AUTHOR=Santoro Morgan , Heaton Lisa J. , Cheung Hannah J. , Preston Rebecca A. , Tranby Eric P. 
  
TITLE=Dental distrust and discrimination: a nationally representative perspective on LGBTQ+ adults' experiences with oral health care
  
JOURNAL=Frontiers in Oral Health
  
VOLUME=Volume 7 - 2026
  
YEAR=2026
  
URL=https://www.frontiersin.org/journals/oral-health/articles/10.3389/froh.2026.1843339
  
DOI=10.3389/froh.2026.1843339
  
ISSN=2673-4842
  
ABSTRACT=IntroductionDiscrimination within oral health care settings is increasingly recognized as a key driver of oral health inequities, shaping patient trust, care-seeking behaviors, and health outcomes. Although prior studies document 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. This study measured discrimination using the Everyday Discrimination Scale–Oral Care (EDSOC) and assessed microaggressions 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. This study's 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 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 (β = 0.16, 95% CI = 0.11–0.21) and DOCS (β = 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 questioning and gender-diverse individuals, 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.