Gender is a hot topic in the 21C. Oral health not so much. However, these two topics when brought together by circumstance have something important to say to us all about our humanity. The influence of gender on oral health shines a light on some of the cracks in our social fabric, which should concern us.

“The role of sex as a biological variable in the biomedical research has drastically changed over time since regulatory frameworks were established to protect human subjects against the atrocities of the World War II–related medical experiments. At first, research was encouraged to minimize data variance by enrolling participants with similar characteristics (age, gender, weight). As such, women were excluded from clinical trials due to their hormonal differences. Nevertheless, the lack of consideration of sex differences precludes adequate interpretations, and data obtained from one sex cannot be generalized to the other.”
– 1.Sangalli L, Souza LC, Letra A, Shaddox L, Ioannidou E. Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects. Journal of Dental Research. 2023;102(13):1395-1416. doi:10.1177/00220345231197143

The afore-mentioned sentence that women were excluded from clinical trials due to their hormonal differences should set off alarm bells in the awareness of readers. This is a keen example of the bias of science over the years, as men dominate the science departments at our universities and institutions globally. The cultural dominance of the male seeds their pre-emptive concerns over all others in science and most other areas of human life. Did you know that when women were first allowed to attend universities at the turn of the 20C, the deans of faculties used to pointedly challenge them that they were taking the place of a deserving man. This happened to Ruth Bader Ginsburg at Columbia University, where she went on to graduate first in her class at Columbia Law School. She would become one of the finest Supreme Court justices of the United States from 1993 until her death in 2020.

The Female Gender Marginalised in Oral Health Studies

Therefore, in the studies of oral health women were not included for many years and in the results of this research – the data and conclusions were transposed upon women. Assumptions were made and this is sloppy, bad science. This arrogant male science made women second class citizens, which of course men have been doing for millennia. Did you know that in Ancient Greece, especially in Sparta, men in their late 20’s and early 30’s were assigned a young male in puberty as student/lover. This is where we get the Greek term paedophilia from. They would teach their protégé how to become a man. We find such sexual relationships revolting in this day and age. I bring it up here to highlight not the paedophilia but what it says about the Ancient Greeks’ attitude to women. Women ranked far below men on the scale of their respect for intelligence and rationality. The female was kept in the home and her purpose was primarily for breeding. The Western European intellectual and cultural traditions have maintained Ancient Greece and Rome as the apogee of our Golden Ages. The great divide between men and women in the power stakes has its roots in these Classical assumptions regarding the place of men and women in society.

Women’s Health Institutionally Neglected For Centuries

Of course, transposing assumptions from male derived data to females does not work, as the physiologies have distinct differences. The truth of the matter is that the health sciences had enormous black holes in their data bases when it came to women. This is neglect and arrogant indifference writ large by a male dominated society serving its own constituents in disregard of its partner species. It is difficult for many to get their head around the way the world was just a short time ago. Women’s liberation was not about burning bras, rather it was about women setting up their own health and medical centres in cities across the Western world in the 1960s and 1970s onwards. It was about filling this immense void with women doctors, dentists, and female researchers. The media, because it was and is male dominated, did not cover this with due regard, of course. A huge and largely quiet revolution has occurred in women’s health without the ego driven fanfare of male achievements in the public space. Women have been putting up with second rate service from men from time immemorial and the sciences are no different. Still today, we hear that the STEM subjects are largely controlled and dominated by male academics to the detriment of those girls wanting to break into these fields.

“Subsequently, in 1986, the National Institutes of Health (NIH) instituted the first policy that encouraged women to be included in clinical trials. The risen attention given by research funding agencies (such as the NIH, the European Commission, and the Canadian Institutes of Health Research) on sex/gender led biomedical research to critically investigate the differences between sex/gender in diagnosis, prevention, and treatment of several diseases. “
– Sage Publication

Worth Still Dividing Women From Men

The influence of gender on oral health has been profound in all the wrong ways. When I was a kid, the only women you saw at the dentist were in the hygienist nurse and receptionist roles. Women mattered only in the home and in servile roles around the edges of the main game. Still today, we see an income divide of considerable measure in 2023/4.

– The national gender pay gap, on base salary, is 13.3%.
– For every $1 men make on average, Australian women make 87 cents.
– On average, women working full-time earned a base salary of $1,653.60 per week, while men working full-time earned $1,907.10.
– This means women earn $253.50 less than men every single week as a result of gender.
– WGEA.gov.au

Transgender People & Oral Health

Things are getting better for women, slowly, which is not something we can say for gender diverse people.

“Transgender and gender nonconforming (TGNC) people are a marginalised set of the population that continues to experience health care inequalities. Poor oral health and significant oral mucosal disorders were reported in transgender adults that have shown a higher rate of behavioral risk factors such as tobacco and alcohol consumption. Further longitudinal studies in different world regions are warranted to understand the barriers to good oral health in transgender adults and how to implement effective prevention and management strategies.”
– BM Coral Health Biomed Central

Gender identity has become a lightning rod for social conservatives around the world. Religious groups take umbrage at those human beings who dare to question God’s dealt hand in the game of life. Book banning and attacks on queer storytelling at libraries in the US and elsewhere are becoming a new crusade for the hardline religious right. What may be so appalling about the attitude of these members of our communities is that they want to impose their beliefs upon the greater community around them. These socially conservative crusaders want to prevent gender diverse people from taking part in community activities. These Moms For Liberty take offence at the existence of books written for those in the transgender community. They want to turn back the clock to a time when LGBTQIA folk had no rights and suffered on the fringes of our societies.

Treating Transgender Over Time

Studies into the oral health of members of the transgender community have revealed poor standards of health. The inference stated by researchers is that this group of human beings have suffered social stigma, violence, and socioeconomic problems stemming from their appearance. Unemployment is often a common issue for transgender individuals, as they do not fit in with societal expectations. Gender is a primal button for many of us, especially non-college educated or working class folk. They often have visceral reactions to transgender people and take such things personally. In Sydney for many decades in the 1970’s, 80’s and 90’s groups of angry young men would bash and murder gay and transgender men. The NSW police did little to investigate these hate crimes and enquiries are still going on today in regard to these offences.

Smoking and drinking alcohol became habitual behaviour refuges for transgender folk in reaction to the stress. Depression, drug use disorder, and attempted suicides were far too common in such a small population sample. Something like more than 40% of transgender folk have tried to kill themselves compared to just 2% of the general population in the US. (Manpreet, 2021)

“However, oral examination in the present study reported a significantly higher prevalence of oral mucosal lesions (p = 0.026), such as oral ulcers, leukoplakia, nicotine stomatitis, and malignant tumors among the TGNCs compared to the control group (Table 2). During the study period, one transgender person was diagnosed with oral cancer involving the right buccal sulcus area. “
– Manpreet, K., Ajmal, M.B., Raheel, S.A. et al. Oral health status among transgender young adults: a cross-sectional study. BMC Oral Health 21, 575 (2021). https://doi.org/10.1186/s12903-021-01945-x

Conclusions & Gender In Oral Health

The moral of the story is that shunning and demonisation by the wider community has serious consequences for the health of those in the cross hairs of the righteous among us. White heterosexual people are inordinately sensitive about their right to stamp out diversity from their populations. Bronze Age religious doctrines call for the stoning of such sinners and for God to smite them from existence. Our mouths are probably one of the most intimate receptacles and poor oral health is not surprising when life leaves such a bad taste in your mouth.

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