Abstract
Introduction:
Discrimination within oral health care settings is increasingly recognized as a key driver of oral health inequities, shaping patient trust, care-seeking behaviors, and health outcomes. Although prior studies document discriminatory experiences among racially and ethnically minoritized populations, nationally representative evidence on discrimination and dignity in dental care among LGBTQ+ adults remains limited. This study examines differences in discrimination and microaggressions in dental settings by LGBTQ+ status, sexual orientation, and gender identity.
Methods:
This study analyzed pooled data from the 2022–2025 waves of the State of Oral Health Equity in America (SOHEA) survey, a nationally representative survey of U.S. adults aged 18 and older. This study measured discrimination using the Everyday Discrimination Scale–Oral Care (EDSOC) and assessed microaggressions using the Dignity in Oral Care Scale (DOCS). Descriptive and bivariate analyses compared mean scores across identity groups. Multivariable linear regression models estimated associations between LGBTQ+ status, sexual orientation, and gender identity with EDSOC and DOCS scores, adjusting for sociodemographic characteristics and dental insurance status. This study's analyses focused on group differences and associations and were conducted without applying survey weights.
Results:
The analytic sample included 15,591 adults from the 2022–2025 SOHEA surveys with complete data (52.5% of the total N = 29,679); 12% identified as LGBTQ+. Overall, LGBTQ+ individuals reported significantly higher mean discrimination (EDSOC: 2.97, SD = 4.99) and microaggression (DOCS: 2.19, SD = 3.22) scores than non-LGBTQ+ individuals (EDSOC: 1.72, SD = 3.79; DOCS: 1.62, SD = 2.80; p < 0.001). Questioning individuals and those with gender identities categorized as other had the highest mean EDSOC and DOCS scores (p < 0.001). In adjusted models controlling for sociodemographic and insurance factors, LGBTQ+ identity remained significantly associated with higher EDSOC (β = 0.16, 95% CI = 0.11–0.21) and DOCS (β = 0.08, 95% CI = 0.03–0.13) scores. Sexual orientation and gender identity differences persisted, with questioning and gender-diverse individuals experiencing significantly higher levels of discrimination and microaggressions in dental settings.
Discussion:
Findings demonstrate that LGBTQ+ adults, particularly questioning and gender-diverse individuals, experience disproportionate discrimination and microaggressions in dental care settings. Addressing interpersonal and structural sources of bias in oral health care is critical to advancing equity and improving access to respectful, high-quality care for LGBTQ+ populations.
Introduction
Discrimination in oral health care is a critical driver of patient trust, care utilization, and health outcomes. Experiences of microaggressions, feelings of disregard, and differential treatment from providers during dental visits have been linked to poorer self-rated oral health, decreased dental utilization, and delayed or foregone dental care (, ). Racism and everyday discrimination during prior dental visits are associated with worse self-rated oral health, longer intervals between dental care, and a reduced likelihood of planning future preventive visits (). Population-level evidence further supports these findings. Using Behavioral Risk Factor Surveillance System data, Wael Sabbah and colleagues found that emotional experience of racial discrimination significantly predicted a lower likelihood of dental visits among United States (U.S.) adults (). Collectively, these studies suggest that oral health inequities arise from both structural barriers and interpersonal discrimination.
Emerging research also highlights mechanisms through which discrimination in oral health care contributes to reduced utilization. Sokoto et al. found that experiences of racism in dental settings were significant predictors of dental care–related fear and anxiety, which in turn predicted lower dental utilization among Black/African American women (). The relationship between racism in oral health care settings and dental utilization was mediated by dental fear and anxiety, suggesting that discriminatory encounters may discourage care by fostering emotional distress and avoidance. Evidence of discrimination shaping oral health behaviors is not limited to the U.S. In a Brazilian study, researchers found a negative relationship between preventive dental attendance and discrimination based on social class (). Additionally, perceived racial discrimination is linked with higher frequencies of poor oral health in Australian adults, suggesting that socially marginalized groups have a higher burden of oral health effects based on racial discrimination (). Collectively, these findings highlight discrimination as a pervasive and consequential determinant of oral health across diverse contexts.
