Everyday dental problems such as gum disease, tooth decay and delayed check ups do not affect everyone equally, and new research suggests the reasons go far beyond brushing habits or diet. Differences in biological sex, gender roles and sexual identity quietly shape who gets care, how early problems are spotted, and how effective treatment can be. The findings were published in Advances in Dental Research.
A new review highlights how oral health research has traditionally relied on narrow demographic categories, often treating sex as a simple male or female tick box while overlooking gender and sexuality altogether. This approach, researchers argue, leaves significant gaps in knowledge and contributes to avoidable inequalities in dental health and access to services .
Biological sex influences oral health in measurable ways. Hormonal changes across the lifespan affect inflammation, saliva and immune responses, helping explain why certain gum conditions are more common or severe at different stages for men and women. When studies fail to analyse these differences properly, treatments are often based on incomplete evidence that may not work equally well for everyone.
Gender, as a social and cultural experience, also plays a role. Expectations around appearance, health seeking behaviour and caregiving influence how often people attend dental appointments and how they respond to advice. Stress linked to social roles can worsen oral health outcomes, yet these pressures are rarely examined in dental studies.
Sexuality introduces another layer that has been largely ignored. Lesbian, gay, bisexual and other sexual minority groups often face stigma, discrimination or discomfort in healthcare settings, including dental clinics. This can lead to delayed visits, untreated problems and poorer long term outcomes. Research that does not record or analyse sexual orientation risks masking these patterns entirely.
The review also points to a lack of reliable global data. Many people do not disclose their sexual orientation or gender identity, even in surveys, which means existing estimates almost certainly undercount sexual and gender minority populations. This under-reporting makes it harder to identify oral health disparities and design services that meet real needs.
An intersectional perspective is central to the findings. Oral health is shaped by overlapping factors such as sex, gender, sexuality, income, education and geography. Focusing on one factor in isolation fails to reflect real life experiences and can result in policies and interventions that miss those most at risk.
Training and education are highlighted as part of the problem. Dental education has often focused on disease treatment rather than person centred care, with limited teaching on how sex, gender and sexuality influence health. This leaves future professionals underprepared to recognise bias, address barriers, or provide inclusive care.
Globally, the challenges are even more pronounced. In some countries, legal and social hostility towards sexual and gender minorities makes inclusive research and care extremely difficult. This not only limits scientific understanding but can actively endanger lives by restricting access to basic health services.
The authors argue that improving oral health outcomes requires a shift in how research is designed, taught and funded. Integrating sex, gender and sexuality meaningfully into studies is presented not as an ideological choice, but as a matter of scientific accuracy and public health.