Oral Health Needs of Women and Gender-Diverse Members of the Canadian Armed Forces

Funding opportunity

Researchers are invited to apply for a new grant funding opportunity sponsored by Canadian Forces Health Services (CFHS) Women and Diversity Health program (WDH) to assess the unique oral health needs of women and gender-diverse members of the Canadian Armed Forces (CAF).

Anticipated timeline and budget

Background:

Women and diverse populations have been historically under-researched in medicine, and this has limited our knowledge of their unique health needs, including health risks, prevention, and treatment options. For these reasons, CFHS established the WDH program. The program aims to optimize prevention and care for women and members with diversity factors, using an intersectional lens, to improve their physical, mental and psychosocial well-being. This is aligned with governmental priorities and current shifts in research.

Since its inception in 2022, the WDH program has focused on establishing relationships with stakeholders and partners to identify collaborative opportunities and minimize duplication of effort, as well as to begin to identify opportunities for high priority research.

Although CAF provides universal dental coverage for active members, the system remains underprepared to meet the specific oral health needs of women and gender-diverse personnel. There currently exists no systematic clinical study or meta-analysis documenting how the unique physiological factors affect the oral health of women and members with diverse identity factors in the Canadian population, nor specifically in the CAF and CFHS. This limited evidence and lack of research prevents the implementation of effective preventive measures for these populations and presents an opportunity to improve the oral healthcare of these members. Emerging systematic evidence has identified oral health vulnerabilities in gender-diverse individuals undergoing gender-affirming hormone therapy, including altered salivary composition, decreased salivary flow, and increased risk of mucosal lesions (Van den Bosch, et al., 2021)^{Footnote 1}. The intersection of biological sex and gender identity plays a critical role for oral health, for example, in the onset and progression of chronic periodontal conditions, yet it remains largely unaccounted for in clinical protocols (Ioannidou, 2017)^{Footnote 2}.

For example, oral contraceptives are one of the most prescribed medications for women and research supports that they influence gingival and periodontal disease progression (Prachi, et al., 2019)^{Footnote 3} . The hormones in these medications (estrogen and progesterone) can cause alterations that lead to a reduction in the reparative efficiency and modify the gingival balance (De Falco, et al., 2022)^{Footnote 4}. Women taking these medications have also been shown to have a higher prevalence of streptococcus mutans, and consequently, a higher incidence of caries (Ali, et al., 2016)^{Footnote 5}. Due to the high levels of estrogen and progesterone, individuals on oral contraceptives have conditions that mimic that of a pregnant woman, though these changes are typically seen after long-term use (Ali, et al., 2016)^{Footnote 6}. Local hygiene factors have a major role in establishing periodontitis in these cases, which presents an excellent opportunity for targeted clinical intervention (Brusca, et al., 2010)^{Footnote 7}. Additionally, the inevitable hormonal shifts that occur during menopause, particularly estrogen deficiency, significantly increase the risk of xerostomia, caries, periodontal breakdown, and mucosal discomfort (Ciesielska, Kusiak, Ossowska, & Grzybowska, 2022)^{Footnote 8}. These are just some examples of the many unique challenges faced by these populations underscoring the need for sex and diverse gender specific dental care strategies.

The research focus areas include:

1. What are the distinct oral and dental health needs of women and gender-diverse members of the Canadian Armed Forces compared to their male counterparts?
2. Which specific physiological or hormonal factors (e.g., menstruation, pregnancy, menopause, gender-affirming hormone therapy) influence oral health outcomes in these populations?
3. What evidence-based clinical interventions or preventive strategies can be adapted or optimized to meet the oral health needs of women and gender-diverse CAF members?
4. Are current CAF dental protocols sufficiently inclusive of physiological differences related to sex and gender identity? If not, what clinical updates are warranted?
5. What patterns of disease presentation or progression (e.g., periodontal disease, soft tissue lesions, caries susceptibility) differ in CAF women and gender-diverse individuals due to sex hormones or long-term hormonal therapy?
6. How can dental providers in CAF settings be better supported to recognize and respond to the unique oral health risks and preventive needs of these populations?

It should be noted that while the proposal for this study is focused exclusively on the clinical and physiological dimensions of oral health, it is recognized that broader issues (such as including trauma-informed care, access barriers, and psychosocial stressors) are equally critical to long-term health equity. These factors lie beyond the scope of this initial investigation and may be explored in future research phases.

