which may involve oral health professionals. Facial reconstruction (masculinization or feminization) and gender affirmation surgeries are often not covered by health insurance.24 Implications for Dental Hygiene Treatment Health conditions common to LGBTQ+ individuals include anxiety and depression, eating disor- ders, and STDs, which may affect oral health. Smoking is also common among the LGBTQ+ population.25-29 An increase in dental anxiety due to explicit or implicit biases may also prevent LGBTQ+ patients from seeking care or maintain- ing regular preventive appointments.26,27 In 2018, the US Centers for Disease Control and Prevention identified the LGBTQ+ community as a priority population needed for tobacco cessation efforts.29 The high prevalence of tobacco smoking in this population can be linked to a history of targeted advertisement by tobacco companies; increased use in places such as bars and clubs; stress; and being in the environment of oth- ers who smoke.30,31 Oral health professionals should question this population during the medical history regarding frequency and quantity of tobacco use in order to support treat- ment planning for tobacco cessation education. Additionally, prior knowledge of patient tobacco use may assist with differential diagnosis during intra- and extrao- ral examinations, should a lesion be found. As smoking may also increase the inci- dence of caries and exacerbate periodontal diseases,11 the clinician may consider increased fluoride use and possible nonsurgical periodontal therapies or more frequent periodontal maintenance appointments to manage disease. Alcohol, heroin, and opioids are often misused in this population.32 The clini- cian should ask questions regarding their use during the medical history as it may affect dental care appointments should local anesthesia, nitrous oxide, or laser bacterial reduction therapy be recommended. Oral health professionals often see patients more frequently than primary care physicians and can provide the appropriate referral should the patient present with these lifestyle behaviors. While oral health is linked to overall health, it may also be linked with mental health. Mental illnesses, such as anxiety and depression, may lead to poor oral health due to malnutrition and poor oral hygiene, comorbid substance abuse, and oral side effects from medications used to treat these illnesses.33 Xerostomia is one of the most common side effects of anti-anxiety and anti- depressant medications, and may increase the instance of dental caries and periodontal diseases.34 Eating disorders are also common among LGBTQ+ individuals due to gender dysphoria, fear of rejection by family and friends, and experiences of victimization, bullying, or violence.12,25 These disorders may affect oral health by causing enamel erosion, caries, and gingivitis related to nutritional deficiencies and vomiting.35 LGBTQ+ individuals are also at increased risk for contracting sexually transmitted infections (STIs) or STDs. Human immunodeficiency virus (HIV), human papillomavirus (HPV), syphilis, and gonorrhea are common among LGBTQ+ populations.28 HPV causes more than 70% of oropharyn- geal cancers in the US.36 As such, oral health professionals should routinely perform intra- and SECTION 2 DIMENSIONS CE TABLE 1. Lesbian, Gay, Bisexual, Transgender, and Queer+ Glossary of Terms9 40 Dimensions OF DENTAL HYGIENE • July/August 2023 dimensionsofdentalhygiene.com Sexual Orientation Heterosexual One who is attracted to the opposite gender, such as men attracted to women and women attracted to men, “straight” Bisexual One who is attracted to both women and men Pansexual One who is attracted to people of all gender identities or whose attractions are not related to other people’s gender Asexual One who experiences little or no sexual attraction to others; asexual people may still engage in sexual activity Queer Umbrella term describing those who think of their sexual orientation or gender identity as outside of societal norms; term is often viewed as fluid and inclusive Gender Identity Cisgender A person who identifies in a traditional sense with sex assigned at birth, such as a person assigned female sex at birth whose gender identity is woman Transgender A person whose gender identity and sex assigned at birth do not correspond based on traditional expectations, such as a person assigned female sex at birth who identifies as a man (transgender male), or a person assigned male sex at birth who identifies as a woman (transgender female) Non-Binary A person whose gender identify falls outside of the traditional gender binary structure of woman or man Genderqueer Umbrella term describing those whose gender identity falls outside the traditional gender binary of male and female Intersex A group of congenital conditions in which the reproductive organs, genitals, and/or other sexual anatomy do not develop according to traditional expectations for females or males Belmont Business Media Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. July 1, 2023 to June 30, 2026 Provider ID# 317924 AGD Subject Code: 558 Belmont Business Media designates this activity for 2 credit hours of self- study continuing education units. This course is released July/August 2023 and expires July/August 2026. Belmont Business Media is an ADA CERP-recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at: ada.org/cerp.
