A summary of: Hania, M., Roberts, A. and Sharif, M. 2021. Gender incongruence/dysphoria in children and adolescents: overview and implications for dentistry. Br Dent J. 230,369–373. https://doi.org/10.1038/s41415-021-2734-4
Overview of gender dysphoria:
Gender identity is defined as the subjective sense of belonging to a gender category. Incongruity between birth sex and gender ranges on a varied spectrum. Awareness and recognition of gender incongruity has been increasing over the past decade and when associated with symptoms of significant distress/disability the disorder is termed gender dysphoria. The distress/disability ranges from anxiety and depression to suicide. The cause remains ambiguous but biological and psychosocial factors have been linked. As dental clinicians, it is important that we help individuals who are suffering and do not contribute to ignorance towards minority groups in society.
Implications of gender dysphoria for the provision of dental treatment:
To provide safe and effective treatment at the individual patient level, it is essential that the dental team have a sound knowledge of dental dysphoria. The following points illustrate some of the ways in which gender dysphoria and dental treatment are implicated.
- A survey of transgender individuals found that 28% postponed dental treatment due to fear of discrimination and 50% felt there was a lack of clinician knowledge regarding dental implications for transgender individuals.
- Hormone therapy may affect tooth eruption sequence/timing.
- Functional appliances used at the peak of puberty for orthodontic treatment may be affected by puberty suppression.
- Gender dysphoria has been linked with mental health issues; the dental team can identify the clinical manifestations of depression including low motivation for oral hygiene, a neglected dentition and body scars caused by self-harm. Following this, a safeguarding protocol should be followed.
- Be aware that puberty suspension hormone therapy can lead to vasovagal syncope and hot flashes in the dental surgery. Reducing the temperature in the surgery may increase patient comfort.
- Communication is key for effective patient management and use of the patient’s correct pronouns would help to create a welcoming environment throughout treatments (see Table 1.).
- It is important that the dental team understand the clinical implications of the medical and surgical treatment involved in different stages of the gender transition journey. This includes knowledge of drug side effects, drug interactions and contraindications.
- Risks of testosterone hormone therapy include polycythemia, abnormal liver function, high blood pressure and high cholesterol.
- Risks of oestrogen hormone therapy include cardiac problems, blood clots and abnormal liver function.
Table 1. Gender pronouns
Summary by Clare Ginty, UCLan (BDS 4)