and demographic variables, suicidal ideation, self-perception of oral health, and experiences of dental care in the Brazilian adult LGBTIQ+ population. A sample of 464 participants completed self-administered online questionnaires and provided information for OHRQoL assessment, using the OHIP-14 instrument at three hierarchical levels of explanatory variables: LGBTIQ+ identities; socioeconomic and demographic data and existential suffering; and self-perception of oral health and experience of dental care. The collected data were fitted to hierarchical multiple logistic regression models, in which the associations between each independent variable with the OHIP-14 prevalence outcome were analyzed. The OHIP-14-prevalence index showed that 33.2% of the participants answered 'frequently' or 'always', and the highest frequencies were obtained for the psychological discomfort (27.8%), psychological disability (18.3%), and physical pain (17.5%) domains. According to the adjusted final model, LGBTIQ+ individuals who were more likely to have their OHRQoL affected were those who were indifferent (OR=3.21; 95% CI: 1.26-8.20), dissatisfied (OR=10.45; 95% CI: 3.86-28.26), or very dissatisfied (OR=53.93; 95% CI: 12.12-239.93) with their oral health status, and also those who had or have difficulty accessing dental treatment (OR=2.06; 95% CI: 1.24-3.41) (p<0.05). It may be concluded that the OHRQoL of the investigated Brazilian LGBTIQ+ population showed associations with individual aspects and with access to dental services.

pdf/oral-health-related-quality-of-life-in-the-lgbtiq-population-4s8m7nunsh.pdf

Oral health-related quality of life in the LGBTIQ+ population: a cross-sectional study.

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.

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

O objetivo deste estudo observacional do tipo transversal foi o de avaliar as possíveis associações entre a autopercepção do estado de saúde bucal com as especificidades das identidades LGBTQIAPN+ e com o histórico de atendimento odontológico. Para tal, por meio da utilização de um questionário autoaplicável, coletaram-se, em ambiente virtual, dados de uma amostra composta por 463 participantes adultos LGBTQIAPN+ brasileiros. Dentre as principais informações estatisticamente significativas encontradas destacaram-se: as maiores prevalências e chances em relatarem satisfação para o estado de saúde bucal foram encontradas nos cisgêneros (RP: 1,73/ IC:95%: 1,29-2,30; OR: 2,57/ IC:95%: 1,64-4,01), homossexuais (RP: 1,33/ IC:95%: 1,09-1,62; OR: 1,72/IC:95%: 1,19-2,5) e naqueles que vivenciaram ou temiam vivenciar LGBTQIAPN+fobia (RP: 1,37/IC:95%: 1,08-1,74; OR: 1,78/IC:95%: 1,18-2,68) ou que deixaram ou deixariam de ir a uma consulta odontológica por medo de discriminação (RP: 1,66/IC:95%: 1,22-2,24; OR: 2,38/IC:95%: 1,49-3,80); já a dificuldade em acessar tratamento odontológico reduziu a prevalência (RP: 0,304/IC:95%: 0,217-0,427) e as chances (OR: 0,142/IC:95%: 0,0891-0,226) em autorreferenciar satisfação com o estado de saúde bucal. Conclui-se que as informações levantadas podem subsidiar futuras políticas públicas de atenção odontológica voltadas à redução das iniquidades bucais experienciadas por essa vulnerável população. 

pdf/saude-bucal-e-o-ser-pessoa-lgbtqiapn-um-estudo-transversal-5xr29rj8be8l.pdf

Saúde bucal e o ser pessoa lgbtqiapn+: um estudo transversal sobre as inferências entre a autopercepção do estado de saúde bucal com as identidades e com o histórico odontológico

Transgender women in Malaysia face social and healthcare marginalisation. Research about their oral health and oral health care utilisation is sparse. Despite growing clinical evidence highlighting the risk of transmission of sexually transmitted infections (STIs) through oral sexual practices, research in this area remains less explored. This study aimed to understand the experiences of transgender women in Malaysia by exploring oral health care needs and the barriers and enablers of oral health care utilisation as well as safe sexual practices relating to oral transmission of STIs. Participants were recruited through a snow-balling method of sampling with the help of community workers. Semi-structured in-depth interviews (IDIs) with transgender women in northern Malaysia and Focus group discussion (FGD) with a mixed group of transgender women and health care professionals were conducted to gain insights into the needs of the community. Data obtained from IDIs and FGD were coded, transcribed, and thematically analysed to derive codes and themes through the interpretative lens of the Information, Motivation and Behavioural skills (IMB) theory. Participants of the IDIs were transgender women (n = 20, median age 39.8 (9.75 IQR) years). Aesthetic dental needs were prioritised, yet poor utilisation of dental services was reported, with many opting for self-medication or care from a non-qualified dental practitioner. Routine engagement in oral sex practices, primarily receptive fellatio with or without ejaculation with multiple cis-gender male partners, was reported. Low awareness of oral STIs, along with a perceived low risk of transmission of STIs through oral sex, was reported, with most (18, 90%) not using condoms for clients/partners or inconsistently using them during oral sexual practices. The themes identified from IDIs and FGD included: ‘Place in the society’ ‘Attitudes and beliefs linked with dental care’, ‘Access to dental care’, ‘Lack of trans-specific health care’ and ‘Use of condoms for oral sex’. The study’s findings report poor dental service utilisation among transgender women despite aesthetics being prioritised. Gaps in knowledge regarding the oral transmission of STIs were also noted. These insights underscore the need for trans-specific health campaigns designed to address these concerns and enhance awareness through an integrated approach to improve access to inclusive oral health care and sexual health care for this vulnerable population.

Exploring the barriers and enablers of oral health care utilisation and safe oral sex practices among transgender women in Malaysia: a qualitative study

This article aims to verify the use of dental services, oral health self-perception, and the impacts of oral health on the daily lives of transgender people. A controlled cross-sectional study was conducted in which transvestites, transsexuals, and transgender people were compared to cisgender people. For data collection, the oral health self-perception questionnaire was applied to 90 people, from which 45 were cisgender and 45 were transgender. There were no differences regarding access to dental services. The data analysis revealed that transgender people perceive their teeth to cause nervousness (p=0.002) and shame (p=0.033), respectively 3.8 and 5.0 times higher than that observed for cisgender people. Although differences in access were not observed, there was a difference in the perception of the need for treatment and the impacts of oral health. Therefore, it is important to consider that comprehensive care for the transgender population should go beyond the treatment of oral diseases and include aesthetic expectations as well.

/pdf/oral-health-self-perception-for-transgender-people-a-3rs5xb0ymr.pdf

Oral health self-perception for transgender people: a controlled cross-sectional study

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Oral health self-perception for transgender people: a controlled cross-sectional study