Impact of Oral Hygiene and Medication on a Patient Undergoing Gender Reassignment Surgery

Matthew J Meyer

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Meyer, Matthew J
Faculty / Advisor: Chang, Yu Cheng
University of Pennsylvania School of Dental Medicine, Department of Periodontics

Introduction

There is limited literature publish regarding dental-related issues that arise in the transgender community. This case study examines one patient with moderate to severe plaque-induced gingivitis before gender reassignment surgery (GRS). The patient presents with a score of four modified gingival Index with severe gingival inflammation and spontaneous bleeding. The outcome of the Periodontal phase I treatment was evaluated after the completion of GRS.

Methods

The patient was given oral hygiene instructions and full mouth debridement every two weeks for two months leading up to the surgery. After the GRS surgery, the patient stopped taking Leuprolide, a medication known to cause gingivitis, typically given to transgender females to help with the effects of gender dysphoria. The patient was reexamined one-month status post-gender reassignment surgery. Clinical photos were taken one month before surgery, two days before surgery, and one month post-GRS. The modified gingival Index was recorded for two months and one month pre-GRS.

Results

The clinical presentation of the patient’s gingivitis was most prevalent in the lower anterior teeth. After the first month, the patient's modified gingival index has improved from a score of four to a score of three. The bleeding index for the lower anterior went from 20 sites to 12 sites. Clinical photos show significantly reduced erythema and edema around the gingival margins of the lower anterior teeth. Red tissues around the gingival margins pre-op improve to healthy pink tissue one month post-op. Tooth number 24, which crown was covered by gingiva in the pre-op photos, is visible in the photo one-month post-op/discontinuation of Leuprolide.

Conclusion

A combination of change in medication and oral hygiene results in a reduction of gingivitis. Although not much is understood about Leuprolide's effects on the gingiva, cases must be documented to educate clinicians to facilitate the best care to individuals in the trans community.