Transgender patients report feeling discrimination when visiting dentist

CWRU studies LGBT community’s perceptions of dental care

William JacobsonA dentist’s uncomfortable reaction upon learning a patient is transgender creates a barrier that prevents some patients from returning, according to a new study that examined how members of the lesbian, gay, bisexual and transgender (LGBT) community perceive their dental care.

As a result, only 10 percent of transgender participants report visiting the dentist regularly, according to a Case Western Reserve University public health survey of Cleveland’s LGBT community about its dental experiences.

Learning how strongly transgendered participants felt discriminated in the dental offices surprised William Jacobson, the first dual-degree student in dental medicine and public health (DMD-MPH) and in his final year at the university’s School of Dental Medicine.

Jacobson is lead author of the study, “Oral Health Care in the LGBT Population: Access, Perceptions, Barriers and Potential Solutions.” Henry Ng of MetroHealth, Laura Santuri (former administrative director of CWRU’s master of public health program), and Sena Narendran of the dental school co-authored the study.

Jacobson presented his findings at the 32nd annual conference of the Gay and Lesbian Medical Association (GLMA): Health Professionals Advancing LGBT Equality in Baltimore and the American Association of Public Health Dentistry in Fort Worth, Texas. He will also present at the American Public Health Association Conference in New Orleans later this year. His research received support from the Health Resources and Services Administration and CWRU dental and medical schools.

The research was conducted for Jacobson’s master of public health degree, which he earned in January. He is scheduled to complete his doctor of dental medicine degree in May 2015.

The LGBT community comprises about 3.5 percent of the United States population, with 0.3 percent identifying as transgender, he said.

Jacobson surveyed 355 people, mostly men (72 percent), from five Cleveland LGBT organizations: MetroHealth Pride Clinic, the LGBT Center of Greater Cleveland, Parents Families and Friends of Lesbians and Gays Cleveland, Cleveland Leather Annual Weekend and Cleveland Pride.

Despite the reluctance of transgender people to see the dentist, Cleveland’s LGBT community generally visited the dentist more often than the general population (65 percent vs. 62 percent).

Jacobson attributes the higher percentage of people visiting dentists to Cleveland’s strong health-care sector, which offers accessibility to care. And senior participants in the study reported better attention to their dental care than younger participants.

While most sought care from private dentists, finances were the main reason why others did not.

Survey respondents said they wanted dentists to be more supportive of the LGBT community by understanding and treating them fairly and judgment-free.

The participants also wanted dental care incorporated into places like the MetroHealth System’s Pride Clinic—one of 14 hospitals, clinics and Federally Qualified Health Centers nationally dedicated to the health needs of LGBT patients. Only seven of them offer dental services.

Jacobson suggested the following public health strategies to improve oral health of the LGBT population:

  • Develop LGBT cultural and clinical competency trainings to prepare future and current dentists and their staff about the needs of the LGBT community.
  • Develop resources to train and recruit dentists to work in all 14 LGBT health clinics in the country and also open additional clinics.
  • Provide new patient intake forms that include a question about how patients would like to be addressed in terms of preferred name, sex assigned at birth, pronoun preference and current gender identity.
  • Encourage collaboration between the America Dental Association and GLMA: to increase medical and dental providers listed on GLMA’s LGBT-friendly provider directory.
  • Encourage the American Dental Association to add “sexual orientation, perceived sexual orientation, gender identity and gender expression” to its non-discriminatory policies within its code of ethics.