By Andrew Gilliver, Pride in Practice Coordinator at LGBT Foundation and Don Dimitroff, Education Support Officer, Manchester Royal Eye Hospital & University Dental Hospital of Manchester
The experiences we have during our studies should be ones of equality, inclusion, respect and embracing diversity. We all want to live and work in a world where people are accepted for who they are and it's important that our patients feel comfortable in sharing anything with us that is appropriate to their ongoing health care.
LGBT Foundation have found in their work supporting lesbian, gay, bisexual and trans patients that providing training to dental providers is essential to ensure 'excellence in LGBT healthcare.'
The charity is one of the leading support organisations in the UK for LGBT people and one of the regular requests their Pride in Practice team receives from members of the LGBT community is 'where can I find a dentist that is LGBT inclusive?'
This is something that The University Dental Hospital of Manchester and the University of Manchester have been keen to support to ensure that the next generation of dental practitioners are fully aware of the needs of their LGBT Patients.
Manchester University NHS Foundation Trust have also been developing a pilot Pride in Practice Programme at the Trust with LGBT Foundation to meet the needs of acute services
Feedback from users of community dental services that the Dental Hospital have provided include LGBT asylum seekers, HIV+ people, trans and non-binary people and others who identify as LGBT+ and all have reported increasing difficulty in accessing an NHS dentist they felt comfortable with.
“Visibility is a key component to creating a safe space and helping patients to feel recognised”
So how can dental students make sure that they are catering for the needs of their future patients who may identify as LGBT+?
We've put together ten tips learned from our experience working with LGBT+ people, dental providers, dental students and tutors to assist you in approaching this issue with improved confidence and knowledge.
1. Reach out to the LGBT Community
Find out what local LGBT services are in your area and share their information resources. Visibility is a key component to creating a safe space and helping patients to feel recognised. One example would be to display posters showing diverse communities or local LGBT organisations. Familiarising yourself with LGBT services can also help you to understand the challenges faced by your LGBT patients. Signposting to a mix of mainstream and LGBT specific services will help your patients to have confidence in you and your practice too.
2. Utilise monitoring opportunities
The clinical systems we may have to use are not always inclusive, as many I.T systems have not been updated for a long time. One shortcoming when you have to input a new patient is that male or female may be the only options for gender. Alongside this, many paper forms used to register new patients also have a binary M/F choice. It's important to understand that before you see your patient in clinic, the patient might have already experienced a barrier in simply registering for treatment.
One of the biggest barriers to treatment can be patient anxiety about seeing the dentist and sometimes getting them in the door is the hardest part. Even though something like an application form or a choice to be made for computer input sounds small, it could be something that tips the decision of an already anxious patient away from treatment.
“Dentists are well placed to give a patient advice on sexual health based on their oral health”
Patient forms and medical histories with no representation of diverse sexual orientation or gender are a sign that LGBT people are not acknowledged. It can help all organisations and businesses to show that they understand the importance of representation. It also demonstrates that we are following legal guidance in recognising our patients' protected characteristics. Collecting a range of demographic information can help us to avoid assumptions and initiate conversations around our patients' identities, using correct pronouns and discussing wider health issues relevant to them personally.
More places are realising the need to update their computer systems to be all encompassing of all clinical and administrative functions, so it is important to be mindful that wherever you are you get to know what plans are under way for ensuring better capture of patients' diverse identities.
3. Talk openly about the connection between oral health and sexual health
Dentists are well placed to give a patient advice on sexual health based on their oral health. HIV, HPV and syphilis are all conditions that can be diagnosed in the mouth. However, patients may not be aware of this and dental students may not feel confident in initiating discussions on this topic. Proactively engaging in conversations with patients can help them to be more aware and informed about their oral health and the effects of STIs on the oral cavity. It also indicates that they are in a safe environment where they can discuss any concerns without fear of judgement.
4. Share your knowledge with your LGBT patients
As a dentist, identifying, treating and signposting are crucial to our role. LGBT people have higher rates of smoking, alcohol consumption and substance use than the general population. Talking to your patients about the effect of substances on their oral health can help them to make informed decisions. For example, explaining that party drugs can lead to the gradual destruction of the tooth and damage to the gums. Your patients will understand that you are supporting them and providing the care that they need, even if they are not initially aware that they need it.
5. Help reduce HIV stigma
Many people worry about discussing HIV with any health professional. Some will have been refused appropriate care and services and be anxious to know if their dentist is informed and supportive. HIV is easily treated and a patient on long-term HIV medication is doing their best to look after their health. HIV positive patients, whatever their identity, have the same right to medical attention as everyone else. It is important to understand the complications that HIV and HIV medications can cause in relation to oral health. Knowing where to refer patients for further support is vital for your reputation as a trusted health professional.
6. Understand Trans people's experiences
Trans people face a range of challenges when accessing mainstream services, and as a result may choose to avoid them altogether. Many trans people experience anxiety before accessing treatment due to fears of insensitivity, misgendering and discrimination. By better understanding your trans patients, you can help to signpost them to appropriate, relevant and specific sources of support for their health and wellbeing.
7. Be aware of non-binary identities
The spectrum of gender identities is wider than many people may think. It's not difficult to understand if we try not to assume a person's identity until they have told us how they define themselves. Instead of using the pronouns 'He' or 'She' use 'They' or 'Them'. Instead of Husband/Wife or Boyfriend/Girlfriend, use Partner. Even better ask your patients how they identify, most people won't be offended when they understand why you are asking and many will be delighted you asked them first before assuming their identity and potentially getting it wrong!
8. Acknowledge LGBT Parents
LGBT families continue to face discrimination from health care and again, using gender-neutral language e.g. parent or carer can help to avoid assumptions about the gender of parents and their partners. We all make mistakes and assumptions. The important thing is to acknowledge them, apologise, learn and move on.
“LGBT people have higher rates of smoking, alcohol consumption and substance use than the general population”
9. Be True to Yourself
Your own sexual orientation, gender identity and trans status is unique to you and is nobody's business but your own. Being open at work or university can have its challenges but it can also relieve the daily stress of hiding who you are. No one wants to put their security or opportunity for advancement in jeopardy, so find out if your place of work or study has a written non-discrimination policy. Does it specifically cover sexual orientation and/or gender identity/expression? Is there an LGBT+ group at your university or workplace? Being open can make you more productive, and can even benefit your future career because people can see you are open and honest with them. Talk to people you trust before coming out or talk to an LGBT helpline anonymously. There is a lot of support out there.
10. Be an LGBT+ Ally
So what has all this LGBT stuff got to do with you if you aren't part of the community? Well it's even more important that you show yourself to be a person who LGBT People can trust. Allies play an important role in standing up for their friends, colleagues or patients' rights, providing effective services and supporting LGBT+ people to raise their voices and be heard. Allies can take many forms from organisations to individuals. There is a role for everyone, either supporting a friend if they come out as LGBT or knowing what to do if anyone makes a mistake, or if you observe someone else who keeps making jokes about LGBT+ people.
With special thanks to staff at The University Dental Hospital of Manchester and students at The University of Manchester.
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Cite this article
Gilliver, A., Dimitroff, D. Ten things dental students can do to support LGBT+ patients. BDJ Student 28, 18–22 (2021). https://doi.org/10.1038/s41406-020-0172-4