When patients fill out a form at a dentist’s or doctor’s office, do they see themselves represented? For individuals who are lesbian, gay, bisexual, transgender, queer, or have other sexual orientations or gender identities (LGBTQ+), the answer can sometimes be a hard “no.”

And it’s an example of a larger problem in oral health: Structural bias and stigma around gender, gender expression, and sexual orientation can deepen LGBTQ+ oral health inequity.

For the third consecutive year, CareQuest Institute conducted its annual State of Oral Health Equity in America (SOHEA) survey with 5,260 adults — the largest survey of its kind to study knowledge, attitudes, experiences, and behaviors related to oral health. For the third consecutive year, the findings — for example, nearly 70 million adults in the US don’t have dental insurance — point to a system that is still struggling with disparities and challenges.

But there’s hope, as shown by the many efforts underway to improve access and equity.

Kaz Rafia - Chief Health Equity Officer at CareQuest Institute for Oral Health (Boston)

Mr. Rafia is the inaugural chief health equity officer at CareQuest, which he has successfully transitioned into a sustainable and impactful grantmaking institution. In his role, is particularly focused on increasing health equity, Medicare and Medicaid advocacy, safety net clinics and healthcare workforce support. He is active in the Health Equity Compact and contributes to their efforts towards health equity in the state of Massachusetts. 

The shortage was cited in a report released earlier this year describing the “disproportionate burden” of oral health disease faced by American Indians and Native Alaskans in the U.S. from childhood onward, a crisis it said was rooted in structural racism and exacerbated by a lack of access to healthy food and stable housing.