Research objectives:

This funding opportunity is seeking submissions from researchers to conduct a Needs Assessment or Health Needs Assessment. (Watkins, Meiers, & Visser, 2012)^{Footnote 9} (Wright John, 1998)^{Footnote 10}. The successful research team will be required to reach out to a variety of stakeholders and partners, including CAF women and diverse members, veterans, members of CFHS, both military and civilian, as well as partners from Veterans Affairs Canada, other federal government departments, and the broader academic research and health research community. Researchers should use established methods for a Needs Assessment, which may include focus groups and interviews, Delphi and modified Delphi technique, environmental and document scans, and literature reviews. Researchers should have previous experience with Needs Assessments or with some of these methods. The objective of this opportunity is to identify priority research areas for the dental health needs of women and gender-diverse members of the CAF, with a focus on identifying clinically meaningful differences in oral disease patterns, risk factors, and potential intervention strategies compared to other CAF populations.

This research is designed to fill a critical knowledge gap: while CAF dental care is universally accessible, no targeted clinical research currently exists that evaluates how hormonal and sex-related physiological variables affect oral health outcomes within this population. The absence of such data limits the CAF’s ability to implement targeted, evidence-based preventive measures, particularly for individuals undergoing hormonal changes such as pregnancy, menopause, or gender-affirming hormone therapy.

An overall goal of this research is to produce clinical guidance tailored to the physiological realities of female and gender-diverse populations in miliary and similar operational settings with specific application to the CAF. This research may support the creation of tailored clinical guidance on oral health monitoring across hormonal and gender diversity contexts, and it may support the development of personalized care strategies that enable dental providers to recognize and respond to physiological oral health risks based on patients’ unique profiles. The findings may therefore be used to help inform both preventive practices and therapeutic decision-making within military dental care systems.

Desired outputs:

• A needs assessment in the format of a report, including an Executive Summary, Abstract, Introduction, Methods, Data analysis, Results, Discussion and References, and the other specifications as described above. The research team is encouraged to publish their findings in one or more peer-reviewed publications. Any funds needed for publication should be accounted for in the budget.

Produce a Needs Assessment or Health Needs Assessment that includes:

• Executive Summary.
• Introduction, Methods, Data analysis, Results and Discussion, Bibliography.
• The report may include recommendations for research, policy and programs for the coming 2-5 years and ways to address any identified barriers for conducting health research, surveillance and providing oral and dental health care for women and diverse members in the CAF.
• Researchers are invited to provide input that includes the priority areas of interest, as described below, and how these can best be addressed through research and surveillance initiatives.

The needs assessment may address, but is not limited to, the following objectives:

• Define and describe the unique physiological and clinical oral health needs of women and gender-diverse members of the Canadian Armed Forces.
• Identify correlations between hormonal status (e.g., contraceptive use, pregnancy, menopause, gender-affirming hormone therapy) and oral health outcomes such as gingival inflammation, caries risk, and periodontal disease.
• Propose evidence-informed clinical recommendations for CAF dental practitioners on screening, prevention, and care models tailored to sex and gender-related physiological contexts.
• Outline potential revisions or enhancements to CAF dental protocols that better accommodate hormonal variation and sex-based oral disease risk factors.
• Highlight clinical risk indicators that could be incorporated into preventive or diagnostic practice within CFHS dental care.

Include a knowledge translation component, such as:

• A summary infographic or clinical handout for CAF dental teams.
• A slide deck and/or virtual webinar to communicate findings internally.
• A short policy brief with actionable recommendations for CAF and CFHS leadership.
• Include a knowledge translation or knowledge transfer component.
• SAGER guidelines followed, with a detailed description of GBA+ considerations.
• Virtual presentation of findings to project sponsor (may take place after the project end date).
• Quarterly progress reports provided to the D WDH.

Applicant qualifications and requirements:

• Principal investigator (PI) must have a PhD in a relevant field, or a MD/DMD/DSS degree.
• All appropriate academic research guidelines must be followed, including a research ethics board approval from an accredited academic institution in Canada prior to funding being issued if applicable to the method(s) selected.
• Additional internal DND/CFHS approval will be required for research involving CAF members. A CFHS point of contact will be provided to facilitate this process once the research proposals are selected.
• All reports, publications, and presentations from this funding opportunity are required to acknowledge that the research was carried out in response to a Funding Opportunity developed and funded by the CFHS WDH.

Application form

Please download and submit the Research Funding Application form found here.

Applicants are advised to include eight weeks of administrative lead-time in their timelines. This will allow for ethics board submission and approval (if required), and the drafting and signing of the funding agreement.

Enquiries

Questions about this funding opportunity can be sent to the VAC Research office.