Following on from LGBTQ+ History Month, I spoke to Dental Core Trainees Anisha Gupta and Ifan George about their experiences - both personally and treating patients - and whether dentistry does enough to support the LGBTQ+ community.

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How would you describe your experiences of inclusion, respect and understanding throughout dental school and in your jobs?

IG I grew up in a small, conservative town in Shropshire on the border of Wales where diversity was severely lacking. Studying in Liverpool was a huge eye-opening experience and a chance to meet so many people from different backgrounds, faiths, sexual orientations, cultures and beliefs. In a city where every group could find a community this was a chance for people to find their 'niche'.

This has continued into dental core training; I have found this wealth of people. National recruitment has played its part in minimising prejudice and stopping posts becoming 'a job for the boys'. It's not who you know but what you know.

AG Since graduating I have been lucky to have experienced a culture of inclusion, respect, and understanding within the NHS - both in general dental practice and in a hospital setting. I was briefly involved in the LGBT Staff Network at King's College Hospital and won a competition to redesign their logo. At dental school things were a little different - I do remember once having to tell off some of my younger undergraduate classmates for using the word 'gay' as an insult (they were sat behind me in a lecture, attempting to insult each other) - they took the feedback on board and there weren't many incidents like this, but it's always a bit surprising and disheartening to hear young people, including colleagues within healthcare, making jokes at the expense of gay and transgender people.

What are your thoughts on patients seeking out a dentist that reflects their beliefs/values - in this case LGBT inclusive?

AG Patients are in a uniquely vulnerable position, and need to be able to feel that their dentist respects them and will treat them with empathy. If a dentist, or any healthcare professional, is able to cultivate an environment of safety, trust, and respect, this benefits both the patient and the team to be able to work in a more relaxed environment. LGBT people experience health inequalities - in part due to a reluctance to engage with health services due to a fear of discrimination. It's important that barriers to access are reduced for any group facing health inequalities, and one way to do this is to foster environments of inclusivity.

IG Patients need to feel at ease with their practitioner; receiving dental treatment is a very intimate procedure between dentist and patient and anxiety and phobias of dentists is more common now than ever. A patient should feel they can be treated with dignity and respect and if they are able to find a dentist who accepts their beliefs and values this can lead to a great working relationship of trust and mutual respect.

How important is it that a dentist knows how a patient identifies?

AG I think this varies depending on the patient. Some patients might be keen for their sex, gender, or sexual orientation to be known by their healthcare professional, especially if they feel it is impacting their health or relevant to the care they might receive. Other patients may prefer for their identity to stay more private, and in general, most oral healthcare can be provided safely and effectively without necessarily knowing what sex, gender or orientation a patient is.

I do think that it is important that all patients, LGBT or otherwise, are respected with regards to how they like to be referred to, whether by their chosen first name as I might usually do for a younger patient, or by their title/honorific and their surname, which I tend to default to for older patients, unless they specify otherwise. I think it's particularly important when sharing clinical information, or making medical records, for example in any letters of correspondence (use of a patient's correct pronouns, name, title) - no one wants the wrong details on their paperwork.

IG Someone's identity is a fundamental part of who they are. If a practitioner knows how to address someone this can make a patient feel like they are valued and not just another 'customer'. It may be important to have such identifiers on a patient's record so members of the dental team know how patients wish to be addressed. Acknowledging someone's preferred pronouns is a small change a dentist can make which may have a huge positive impact on a patient where they feel respected.

Is dentistry progressive enough to lead on solidarity, being an ally and advocate for minority groups, or do you see it following the wider 'healthcare' industry?

AG If I'm brutally honest, I don't think dentistry in the UK is progressive enough to lead on solidarity, allyship and advocacy. We should be doing all these things, and as healthcare professionals we should be advocates for improving the health outcomes for all marginalised groups. The fragmented nature of the public/private provision of dental care means that practitioners are often isolated and it is harder to build solidarity when working in this way.

Montgomery, consent and treatment plans are pillars of dentistry. Could this put them in a position to discuss Gender Dysphoria with patients?

AG With the correct training, education and support, dentists are able to discuss health issues and conditions with patients - we already do this, to a degree, with conditions such as diabetes, pregnancy, and HIV. If a patient initiates a discussion, as healthcare professionals, dentists should be able to listen to a patient's thoughts and concerns, be respectful and empathetic, and be able to at the very least, signpost to other sources of support and advice.

It's often said that because patients (should) see their dentist regularly that there's a better relationship there than with their GP. Would you agree?

IG I would agree a relationship between patients and dentist may be stronger compared with a GP; we see patients as frequently as every 3 months. This is especially important with children who we are able to watch grow and develop into young adults when seeing them for a long time. At this age they may be discovering their identity and who they are as a person. In this way, we can build up a strong relationship of trust so patients feel like they may share important details with us.

AG I think it's true that some dentists know their patients better than the GP, particularly in the case of a patient with low medical needs and therefore rarely goes to their GP, but meticulously attends their dentist every six months for a checkup. And also for patients who have been seeing the same dentist, or attending the same dental practice, since their childhood. I think it varies hugely though, and one thing I've noticed already in this early stage of my career is that many patients struggle to see the same dentist regularly, which I think is a reflection of barriers to access, and the dental job market in current times, where younger dentists in particular often move frequently between practices in jobs. Additionally, in the NHS, patients are no longer 'registered' with a dentist, and so may not be able to see the same dentist regularly. So I'm not sure if it's still necessarily true for all patients that they have a better relationship with their dentist than their GP.

What needs to happen for dental practices/dentistry to become more LGBT inclusive?

IG Having positive conversations at lunchtime about a patient who may have attended is a chance to educate the dental team and to let people know we should be accepting of others and how people may be facing battles we may not have ever thought of. Call out anti-trans or homophobic abuse whenever you see it such as microaggressive comments passed off as a 'joke'.

The queer, trans communities, and most importantly trans people of colour are some of the most marginalised members of our society and anyone accessing healthcare should feel safe where they may not in wider society. In 2016, when accessing healthcare, two in five trans people said healthcare staff lacked understanding of trans health needs. 1 in 4 trans people have also experienced homelessness and 24% of homeless young people identify as LGBT.

February was LGBTQ+ History Month. This may be a good opportunity to raise awareness, educate other patients and display information about local services and support - similar to Mouth Cancer Action Month and National Smile Month. Displaying such information allows people who may not feel like they are able to disclose something to change their mind.

AG I think practitioners need to be aware of their biases and assumptions, and be sensitive to the issues that impact people from gender and sexual minority groups. I think as a healthcare profession we should be more vocally supportive of those facing discrimination. The recent popularity of Russell T Davies' TV show 'It's a Sin', highlighting the impact of the AIDS crisis on young people in 80s Britain, should be a reminder of the dangers of fear and stigma within the political and media narratives around LGBT people. I see patients on clinic who tell me about the discrimination they faced trying to access dental care in the not so distant past, and am reminded that Section 28 was still in place when I was in primary school.

Reports of hate crimes against gay, lesbian, bisexual and transgender people nearly tripled between 2015 - 2020. Transgender people in particular have been the target of increasingly hostile attacks by mainstream media, with many 'fears' echoing those leveraged against gay men in the 80s during the AIDS crisis (notions of 'spreading disease' and 'preying on young children' being common tropes for both groups). Let's make sure as dentists we are on the right side of history when it comes to supporting LGBT people and challenging homophobic or transphobic rhetoric and policy when we see it. â—†