While a growing body of research has documented oral health outcomes among racially minoritized populations, less is known about how discrimination, specifically in oral health care settings, can affect outcomes for sexual and gender minoritized adults. Results from the Kaiser Family Foundation Survey of Racism, Discrimination, and Health show that LGBTQ+ [lesbian, gay, bisexual, transgender, queer/questioning, and other identities ()] adults experienced significantly higher rates of discrimination across healthcare settings compared to non-LGBTQ+ adults, including receiving poorer treatment, feeling mistrustful of providers, and avoiding dental care due to prior negative encounters (). A study of discrimination in medical settings found that LGBTQ+ patients report higher levels of perceived discrimination by their providers, lower overall patient satisfaction, and worse physical health outcomes in comparison to their heterosexual and cisgender counterparts (). These studies suggest that LGBTQ+ populations encounter systemic barriers within healthcare environments that potentially undermine trust and lower engagement, factors that are important for preventive and routine care.
However, evidence on how these dynamics manifest in dental care for LGBTQ+ individuals remains limited. Empirical studies examining LGBTQ+ patient experiences in dental settings are scarce and geographically limited. One of the few available studies, conducted by Tharp and colleagues, documented discomfort, perceived unfair treatment, and barriers to care among LGBTQ+ patients in oral health settings in Indiana and Michigan (). However, the researchers noted the lack of broader, population-based data to draw causal conclusions. Narrative reviews further underscore this gap, concluding that LGBTQ+ oral health disparities, particularly experiences of discrimination within dental care, remain largely underexplored in national surveillance and epidemiologic research (). Recent descriptive reports from CareQuest Institute for Oral Health using data from the nationally representative State of Oral Health Equity in America survey have highlighted disparities and inequities among LGBTQ+ populations, including LGBTQ+ people of color, emphasizing the need for analyses of large-scale data sets to examine these disparities on a national level (, ).
Evidence from other healthcare contexts provides reason for concern that compounded inequities may exist in oral health care. In 2020, The National Academies of Sciences, Engineering, and Medicine documented how structural and interpersonal stigma, including misgendering, exclusionary policies, and lack of provider cultural competence, erode trust and reduced healthcare utilization among LGBTQ+ populations (). Given that dental care is considered invasive and dependent on patient–provider trust, the lack of robust data on LGBTQ+ experiences in dental settings represents a critical gap in oral health equity research. Addressing this gap is essential for understanding how discrimination and distrust may shape oral health behaviors and outcomes among LGBTQ+ adults and for informing inclusive, patient-centered approaches to dental care delivery.
This study examines discrimination and microaggressions experienced in the dental setting by individuals identifying as part of the LGBTQ+ community. Bivariate analyses of the nationally representative data from the State of Oral Health Equity in America (SOHEA) survey were used to examine differences discrimination and microaggression experiences by LGBTQ+ status, sexual orientation type, and gender identity, and multivariable models examined these differences while adjusting for key demographic variables. It was hypothesized that individuals identifying as part of the LGBTQ+ community, as sexual orientation minorities, or as gender identity minorities would report more discrimination and microaggressions than non-LGBTQ+ individuals.
Materials and methods
Study design and data source
Data for this study came from the 2022–2025 waves of the annual State of Oral Health Equity in America (SOHEA) survey. SOHEA is a nationally representative survey designed to assess adults' oral health–related attitudes, experiences, and behaviors (, , ). Collaborators from CareQuest Institute for Oral Health developed the survey with feedback from external collaborators and was pre-tested (48 adults in December 2021 for the 2022 round; 119 adults in January 2023 for the 2023 round; 25 in February 2024 for the 2024 round, and 59 in December 2024 for the 2025 round). NORC at the University of Chicago administered the survey online (96.7% in 2022; 96.2% in 2023; 96.2% in 2024; 97.3% in 2025) and via telephone (3.3% in 2022, 3.8% in 2023; 3.8% in 2024; 2.7% in 2025) in four rounds in January–February 2022 and 2025, February–March 2023, and March–May 2024, with adults aged 18 and older as part of the AmeriSpeak panel (, ). The WCG Institutional Review Board reviewed this study protocol and determined it to be exempt from Human Subjects review.
