Evaluation of oral health status and barriers in access to oral care services among lesbian, gay, bisexual, transgender, and queer community: A pilot study

INTRODUCTION

The lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) community encompasses individuals who identify as two- spirit, LGBTQ, or who prefer to use other related or adjacent terms.^[1] Transgender individuals are those whose gender identities do not align with the sex they were assigned at birth, which includes non-binary individuals.^[2] The terms “gay” and “lesbian” are traditionally used to describe men and women, respectively, who are attracted to the same gender, while “two-spirit” (2S) is a term frequently utilized within indigenous communities to denote someone whose behaviors or beliefs may be perceived as atypical for their sex.^[3] Members of the 2SLGBTQ+ community often encounter significant social, environmental, and physical obstacles to accessing health care, resulting in health disparities, including elevated rates of mental health issues such as anxiety and depression.^[4,5] Stigma and discrimination pose considerable barriers to health care for 2SLGBTQ+ individuals, particularly those who are gender-diverse.^[6,7] For example, transgender individuals frequently face substantial resistance to social inclusion and experience high levels of prejudice and discrimination due to their gender identity. In some instances, 2SLGBTQ+ individuals may feel compelled to conceal their identity to receive appropriate care without facing belittlement or stigma.^[7] In addition, 2SLGBTQ+ individuals encounter specific social barriers in dental care settings; many have reported experiencing stigma and discrimination related to their gender identity while seeking dental services, which can lead to avoidance of future dental appointments.^[8]

The LGBTQ community is one of the marginalized and vulnerable sections of our society.

There exists a significant likelihood of engaging in various forms of addiction, coupled with a lack of awareness regarding oral health. Furthermore, several obstacles may impede access to vital dental services, including systemic inequalities, societal attitudes, and insufficient healthcare policies. There is a notable scarcity of data, particularly in our region, concerning oral health status and the barriers to accessing dental services. Most of the research pertaining to this specific group has predominantly concentrated on general health disparities, with oral health receiving minimal attention. Consequently, this study has been designed to furnish information that will assist in directing resources for oral healthcare providers, enabling them to deliver the highest standard of care to these individuals.

MATERIAL AND METHODS

RESULTS

The results and the DFMT scores were noted with the help of MS Excel and put into pie charts for observations. The following Table 1-5 summarizes the data using frequencies/ percentages.

DISCUSSION

This pilot study provides baseline data on oral health status and barriers among the LGBTQ+ community in Nagpur, India, an under-researched population locally. The high caries prevalence (58%) and missing teeth due to caries (2.9%) indicate a notable disease burden, likely linked to tobacco use and low oral health awareness, consistent with global patterns in 2SLGBTQ + groups^[9] and higher pooled caries prevalence (78%) reported among Indian transgender populations.^[10] The low gingival bleeding rate (8.82%) suggests relatively better short-term periodontal health in this sample, though this may reflect limited examination scope, underreporting, or selection bias, contrasting with higher periodontal disease rates in similar reviews.^[10,11]

The identified barriers, lack of awareness, economic constraints, discrimination by medical professionals, and social inhibitions, align with international evidence where stigma and bias contribute to avoidance of dental care, unmet needs, and poorer outcomes.^[7-9] In India, these are intensified by socio-cultural attitudes, economic marginalization, and limited inclusive policies.^[10,12] High caries aligns with patterns in marginalized groups driven by stigma-related avoidance, tobacco, and dietary factors,^[9] while discrimination and inhibitions mirror reports of delayed treatment in gender- diverse and sexual minority populations.^[7,8,13]

Targeted interventions are needed, including community awareness campaigns, culturally sensitive training for dental providers, and policy reforms to address access inequities.^[13] Limitations include the small sample size, snowball sampling (potential selection bias), and single-site design, limiting generalization. Larger, representative studies are recommended.

CONCLUSION

This descriptive study offers novel insights into the oral health status and barriers to care among the LGBTQ community in Nagpur, India. The high caries prevalence and identified barriers – lack of awareness, economic constraints, discrimination by medical professionals, and inhibitions – underscore the need for targeted interventions, including awareness campaigns and culturally sensitive training for healthcare providers. These findings will guide efforts to reduce oral health disparities in this population.