Ethical and other considerations when treating transgender patients

Transgender patients can face obstacles when seeking dental care, but through education and communication, dentists and their teams can help make these patients feel accepted and comfortable.

Dr. Farmer

“One of their main concerns is whether the provider and dental team will be accepting,” said Dr. Michael Farmer, who owns a dental practice in Charlotte, North Carolina, and graduated from dental school in 2008 and the American Dental Association Institute for Diversity in Leadership in 2019. “If they feel that they are going to be judged or talked about, they may avoid seeking care at all.”

The ADA Principles of Ethics and Code of Professional Conduct states that “dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, gender, sexual orientation, gender identity, national origin or disability.”

The ADA Center for Professional Success offers ways for dentists to avoid gender identity discrimination and be inclusive towards all patients at Success.ADA.org.

These steps include adding a blank space as an option to the gender portion of patient intake forms to allow for self-identification; training all staff in office standards of respect towards transgender people, including using their chosen name and referring to them by their chosen pronoun; and having an open dialogue with patients about their gender identity/expression.

Actions such as these relate back to sections of the ADA Code that call for dentists to respect the patient’s rights to self-determination and confidentiality, refrain from harming the patient and promote the patient’s welfare, according to “Understanding the Transgender Patient,” published in the January issue of The Journal of the American Dental Association.

“The most important thing that dentists can do is to educate not only themselves but also their dental team regarding transgender patient care,” Dr. Farmer said. “Talking about it beforehand gets everyone on the same page and lets the staff get their questions answered, creating a better patient experience.”

If dentists or their team members make a mistake with a patient’s preferred name or pronoun, they may wish to apologize directly and let them know they will continue to do their best not to let that happen in the future, he said.

“Overall, education of transgender issues and proper communication will provide the patient with a better experience and a more trusting doctor-patient relationship,” Dr. Farmer said. “By developing dental providers and a dental team that is well educated on gender issues, the office becomes more diverse and better equipped to treat a variety of patients effectively.”

The ADA House of Delegates expanded its definition of diversity to be more inclusive in 2019. The ADA defines diversity through many dimensions, including, but not limited to, race, ethnicity, national origin, gender identity, age, physical abilities/qualities, sexual orientation, religious and ideological beliefs, professional practice choices and personal lifestyle preference, according to the resolution the House passed.

The goal of taking steps to improve transgender patients’ dental experience is to create a provider-patient relationship that allows for optimal care by building trust and a level of comfort in being honest with each other, Dr. Farmer said.

“If the patient does not feel that they can trust the provider, they may not disclose their concerns and may even avoid seeking care when needed,” he said. “Once we have that level of trust, patients can finally be open to making treatment decisions and having honest conversations regarding the options and outcomes.”