The World Health Organization (Petersen, Bourgeois, Estupinan-Day, & Ndiaye, 2005) reported that oral diseases are the most common noncommunicable diseases. Aside from its overwhelming prevalence, dentistry has an important role to play in speech, diet, and facial esthetics. It is not just a question of toothache or missing teeth; dental esthetics significantly influence a patient’s confidence, hence her/his social interactions. Furthermore, oral infections serve as a gateway to serious conditions in other parts of the body, such as endocarditis, heart infections, cardiovascular diseases, pregnancy and birth complications (such as premature birth), exacerbation of pre-existing diabetes, and pneumonia. Oral diseases cause significant changes in patients’ lives. Without quality dental care, patients cannot talk, eat, or smile with confidence. Oral health should not be limited to biomedical discourse; its inverse relationship with socioeconomic status illustrates how socioeconomic, cultural, and gender discourses are critical to painting the full picture of dental health.

Sex and gender differences translate into disparities in health experience (Hamberg, 2008; Krieger, 2003). Certain conditions may mostly affect women. Other diseases may have an equal female/male patient ratio, but present different sets of symptoms for each gender. Nonetheless, “women’s diseases” or “women’s symptoms” have long been relegated to the bottom of traditional medical academia’s hierarchy. Marginalizing women’s bodies as “the other,” doctors enshrined Caucasian male adult bodies as a stable standard (Keane, 2014). Only male suffering received scholarly attention, resources, and funding, while illnesses inflicting women were dismissed as whining or unexplainable. Such a neglect of women’s health could be attributed to the fact that “women’s diseases” often exhibit a diffuse spectrum of symptoms in multiple body parts and have multifactorial causes, compared to male-dominant diseases with distinct symptoms and evident causal relations; women’s suffering was too difficult for a male-biased medical academia to comprehend (Barsky, Peekna, & Borus, 2001).

Even for conditions that can affect both men and women, male symptoms are labeled “typical,” while symptoms reported more often in women are shoved under the “atypical” category (Ricci, Cenko, Varotti, Puddu, & Manfrini, 2016). The resultant diagnostic and therapeutic strategies have been tailored to men’s bodies, which may inflict harm on women (Schiebinger, 2012). Disastrous aftermaths have been observed; for example, 80% of the drugs withdrawn from the market between 1997 and 2001 were proven to cause more harm in women than in men (Gahart, Rowe, & Bradley, 2001).

Although the issue of sex and gender differences in biomedicine has slowly been gaining interest over the past few decades, the amount of evidence available is still in its infancy, and some areas are still very far from providing evidence-based guidelines for practicing clinicians (Holdcroft, 2007; Tingen, Kim, Wu, & Woodruff, 2010). Much medical research omits women (Lempert, 1986; Sugimoto, Ahn, Smith, Macaluso, & Larivière, 2019) and until 2007 clinical studies had more male participants than female participants (Sugimoto et al., 2019). Beyond the issue of numbers, research often fails to factor in the concepts of sex and gender in research design and data analysis.

Oral health is not impervious to sex and gender differences (Zitzmann, Schilling, Weiger, Pastoret, & Loretan, 2007) but these issues have received limited attention within dental academia (Doyal & Naidoo, 2010). That these gender gaps need to be filled serves not only as a means for achieving social equity but also as a prerequisite for dental care that is optimized for the marginalized gender (Doyal & Naidoo, 2010). Due to the lack of gendered research in dentistry, articles on sex/gender differences in common dental illnesses—such as dental caries or periodontitis (WHO, 2003)—have been insufficient or conflicting, failing to reach a consensus (Martinez-Mier & Zandona, 2013; Shaffer et al., 2015). It is important to note that despite this insufficiency, caries and periodontitis are relatively well researched from sex/gender-specific perspectives when compared to other rarer dental disorders. There are many less common dental diseases with a significantly higher prevalence among women than for caries and periodontitis. However, despite their higher female patient ratios, these dental disorders lack sex/gender-specific research. The skewed sex ratio itself implies the influence of sex and gender on disease presentation.

