Dental Distrust and Discrimination: A Nationally Representative Perspective on LGBTQ+ Adults Experiences with Oral Health Care

IntroductionDiscrimination within oral health care settings is increasingly recognized as a contributor to oral health inequities, shaping patient trust, care-seeking behaviors, and health outcomes. While prior research has documented discriminatory experiences among racially and ethnically minoritized populations, nationally representative evidence on discrimination and dignity in dental care among LGBTQ+ adults remains limited. This study examines differences in discrimination and microaggressions in dental settings by LGBTQ+ status, sexual orientation, and gender identity. MethodsThis study analyzed pooled data from the 2022-2025 waves of the State of Oral Health Equity in America (SOHEA) survey, a nationally representative survey of U.S. adults aged 18 and older. Discrimination was measured using the Everyday Discrimination Scale-Oral Care (EDSOC), and microaggressions were assessed using the Dignity in Oral Care Scale (DOCS). Descriptive and bivariate analyses compared mean scores across identity groups. Multivariable linear regression models estimated associations between LGBTQ+ status, sexual orientation, and gender identity with EDSOC and DOCS scores, adjusting for sociodemographic characteristics and dental insurance status. Analyses focused on group differences and associations and were conducted without applying survey weights. ResultsThe analytic sample included 15,591 adults from the 2022-2025 SOHEA surveys with complete data (52.5% of the total N=29,679); 12% identified as LGBTQ+. Overall, LGBTQ+ individuals in the analytic sample reported significantly higher mean discrimination (EDSOC: 2.97, SD=4.99) and microaggression (DOCS: 2.19, SD=3.22) scores than non-LGBTQ+ individuals (EDSOC: 1.72, SD=3.79; DOCS: 1.62, SD=2.80; p<0.001). Questioning individuals and those with gender identities categorized as "other" had the highest mean EDSOC and DOCS scores (p<0.001). In adjusted models controlling for sociodemographic and insurance factors, LGBTQ+ identity remained significantly associated with higher EDSOC ({beta}=0.16, 95% CI=0.11-0.21) and DOCS ({beta}=0.08, 95% CI=0.03-0.13) scores. Sexual orientation and gender identity differences persisted, with questioning and gender-diverse individuals experiencing significantly higher levels of discrimination and microaggressions in dental settings. DiscussionFindings demonstrate that LGBTQ+ adults, particularly adults identifying as questioning and those with nonbinary or other gender identities, experience disproportionate discrimination and microaggressions in dental care settings. Addressing interpersonal and structural sources of bias in oral health care is critical to advancing equity and improving access to respectful, high-quality care for LGBTQ+ populations.