medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients
can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
ORAL HEALTH IN THE DEVELOPING WOMAN
In recent years, organized dentistry has increasingly recognized that oral health habits, conditions, disorders, and diseases may differ between the sexes for a variety of reasons. These include, but are not limited to, oral hygiene practices, esthetic considerations, eating behaviors, temporomandibular disorders, Aggressive periodontitis in childhood Like adults, children and adolescents can develop periodontitis in a chronic form, either as a manifestation of systemic diseases or as an aggressive course. Aggressive periodontitis may be more common in children and adolescents than in adults, typically appearing around the onset of puberty and characterized by severe angular bony defects adjacent to the permanent molars and incisors. The disease is generally recognized in two clinical forms: localized and generalized (Babay, et. al., 2019; Hamasni, El Hajj, & Abdallah, 2018). The prevalence of localized aggressive periodontitis (LAP) varies by gender and race. African American individuals are more prone to develop LAP compared to Caucasians. Females are more prone to develop (LAP) than males among Caucasian individuals while among African American individual males are more prone to develop LAP compared to females (Mani, et. al., 2018). However, older studies reporting a female Hormonal influences on periodontal health Hormones have potent effects on the development and integrity of the craniofacial skeleton and the soft tissues of the oral cavity, including periodontal tissues (American Dental Association [ADA], n.d.; Meghana, et al., 2019; Nirola, et al., 2018; Shee tal, et. al., 2018). It has long been recognized that sex hormones influence periodontal tissues (cellular proliferation, differentiation, and growth of keratinocytes and fibroblasts), bone turnover rate, wound healing, resistance to dental plaque, and the progression of periodontal disease. Estrogen, progesterone, and chorionic gonadotropin (during pregnancy) Periodontal health during puberty The sexual maturation of an individual begins at puberty, a period in which gingival inflammation and enlargement can occur in both sexes, but it is more common in females (Cleveland Clinic, 2018; Tevatia, 2017). Sex hormones affect females at puberty with transitory changes in levels of estrogen and progesterone, followed by a return to normal levels in the postcircumpubertal period. When concentrations of sex hormones are high, some bacterial species can flourish. In addition, the gingiva can exhibit a heightened inflammatory response to food debris, materia alba, and plaque. Periodontal health and menses Many oral changes may occur with the start of menses and during the menstrual cycle. These include swollen gingival tissues, herpes labialis, aphthous ulcers, prolonged bleeding following oral surgery, and swollen salivary glands. Menstruation typically begins one to two days prior to the start of menses and dissipates shortly after the menstrual period has begun (Cleveland Clinic, 2018). Some women regularly experience swelling and bleeding of the gingiva before the onset of menstrual flow, which resolves with the beginning Lifestyle choices Habits affecting health develop throughout adolescence and are usually established during the young adult years. For example, a lifestyle choice that often begins during the teen
and the effects of hormones at different stages of life (Patton and Glick, 2016). Gender-specific conditions may affect a woman’s oral health over the course of her life span (e.g., from pregnancy gingivitis to burning mouth syndrome during menopause) and should be taken into account in the approach to therapy. predominance may reflect selection bias because females are more likely than males to seek dental care. More recent studies generally fail to demonstrate a marked greater prevalence in females (Koroluk, 2017). For example, a 2014 study focused on the demographics of aggressive periodontitis, looking more specifically at ethnicities and cultures of prevalent periodontitis. In examining various demographics, the study noted that there is no notable difference between men and women; however, there is a prevalence of periodontitis in older adults. The study also draws attention to the lack of studies examining the various demographic differences for periodontitis (Susin, Haas, & Albandar, 2014). Additional studies are needed to definitively establish the association between gender and the prevalence of aggressive periodontitis in children and adolescents. all affect the microvascular system by influencing endothelial cells and pericytes of the venules, adherence of granulocytes and platelets to vessel walls, the formation of microthrombi, disruption of the perivascular mast cells, vascular permeability, and vascular proliferation (Meghana, et al., 2019; Nirola, et al., 2018; Sheetal, et al., 2018; Kshirsagar and Balamurugan, 2018). Estrogen is mostly responsible for alterations in blood vessels, and progesterone stimulates the production of inflammatory mediators. Most pubertal females with healthy gingiva will not develop signs of gingival inflammation, but others will, even with relatively little accumulation of dental plaque. Clinically, puberty- associated gingivitis is characterized by inflammatory signs, such as redness and swelling and bleeding on probing. These features generally resolve with improved oral hygiene and are reversible following puberty. Radiologic evidence of bone loss is not a common feature of puberty-associated gingivitis. of menstruation (American Academy of Periodontology, n.d.). Salivary gland swelling, particularly of the parotid, may occasionally occur during menses. Recurrent intraoral aphthous ulcers and herpetic lesions may appear during the luteal phase (between ovulation and menstruation) of the cycle and heal after menstruation. Dental professionals should be aware of these issues in the context of hormone fluctuations associated with the menstrual cycle.
ORAL HEALTH ISSUES IN YOUNG ADULT FEMALE PATIENTS
years is smoking, which is associated with tooth loss, periodontal disease, and poor wound healing (Centers for Disease Control and Prevention [CDC]; Today’s RDH, 2020). This is also the
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