Terminology An understating of gender and sex is important. Sex assigned at birth refers to one’s biological identity as either male or female and is associated with physical characteristics such as chromo- somes, hormones, and external/internal anatomy. Gender refers to the roles, behaviors, and attrib- utes that a society defines appropriate for men and women.9 Sex and gender can vary based on an individual sense of being male, female, or neither which is known as gender identity.9 Gender identity is also often termed cisgender (gender identity con- forms with sex assigned at birth), transgender (gender identity does not conform with sex assigned at birth), or nonbinary (gender identity does not conform with binary belief of gender, not exclu- sively male or female). A transgender person may identify as a transgender male (assigned at birth as female and tran- sitioned to male) or transgender female (assigned at birth as male and transitioned to female). Indi- viduals may choose a specific gender identity; however, their gender expression may differ from what society attributes to their gender. Gender expression refers to the way individuals choose to communicate their gender identity (femininity, masculinity, or neither) through clothing, hairstyles, voice, or behaviors.9 Sexual orientation refers to an individual’s physical, emotional, and/or romantic attraction to another person.10 Terms to identify sexual orientation include: heterosexual (physical, emotional, and/or romantic attraction to those of the opposite sex); homosexual (physical, emotional, and/or romantic attraction to those of the same sex); bisexual (physical, emotional, and/or romantic attrac- tion to both sexes, male and female); and pansexual (physical, emotional, and/or romantic attrac- tion to all gender identities). Labels may be used to describe an individual’s sexual orientation. The most common are les- bian (women attracted to women), gay men (men attracted to men), and bisexual people (men or women attracted to both sexes, male and female). Some individuals may use different labels than these or also choose to use none. Table 1 provides descriptions of additional terms (page 40).9 Social Determinants of Health According to the National Institute of Dental and Craniofacial Research’s Oral Health in America: Advances and Challenges, LGBTQ+ individuals are an underserved population subject to social stigmas and discrimination, leading to a negative effect on overall health and oral health.10–13 The minority stress model explains the relationship between members of a minority population — in this case the LGBTQ+ community — and their struggles related to their sexual orientation or gender identity and health disparities. This model by Meyer14 suggests stresses experienced by this minority population may result in poorer health due to fear of potential rejection and discrimi- nation, internalized hatred toward one’s sexual orientation or gender, and prejudicial experiences. These issues may also impact mental and physical health. LGBTQ+ individuals often face social disparities including legal discrimination in accessing health insurance, employment, housing, marriage, adoption, and retirement benefits as well as poorer healthcare.3,15 This community also experiences a higher risk of poor mental health, smok- ing, substance abuse, sexually transmitted diseases (STDs), and violence.16–20 LGBTQ+ individuals face barriers to high-quality healthcare such as limited availability, past nega- tive experiences, and lack of providers with the necessary knowledge and cultural competence.3,21 A study surveyed a sample of 3,453 LGBTQ+ adults with various race and ethnicity backgrounds regarding personal experiences with discrimination and found 57% of LGBTQ+ adults have experi- enced slurs related to their sexuality or gender and 53% have been subjected to offensive com- ments in their lifetime.22 LGBTQ+ individuals may experience this discrimination from healthcare professionals making them less likely to seek treatment.16,23 Some LGBTQ+ patients will seek gender affirmation surgeries or gender facial reconstruction, SAMANTHA VEST, RDH, MSDH, is an adjunct assistant professor at the Hirschfeld School of Dental Hygiene at Old Dominion University (ODU) in Norfolk, Virginia, where they teach clinical care and laboratory courses to junior and senior students. Vest has worked as a clinical dental hygienist prior to becoming an adjunct assistant professor and currently works in education and provides continuing education courses to dental professionals. EMILY A. LUDWIG, RDH, MSDH, is an assistant professor at the Hirschfeld School of Dental Hygiene at ODU, where she teaches oral radiology and clinical care to junior and senior students. Her research primarily focuses on ergonomics/workplace safety and diversity and inclusion issues affecting dental hygiene. She frequently contributes to peer- reviewed journals and presents research findings at national and international conferences. Ludwig has also been awarded and part of extramurally funded grants related to ergonomics of the dental hygienist. She is a member of Dimensions of Dental Hygiene’s Peer Review Panel. LAUREN EUSNER, RDH, BSDH, MS, is the director of clinical affairs at the Hirschfeld School of Dental Hygiene at ODU where she also teaches clinical care to both junior and senior dental hygiene students. Prior to accepting her current position, Eusner served as a lecturer and adjunct assistant professor at ODU and worked as a clinical dental hygienist in a variety of settings for more than 15 years. The authors have no commercial conflicts of interest to disclose. dimensionsofdentalhygiene.com July/August 2023 • Dimensions OF DENTAL HYGIENE 39
