Beyond Demographics: Sex, Gender, and Sexuality in Oral Health Research.

Abstract

Sex, gender, and sexuality are crucial and interrelated factors influencing oral health outcomes, yet they are often overlooked and inadequately addressed in human studies on oral health. Biological sex influences oral disease susceptibility through hormonal, immunological, and microbiome-related mechanisms. Concomitantly, gender as a social construct modulates health through psychosocial stress, health care access, and societal norms. Sexuality intersects with oral health through behavioral risks, stigma, and discrimination, especially among lesbian, gay, bisexual, transgender, and queer or questioning populations. Despite their importance, oral health research often treats sex as a binary demographic variable, excluding sexual and gender minority individuals. There is a lack of meaningful integration of these variables across all phases of research, from proposal development and data collection to analysis and knowledge creation. This results in limited generalizability, perpetuates health inequities, and impedes the development of inclusive, evidence-based, and person-centered interventions. Furthermore, dental education and research training programs often lack comprehensive content on sex, gender, and sexuality, contributing to research approaches and training that reinforce binary-centered investigations. Substantial gaps in mentorship, representation, and inclusive curricula largely contribute to the underrepresentation of gender-diverse scholars and leaders in oral health. To address these gaps, a multipronged action plan is necessary, including an inclusive research design, robust data collection tools, curriculum reform that integrates person-centered frameworks, community engagement and service-learning, policy change, and accountability mechanisms. The integration of intersectionality, pertinent sex, gender, sexuality, and social determinants of health in oral health research and education is essential for achieving scientific rigor, health equity, and culturally responsive care for all populations.