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Quick Clinical Scan: Oral Health Care Experiences of Transgender and Gender Non-Conforming Patients

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Source Article: “I just want to be treated like a normal person.” Oral health care experiences of transgender adolescents and young adults. Journal of the American Dental Association, September 2019, Volume 150, Issue 9, Pages 748–754

A Cincinnati-based team of researchers conducted this study to “understand the experiences, knowledge, and perceptions of oral health care among transgender, gender non-conforming (TGNC) youth, and their families throughout the (gender) transition process.” Specifically, this study sought to understand how TGNC adolescents and young adults interact with their oral health providers. It was conducted in the Transgender Health Clinic at the Cincinnati Children’s Hospital.

Participants

  • A total of 20 patients and 16 caregivers completed semi-structured interviews.
  • 16 were assigned female at birth and identified as male (female to male [FTM]); 3 were male to female (MTF); and 1 identified as nonbinary.

Clinical Relevance

  • Oral health care teams must provide safe, well-informed, culturally competent care for TGNC patients.
  • Many study participants said they felt welcome or comfortable in their dentist’s office.
  • Though participants felt welcome, they indicated that some elements of the experience could be improved to increase their comfort.
  • Modifications to office intake forms and the office design can improve patient experience and reduce stress and anxiety related to gender identity.
  • Dental offices with an open-bay (open concept) treatment area caused anxiety; and many participants said they preferred discussing sensitive topics in a private space.
  • Participants found it comforting to see a pride flag or non-discriminatory policy statement on the wall, indicating that the dental office is a safe space.
  • Study participants who had negative experiences reported that the problems were corrected quickly.
  • Most participants reported a neutral or positive experience when answering questions about disclosing their TGNC identity to their oral health care team.
  • Some participants reported difficulties processing insurance due to issues with their legal and chosen name.
  • One participant felt unwelcome when an oral health team member continuously used the incorrect pronoun to address them; and another said they were uncomfortable when a dental office team indicated they could not use the person’s chosen name.
  • Negative remarks and uncomfortable interactions with the dentist or staff concerning gender were addressed quickly without disrupting care.
  • Participants said attempts by the dental health care team to build rapport, by using terms like “sweetheart,” “honey,” or “dude,” could be emotionally jarring when the term did not correspond with the patient’s gender identity.

Study Recommendations for Clinicians

Improve comfort for TGNC patients in the dental office by:

  • Posting a transgender pride or gay pride flag or sticker, serving as a sign of acceptance and comfort to patients and families.
  • Updating office forms to include a separate selection for “Sex at Birth” and “Gender Identity.”
  • Updating office forms to include a separate selection for “Legal Name” and “Chosen Name.”
  • Updating office forms to ask for patient-specific pronouns or how a patient would like to be addressed i.e., she/her, he/him, or they/their.
  • Taking precautions when thinking about gender and avoiding terms like “dude” or “darling.”
  • Connecting patients and families to local resources, if possible.

Study Strengths and Limitations

  • Not all of the interviews with TGNC youth were conducted in the presence of their caregivers, because some caregivers elected not to participate while others did not know that their children are TGNC.
  • Some caregivers indicated that they disclosed the TGNC patient’s transition to the dental team in advance and informed them of the patient’s prior difficulties with others’ reactions and difficulties with insurance. 
  • Advanced disclosure by a caregiver may have influenced the dental team to create a more positive and welcoming environment for the patient.
  • Patients who attend the Transgender Health Clinic, where the study was undertaken, exhibit health-seeking behaviours that may have contributed to a selection bias.
  • Study results may not be generalizable given that among TGNC people there are a substantial number who are homeless or have not come out about their status.
  • Due to a lack of available research, this study’s strengths are in building a foundation for future studies into the relation of TGNC people with their oral health care.
  • Interview results reveal important insights into how oral health care providers can interact positively with TGNC patients and enhance their experiences in the dental office.
  • Interviews were transcribed verbatim, coded, and analysed for major themes, using grounded theory methodology (the theory is a hypothesis-generating method that is used when there are no existing theories to be tested).
  • The authors believe that TGNC patients represented a prime example of the shift towards person-centered care.
  • For oral health care providers, person-centered care for TGNC patients may include reframing orthodontic, cosmetic, or surgical procedures, and talking with patients about preferred outcomes as they relate to the individual’s gender identity rather than taking a one-size-fits-all approach.

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Until next time!

CDA Oasis Team

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1 Comment

  1. Lesia October 8, 2019

    This is great. Thanks for sharing the key points of the article with those of us who aren’t ADA members or subscribers to the ADA’s publications.

    I know that despite our best intentions, it’s sometimes difficult to honour patients’ preferences as to pronouns, especially if we’ve known them when they expressed a different gender identity before their transitions, so I was heartened to read that when such mistakes are brought to the attention of dental care workers and corrected, the dental environment can still be seen as welcoming.

    I really liked the simple idea of displaying a pride sticker in our workplaces to indicate our attempts to create an inclusive environment. As an ally I’d been unsure of whether such symbols continue to be appropriate and helpful when I read that some queer activists have had enough of the rainbow flag, but I guess it depends on the context, and I’m so glad that the ADA published this qualitative study, which helps us hear the voices of dental patients directly on this topic.

    Reply

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