AmeriSpeak is a probability-based panel designed to be representative of the U.S. household population (). Sampled households were recruited via U.S. mail, telephone, and in-person field interviews. In the 2022 survey round, a sampling frame of 17,603 households yielded a final analytic sample of 5,682 respondents, corresponding to a survey completion rate of 32.3%. In the 2023 round, the sampling frame, final sample, and completion rate were 18,521 households, 5,240 respondents, and a 28.3% completion rate. In 2024, these figures corresponded to 22,448 households, 9,307 respondents, and a 41.5% response rate; in 2025, there were 19,193 households, 9,450 respondents, and a 49.2% response rate.
Participants
Participants were adults aged 18 and above participating in the SOHEA survey through the Amerispeak panel. Each adult responded on behalf of themselves and others in their household. Adults were ineligible to participate if they were under the age of 18 or if someone living in their household had already participated in that year's SOHEA survey.
Dependent variables
Respondents reported their experiences with discrimination in the dental setting using the Everyday Discrimination Scale—Oral Care (EDSOC). Prior research adapted the 7-item EDSOC from the medical version of the Everyday Discrimination Scale for relevance to the dental setting (, , ). The EDSOC items ask respondents to indicate how frequently they experienced a discriminatory situation in an oral health care setting within the prior year (e.g., “How often have any of the following things happened to you in the last year? You felt that a dental provider or a member of the dental team acted as if they were better than you”) on a 5-point scale (0 = never; 1 = rarely; 2 = sometimes; 3 = mostly; 4 = always). Total scores range from 0 to 28, with higher scores indicating more discriminatory experiences in the dental setting. Prior studies have shown the EDSOC to have good internal reliability (Cronbach's alpha = 0.88) (). This study calculated mean EDSOC scores for groups based on sexual orientation and gender identity.
Participants reported their experiences with microaggressions (i.e., being treated without dignity) in the dental setting using the Dignity in Oral Care Scale (DOCS). The DOCS is a 4-item scale that asks respondents how much they agree with statements regarding their most recent dental visit (1 = strongly agree; 2 = somewhat agree; 3 = neither agree nor disagree; 4 = somewhat disagree; 5 = strongly disagree). For example, respondents are asked, “At my last oral health visit, my dental provider respected me.” The DOCS is scored such that higher item scores represent stronger disagreement with positively worded items; total scores range from 4 to 20, with higher scores representing more experiences with microaggressions and less dignity. Prior studies demonstrate that the DOCS has excellent internal reliability (Cronbach's alpha = 0.92) (). This study calculated mean DOCS scores for groups based on sexual orientation and gender identity.
Independent variables and covariates
Respondents reported their sexual orientation as bisexual, gay/lesbian, questioning, other, or straight, and indicated their gender identity as female, male, transgender, or other. Throughout this article, the abbreviation “LGBTQ+” is used to specify the sexual orientations and gender identities that were measured specifically [i.e., lesbian, gay, bisexual, transgender, questioning/queer, and other (+)] (). Covariates included age in years (18–29, 30–44, 45–59, or 60 or above), race/ethnicity (Asian/Pacific Islander, non-Hispanic; Black/African American, non-Hispanic; Hispanic/Latino/a/x; Other, non-Hispanic, or White, non-Hispanic), annual household income (less than $30,000, $30,000 to under $60,000, $60,000 to under $100,000, or $100,000 or more), highest education level achieved (less than high school, high school graduate or equivalent, vocational/associate's degree, bachelor's degree, or postgraduate/professional degree), employment status (working—paid employee or self-employed or not working—retired, disabled, or other), and dental insurance status (have dental insurance or do not have dental insurance).
