Investigating sexual orientation-related oral health disparities in the United States

Objective. Recent evidence has documented health disparities according to sexual orientation. Despite the Surgeon General’s call to investigate oral health disparities among lesbian, gay, and bisexual (LGB) individuals, data in this domain are limited. To address this knowledge gap, we investigated objective and subjective oral health indicators among LGB adults in the United States (US).

Methods. We used data from 2 cycles (2009-2012) of the National Health and Nutrition Examination Survey (NHANES), a sample representative of the US community-dwelling population, restricting analyses to 18-59 year-olds. We considered objective measures such as: dental caries, chronic periodontitis, natural remaining teeth, oral HPV DNA. Additionally, we examined self-reported oral health status and receipt of oral health services. We obtained overall and sex-stratified crude and adjusted marginal estimates, accounting for the complex sampling design. We contrasted strata of heterosexual, gay/lesbian, and bisexual participants using a multiple-testing corrected P<0.05 criterion.

Results. We found no differences in clinical oral health measures; however, gay males had 42% higher oral HPV prevalence than heterosexual males (15.4% versus 10.8%). Significant differences were noted in subjective oral health for both sexes: more bisexuals rated their oral health as fair/poor (41.6%) than homosexuals (26.7%) and heterosexuals (27.4%). Homosexuals, particularly males, had the highest reports of “bone loss around teeth” and having “had gum treatment”.

Conclusion. We found significant differences in subjective ratings but not clinical measures of oral health according to sexual orientation. This finding warrants further investigation via studies of the psychosocial construction of oral health among the LGB population.