Sex,Gender and Sexuality in Oral Health Research: Setting the Scene

Biological factors have traditionally been the underpinning to dental, oral and craniofacial research questions. Until recently, the influence of sex, gender and sexuality on oral health outcomes has not been generally considered. The importance of integrating sex, gender and sexuality into almost all aspects of dental research is supported by an emerging body of evidence, however, as these factors can have significant impacts at the laboratory science level and on oral health disparities and access to care more broadly. The impacts are also felt in the oral health workforce, in developed and developing countries, and in dental policy and funding arenas. The ongoing development of sex, gender and sexuality research in the dental, oral and craniofacial space, including the dental workforce, must facilitate frameworks that are equitable and inclusive to better enable clinical and scientific expertise within diverse communities. These approaches will likely provide unique insights into the complex connections between environment and biology, people and place, and culture and science.

The articles in this special issue provide an overview of sex, gender and sexuality in oral health research and show the importance of their inclusion from the laboratory setting to population studies. Conceptualisations of sex, gender and sexuality are provided, including examples from animal research, that

• Interrogate the role of sex in dental conditions

• Examine how the intersection of the social determinants of health with sex, gender and sexuality have multiplicative impacts on negative oral health outcomes

• Explore how gender roles and expectations shape health behaviours and dental care interactions

• Provide justification for inclusion of sex and gender diversity in clinical trials and other human studies involving oral health

• Offer lived-experience examples of sex and gender issues in the oral health workforce

• Describe future directions on how to incorporate sex, gender and sexuality into oral health research, including policy and funding, to improve the quality and equity of dental health care at a global level

The significance of sex, gender and sexuality in oral health research is fundamental—from the cellular mechanisms examined in laboratory settings in animal models (Duan et al 2016) to broader structural, social, political and commercial determinants that influence inequities in dental care access (Lipsky et al 2021) and provision of dental care more broadly (Russell et al 2013). An appreciation of the intersectional nature of factors affecting sex-, gender- and sexuality-related oral health inequities that span other health domains is required, with deeper understanding leading to more effective and appropriate policies that shape oral health care provision (Soares et al 2025). In the laboratory setting, periodontal disease in animal models is shaped by sex differences, with the biological underpinning being largely around female hormones. For example, estrogen’s anti-inflammatory properties affect the periodontium’s immune responses and cytokine expression, meaning that periodontal inflammation and tissue destruction may be attenuated (Huang et al 2025). Conversely, evidence suggests that insufficient estrogen, such as that experienced among postmenopausal women, is associated with increased susceptibility to periodontal clinical attachment loss and alveolar bone resorption (Shrivastava 2024). The same has been reported for temporomandibular joint disease (Robinson et al 2020).

Beyond the biological level, there are multiplicative impacts of social, political and commercial health determinants on sex-, gender- and sexuality-related oral health outcomes (FDI World Dental Federation 2024). Among LGBTQ+ populations (Lesbian, Gay, Bisexual, Transgender, Queer), for example, discrimination in the oral health care setting with lack of provider knowledge and economic inequities leads to irregular dental visiting patterns and avoidance due to dental fear (Schwartz et al 2019; Raisin et al 2023). The commercial determinants of health reinforce gendered labour markets, with a higher proportion of women experiencing financial dependence and caregiving responsibilities, all of which affect regular dental attendance (Morelli et al 2022). In the dental research setting, Albino et al (2019) reported a lack of institutional commitment to equity and unconscious bias leading to gendered advantages, while Haag et al (2023) reported clear gender inequities in dental research publications over the past 2 decades.

A lack of diversity with respect to sex and gender in human oral health studies, including clinical trials, undermines scientific rigour and equity (El-Galaly et al 2023). Traditionally, clinical research in the oral health context favoured male respondents, or data were not disaggregated by sex and gender. This meant a scarcity of information regarding knowledge around differential treatment responses (Lipsky et al 2021). It is important to include diverse populations in all clinical research so that any ensuing dental interventions (population level, behavioural, preventive, or treatment based) are effective across all targeted groups (Schwartz et al 2023). This is especially important in the context of gender-diverse populations to highlight unique inequities in access to oral health care for these groups (Tamrat 2022) and to provide relevant insights into specific issues, including the effects of hormone therapy on periodontal disease (Raisin et al 2023). Inequities in sex, gender and sexuality are also apparent in the dental health workforce. Women and sexual minorities are underrepresented in dental academic roles, particularly those at a leadership level, despite females accounting for an increasing proportion of dental graduates (Campus et al 2024). LGBTQ+ dental professionals report workplace discrimination, which can affect career advancement and job satisfaction (Piano et al 2023).

Moving forward, best practises in oral health research need comprehensive integration of sex, gender and sexuality. Population-level research should be underpinned by relevant theories, including feminist, gender and queer theory, and should challenge traditional binary sex norms that exacerbate oral health inequities. Policy initiatives should mandate the inclusion of sex- and gender-based analysis in research funding to ensure that studies consider these factors from design to implementation. Increased investment in intersectional research approaches are important—for example, working in partnership with LGBTQ+ communities to create more bespoke research to address current knowledge gaps and improve dental care outcomes. Oral health equity at an international level means integrating these concepts into dental education and professional training, thus preparing future oral health professionals with the skills to provide inclusive and safe care.

In summary, including sex, gender and sexuality into dental, oral and craniofacial research is a matter of fairness and a necessity for scientific rigour and improved dental health outcomes. From laboratory investigations of sex-based biological mechanisms to broader population determinants of health, these factors shape the experiences of individuals and communities in profound ways. Acknowledging and addressing sex, gender and sexuality will lead to more equitable and effective oral health policies, research and care systems worldwide.

Author Contributions

L. Jamieson, contributed to conception and design, data interpretation, drafted and critically revised the manuscript; G. Soares, C. Randall, contributed to conception and design, data interpretation, critically revised the manuscript. All authors gave their final approval and agree to be accountable for all aspects of the work.