Statistical analyses
This study calculated descriptive analyses to analyze and summarize the overall sample variables as well as means and standard deviations for continuous variables, including the EDSOC and DOCS scales. Counts and percentages summarized categorical variables, such as gender identity, sexual orientation, LGBTQ+ status, age category, race/ethnicity, income, education, dental insurance coverage, and employment status. Analyses include unweighted analyses in order to improve statistical precision and stability, particularly given the focus on LGBTQ+ status, gender identity and sexual orientation rather than population-level estimates. This study compared mean EDSOC and DOCS scores (with standard deviations) between LGBTQ+ and non-LGBTQ+ groups. Analyses did not include data from respondents who did not have complete EDSOC or DOCS responses or did not respond to either gender identity or sexual orientation questions.
Descriptive analyses examined differences in discriminatory treatment and dignity experiences across LGBTQ+ status, sexual orientation groups, and gender identity. This study compared continuous variables, including the EDSOC and DOCS scales, between two groups using the Wilcoxon rank-sum test or across multiple groups using the Kruskal–Wallis rank-sum test, given the non-normal distribution of these measures. Person's chi-square tests examined differences between groups on categorical variables such as age, race/ethnicity, income, education, employment, and dental insurance status. All tests assessed overall group differences without adjustment for multiple comparisons, as analyses were limited to a priori comparisons and global tests of association, reducing concern for inflated type I error due to multiple comparisons. A two-sided p-value threshold of 0.05 represented statistical significance.
A series of multivariable linear regression models examined the association between the primary identity variables with EDSOC and DOCS scores. Each model included one primary identity variable of interest (e.g., sexual orientation identity, gender identity, or LGBTQ+ status) while adjusting for sociodemographic characteristics, including age category, race/ethnicity, household income, education level, dental insurance status, and employment status. Models included unweighted data, consistent with the analytical goal of identifying group differences rather than generating population-level estimates. These models produced results as β (beta) coefficients, 95% confidence intervals, p-values, and r-squared.
Results
The study sample consisted of 15,591 adults who participated in the 2022–2025 rounds of the SOHEA survey who had complete data (52.5% of the entire sample of N = 29,679 from across 4 years); Table 1 presents the demographic characteristics of the study sample. Twelve percent of the sample identified as LGBTQ+. In terms of sexual orientation, the largest percentage represented after heterosexual/straight (88%) was bisexual (4.4%). More than half of respondents (56%) identified their gender identity as female, 43% as male, 0.6% as other, and 0.2% as transgender. The highest percentage of respondents with complete data were aged 60 or above (42%), white, non-Hispanic (70%), had a vocational/technical/associate's degree or some college (37%), were employed (56%), and had dental insurance (72%; Table 1). Annual household income was equally distributed across four categories.
Table 1
| Variable | Percentage |
|---|---|
| LGBTQ+ status | |
| LGBTQ+ | 12% |
| Non-LGBTQ+ | 88% |
| Sexual orientation | |
| Heterosexual/straight | 88% |
| Bisexual | 4.4% |
| Other | 3.7% |
| Gay/Lesbian | 3.1% |
| Questioning | 1.1% |
| Gender identity | |
| Female | 56% |
| Male | 43% |
| Other | 0.6% |
| Transgender | 0.2% |
| Age in years | |
| 18–29 | 11% |
| 30–44 | 25% |
| 45–59 | 22% |
| 60+ | 42% |
| Race/ethnicity | |
| Asian/Pacific Islander, non-Hispanic | 2.8% |
| Black/African American, non-Hispanic | 10% |
| Hispanic/Latino/a/x | 11% |
| Other, non-Hispanic | 6.1% |
| White, non-Hispanic | 70% |
| Highest education level achieved | |
| Less than high school | 4.3% |
| High school graduate or equivalent | 18% |
| Vocational/associate's degree | 37% |
| Bachelor's degree | 24% |
| Postgraduate/professional degree | 18% |
| Annual household income | |
| Less than $30,000 | 22% |
| $30,000 to under $60,000 | 26% |
| $60,000 to under $100,000 | 25% |
| $100,000 or more | 27% |
| Employment status | |
| Working—paid employee or self-employed | 56% |
| Not working—retired, disabled, or other | 44% |
| Dental insurance status | |
| Has dental insurance | 72% |
| Does not have dental insurance | 28% |
Demographic characteristics of the study sample (N = 15,591).
