He is now she…
Addressing the health history changes for a transgender patient
RDH, MS, is a practicing
clinician, speaker, and writer.
She is an adjunct dental
hygiene faculty member at
Burlington County College.
Eileen offers CE forums to
doctors, hygienists, and their
teams. Reach her at
609-259-8008. Visit her
website at www.
Since Caitlyn Jenner has gone public with her transition from male to female, it’s likely that many oth- er people will move forward and do the same. Some of these people will sit in your dental hygiene chair, as was the case with me last week. Although I had treated a transgender patient once five years ago while temping, I had no history of a patient relationship with the person. But last week was different. My patient, the former Ken, had contacted our office the month before to make us aware that he was transitioning to be- coming a female. We would now know him as Jessica. She had been inactive for 14 months but had scheduled her recare visit, and I was to be her hygienist. I felt slightly apprehensive when my doctor explained to me
the changes that were occurring in Jessica’s life. I had been
treating Jessica as a male patient for more than six years
and knew her, her wife, and children fairly well. (I suppose
I did not know her as well as I thought I did.)
That afternoon I went to the reception area and called
Jessica’s name. I brought her back and began exchanging
my normal pleasantries. It was an adjustment to see what
I had known as Ken’s face and appearance with a longer,
feminine hairstyle, smoother skin and makeup, and breasts
that were very obvious. She was carrying a purse and
garbed in a dress. She sat down and the first thing she did
was thank me for being willing to treat her. She said that
others in her medical community had shunned her, which
I found surprising.
When I updated her medical history, I learned she was
taking medications that have aided in the transformation.
Sublingual doses of 1-4 mg estradiol per day causes the
feminization of physical traits, including skin changes,
redistribution of fat, breast development, and decreased
JUNE 2016 | RDHMAG.COM
muscle mass and strength.
It also makes changes in
the amount of sweat and
to the odor of urine, and
more.1 She was also taking
spironolactone, which is a testosterone blocker.
I explained the impact that hor-
mone modification might have on
host resistance, especially as it per-
tained to inflammation in the peri-
odontium. This coupled with the stress
of transitioning are certainly risk factors
for periodontal disease. Now is the time for
her to be ever vigilant in terms of good self-care
so that she
is less vul-
tion. For the first
time in the years I’d
been treating her, I
felt like a light bulb
went off, as Jessica
seemed to be more
motivated about im-
proving her inter-
proximal care. (Mind
you, this conversa-
tion was taking place
before I’d had the
chance to examine
served as solid clini-
cal evidence when I
probed her gingival
tissues and took note of the evident generalized bleeding.
I found the
awkward only at
the beginning of
Once we got going,
Jessica was as
warm and nice
a person as Ken
had always been.
Frankly, it broke
my heart when
she thanked me
for being willing
to treat her.
She listened closely and appeared very attentive to my
continued on pg. 82
6/6/16 10:42 AM