Figure 1 shows EDSOC (discrimination) and DOCS (microaggression) scores by LGBTQ+ status, sexual orientation, and gender identity. Individuals identifying as LGBTQ+ had statistically significantly higher EDSOC [mean = 2.97, standard deviation (sd) = 4.99]) and DOCS (mean = 2.19, sd = 3.22) scores than non-LGBTQ+ individuals (EDSOC mean = 1.72 (sd = 3.79), DOCS mean = 1.62 (sd = 2.80, p < 0.001). Regarding sexual orientation, individuals identifying as questioning had significantly higher mean EDSOC [mean = 4.92 (sd = 6.57)] and DOCS [mean = 2.90 (sd = 3.44)] scores than individuals identifying as heterosexual/straight [EDSOC mean = 1.70 (sd = 3.76), DOCS mean = 1.61 (sd = 2.79, p < 0.001)]. In terms of gender identity, individuals identifying as other had significantly higher EDSOC [mean = 5.75 (sd = 6.32)] and DOCS [mean = 3.78 (sd = 4.10)] scores than individuals identifying as female [EDSOC mean = 1.88 (sd = 3.92), DOCS mean = 1.61 (sd = 2.82, p < 0.001)] and significantly higher DOCS [mean = 3.78 (sd = 4.10)] scores than individuals identifying as male [mean = 1.74 (sd = 2.85, p < 0.001)].
Figure 1
After controlling for the confounding variables of age in years, race/ethnicity, highest education level achieved, annual household income, employment status, and dental insurance status, individuals identifying as LGBTQ+ scored significantly higher on the EDSOC measure than non-LGBTQ+ individuals [β = 0.16, 95% confidence interval (CI) = 0.11, 0.21; p < 0.001; Table 2; Appendices A–C]. Compared to individuals identifying as heterosexual/straight, those identifying their sexual orientation as other, gay/lesbian, or questioning scored significantly higher on the EDSOC measure, indicating experiencing more discriminatory treatment in dental settings (p's < 0.01). Individuals identifying their gender identity as other scored significantly higher on the EDSOC measure than individuals identifying as male (β = 0.64, 95% CI = 0.45, 0.84; p < 0.001).
Table 2
| Variable | Beta | 95% CI | p-value | R2 |
|---|---|---|---|---|
| LGBTQ+ status | 0.12 | |||
| Non-LGBTQ+ | ref | ref | ref | |
| LGBTQ+ | 0.16 | 0.11, 0.21 | <0.001 | |
| Sexual orientation | 0.13 | |||
| Heterosexual/straight | ref | ref | ref | |
| Bisexual | 0.04 | −0.04, 0.11 | 0.3 | |
| Gay/Lesbian | 0.13 | 0.05, 0.22 | 0.002 | |
| Other | 0.15 | 0.07, 0.23 | <0.001 | |
| Questioning | 0.62 | 0.48, 0.77 | <0.001 | |
| Gender identity | 0.12 | |||
| Male | ref | ref | ref | |
| Female | −0.02 | −0.05, 0.01 | 0.2 | |
| Other | 0.64 | 0.45, 0.84 | <0.001 | |
| Transgender | 0.24 | −0.07, 0.55 | 0.13 |
Multivariable regression models for discrimination/EDSOC scores.
Ref = reference category; models control for age in years, race/ethnicity, highest education level achieved, annual household income, employment status, and dental insurance status; italicized row = significant at the p < 0.05 level.
After controlling for confounding variables, individuals identifying as LGBTQ+ scored significantly higher on the DOCS measure than non-LGBTQ+ individuals (β = 0.08, 95% CI = 0.03, 0.13; p = 0.003; Table 3; Appendices D–F). Compared to individuals identifying as heterosexual/straight, those identifying as questioning scored significantly higher on the DOCS measure (β = 0.29, 95% CI = 0.13, 0.46; p < 0.001), indicating experiencing more microaggressions in dental settings. Individuals identifying their gender identity as female scored significantly lower on the DOCS measure (β = −0.12, 95% CI = −0.15, −0.88; p < 0.001) than those identifying as male. Meanwhile, individuals identifying their gender identity as other had significantly higher DOCS scores than males (β = 0.42, 95% CI = 0.18, 0.66, p < 0.001).
Table 3
| Variable | Beta | 95% CI | p-value | R2 |
|---|---|---|---|---|
| LGBTQ+ status | 0.08 | |||
| Non-LGBTQ+ | ref | ref | ref | |
| LGBTQ+ | 0.08 | 0.03, 0.13 | 0.003 | |
| Sexual orientation | ||||
| Heterosexual/straight | ref | ref | ref | 0.08 |
| Bisexual | 0.07 | −0.01, 0.15 | 0.10 | |
| Gay/Lesbian | 0.03 | −0.07, 0.12 | 0.6 | |
| Other | 0.09 | 0.00, 0.18 | 0.055 | |
| Questioning | 0.29 | 0.13, 0.46 | <0.001 | |
| Gender identity | 0.09 | |||
| Male | ref | ref | ref | |
| Female | −0.12 | −0.15, −0.88 | <0.001 | |
| Other | 0.42 | 0.18, 0.66 | <0.001 | |
| Transgender | 0.32 | −0.04, 0.68 | 0.082 |
Multivariable regression models for microaggression/DOCS scores.
Ref = reference category; models control for age in years, race/ethnicity, highest education level achieved, annual household income, employment status, and dental insurance status; italicized row = significant at the p < 0.05 level.
Discussion
After adjusting for sociodemographic and insurance-related factors, individuals identifying as LGBTQ+ reported significantly higher levels of both discriminatory treatment and microaggressions in dental settings compared with non-LGBTQ+ individuals. Sexual orientation and gender identity differences emerged, with gay/lesbian, questioning, and gender-diverse individuals experiencing higher discrimination and microaggressions, while individuals identifying as female reported fewer microaggressions than males. Overall, the findings indicate persistent disparities in dental care experiences associated with LGBTQ+ identity.
The findings of this study support and expand prior work that shows individuals from racial/ethnic minoritized groups experiencing substantial discrimination and microaggressions in the dental setting (, , , ). A scoping review demonstrated implicit bias among oral health care providers, faculty, and students toward individuals from racial/ethnic minoritized groups that may result in poorer oral health treatment outcomes (). Given known evidence of stigma in oral health care toward minoritized groups, it is critical to understand the prevalence of such discrimination faced by individuals identifying as LGBTQ+.
When examining discriminatory treatment and microaggression experiences across LGBTQ+ status, sexual orientation groups, and gender identity, a multi-year, large nationally representative sample, and consistent survey design over multiple years with previously validated dependent measures yielded comparison and significant results. Additionally, previous research demonstrated the need for detailed sexual orientation and gender identity categories to reduce misclassification and increase representation (, ). SOHEA's survey design collects both binary (male/female) and non-binary (transgender, other) gender identity, categories sexual orientation as bisexual, gay/lesbian, questioning, other, or straight, and uses gender neutral terminology in survey questions. Further research and evaluation should focus on the adoption of standardized responses for gender identity and sexual orientation.
Key limitations of this study include its cross-sectional design, self-reported data, lack of weighting, and small subgroup sizes. The cross-sectional design of the survey design does not allow for causal conclusions. Additionally, the data collected in this survey are self-reported; responses may be affected by recall bias and reporting bias possibly due to societal changes, current health challenges, and social desirability responsiveness. While the survey is nationally representative, analyses did not apply survey weights; therefore, findings should be interpreted as analytic associations and may not be fully generalizable to the U.S. LGBTQ+ population. Just over half of the entire sample had complete data with regards to all EDSOC and DOCS items and questions about sexual orientation and gender identity, limiting the generalizability of the results somewhat due to potential selection bias. However, the percentages of those identifying as LGBTQIA+ (12%) in this sample is consistent with U.S. estimates (). Furthermore, small, absolute numbers in transgender and other identity categories limit comparability and may have joined identities and experiences into one category, further obscuring differences between identities (, ). Future research with larger sample sizes should aim to disaggregate data on gender identities to paint a clearer picture of differences between identities.
The findings of this study emphasize the critical need for inclusive, affirming dental practice environments in which patients of all sexual orientations and gender identities feel comfortable and accepted. As experiencing discrimination in the dental setting is linked to poor self-rated oral health and avoidance of dental care (), providing oral health care that is free of discriminatory treatment and microaggressions is key to ensuring that LGBTQ+ individuals are able to receive care that optimizes their oral health.
Culturally responsive care should be integrated into dental education, training, and licensure frameworks. A recent climate survey by the American Dental Education Association (ADEA) found that dental students, allied dental profession students, staff, faculty, and administrators identifying as LGBTQ+ reported less satisfaction with their academic program and employment and more experiences with discrimination and harassment than their non-LGBTQIA counterparts (, ). While many dental schools signal broad support for diversity, LGBTQ+ inclusion, especially in curriculum and clinical training, remains limited, inconsistent, and largely informal, leaving graduates underprepared to meet the oral health needs of queer and transgender patients (). Increasing representation of LGBTQ+ staff, faculty, and administration in oral health education programs is key to improving a sense of inclusion and belonging within the educational setting and beyond (). Pre-doctoral, post-doctoral, and continuing education programs aimed at increasing cultural responsiveness in providing care to LGBTQ+ patients should be included as part of training and licensure requirements ().
Conclusions
LGBTQ+ adults, especially questioning and other identity groups, experience disproportionate discrimination and microaggressions in dental care compared to non-LGBTQ+ adults. As experiencing discrimination and microaggressions in dental care is linked with poor oral health outcomes, it is critical to address provider biases and structural inequities to provide culturally responsive, supportive, and inclusive care to LGBTQ+ individuals.
Statements
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The WCG Institutional Review Board reviewed this study protocol and determined it to be exempt from Human Subjects review.
Author contributions
MS: Conceptualization, Formal analysis, Investigation, Software, Validation, Writing – original draft, Writing – review & editing. LH: Conceptualization, Investigation, Project administration, Visualization, Writing – original draft, Writing – review & editing. HC: Conceptualization, Project administration, Writing – original draft, Writing – review & editing. RP: Conceptualization, Funding acquisition, Project administration, Resources, Writing – original draft, Writing – review & editing. ET: Conceptualization, Data curation, Funding acquisition, Resources, Supervision, Writing – original draft, Writing – review & editing.
Funding
The author(s) declared that financial support was received for this work and/or its publication. CareQuest Institute for Oral Health provided full-time salary support for all authors.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
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Correction Note
This article has been corrected with minor changes. These changes do not impact the scientific content of the article.
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Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/froh.2026.1843339/full#supplementary-material
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Summary
Keywords
adults, discrimination, LGBTQ+, microaggression, oral health
Citation
Santoro M, Heaton LJ, Cheung HJ, Preston RA and Tranby EP (2026) Dental distrust and discrimination: a nationally representative perspective on LGBTQ+ adults' experiences with oral health care. Front. Oral Health 7:1843339. doi: 10.3389/froh.2026.1843339
Received
31 March 2026
Revised
29 May 2026
Accepted
16 June 2026
Published
09 July 2026
Corrected
15 July 2026
Volume
7 - 2026
Edited by
Fawad Javed, University of Rochester, United States
Reviewed by
Ashek Elahi Noor, Atlantic Technological University, Ireland
Logesh Sidhu, Pondicherry Institute of Medical Sciences, India
Updates
Copyright
© 2026 Santoro, Heaton, Cheung, Preston and Tranby.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Lisa J. Heaton lheaton@carequest.org
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.