One approach to overcoming the abovementioned limitations is “Gendered Innovation” (Schiebinger & Klinge, 2015). Gendered Innovation emphasizes sex and gender analysis for the advancement of scientific innovation and discovery. Sex and gender have been used interchangeably by several biomedical scholars, many baffled by the conceptual distinction between them (Doyal & Naidoo, 2010). Clarification of terms As used in this article, the terms follow the definitions given on the Gendered Innovations website (Schiebinger et al., 2011–2021). “Sex” refers to the biological characteristics of sexually reproducing organisms. Categories include, but are not limited to, female, male, and/or intersex. When determining sex factors in biomedicine, genetic components, hormones, and reproductive organs can be considered. “Gender” is a sociocultural construct. Cultural norms, societal hierarchy, and the economy interact with individual attitudes and behaviors to engender gender concepts. One’s gender may or may not match their sex. Sex and gender factors interact, generating differences in symptom patterns between the sexes, even under identical diagnoses (Clayton & Davis, 2015) and treatment modalities can result in different prognoses for women and men (Rossi et al., 2013). Differences between genders in terms of access to and interactions with health care providers contribute to higher morbidity and mortality among women (Doyal, 2000; Hamberg, 2008) while disparities in health care experience often culminate in women suffering from health inequalities (Marshall-Catlin, Bushnik, & Tjepkema, 2019).

While Gendered Innovation has forced the male gaze of medical academia to examine sex/gender health aspects, efforts so far have focused on dissecting common disorders with even sex ratios. Gendered Innovation has yet to thoroughly examine “women’s diseases,” which many recognize as reproductive health issues. Expanding women’s health beyond reproductive health should be the next step, signifying that the healthcare community recognizes women as beings other than just as mothers and wives. In doing so, Gendered Innovation has concentrated on uncovering sex/gender differences in disease with even sex ratios, unwittingly forsaking diseases unrelated to reproductive organs but with a high ratio of female sufferers.

Through the lens of Gendered Innovation, we focused on oral disorders with an overwhelming female prevalence—Sjögren’s syndrome (SS) and dental fear (DF)—and which therefore have a significant impact on the oral health of South Korean women. The two disease entities were selected because each is unique in its interplay of factors, including hormones, immune system, pain during treatment, and dentist-patient interaction. Although the chosen disorders have low prevalence rates in the general population, they epitomize overarching themes in women’s health. The discourse surrounding these disorders in South Korean women illustrates the absence of sex/gender analysis in South Korean oral health data and the importance of intersectionality in portraying the health of Asian women. In this article, existing studies and reviews are examined, and links between articles are explored to identify what has been established and what remains unknown about women’s oral health. In focusing on these two uncommon dental disorders, we devised an analytical process to investigate the sex and gender aspects of these diseases. The results from our application of sex/gender analysis point to possible paths for future research, serving as groundwork for better women’s oral health.

This article is in line with the Gendered Innovations approach in that we emphasize the significance of capturing both the biological and sociocultural aspects of women’s health in all research steps. However, we diverted from Gendered Innovation’s usual case selection, choosing oral disorders with a high ratio of women: Sjögren’s syndrome (SS) and dental fear (DF). We chose these “women’s diseases” in dentistry for two reasons: 1) A high female prevalence in itself implies the significance of sex/gender factors in the disease. The interplay of sex/gender components in female-prevalent diseases may be even more representative of women’s health than for other disorders; 2) Non-reproductive disorders with high female ratios fall into blind spots in both traditional medical academia and Gendered Innovation. Although these diseases have a greater impact on women’s health than diseases with lower female ratios or reproductive disorders, a thorough examination of their sex/gender mechanisms is lacking. Available explanations for the causes of these diseases are often reductive, restricted to vague hormonal factors or psychological causes. Discovering the interplay mechanism between female biology, gender, socioeconomic factors, and culture that culminates in high female ratios for SS and DF will deepen our understanding of women’s health.

Gendered Innovation suggests implementing overarching themes at the incipient stages of research design. Our study aimed to critically review past dental research, the bulk of which did not apply methods for Gendered Innovation. Analysis of past research data required a new method that carried overarching themes of Gendered Innovation and was appropriate to biomedical discourse. We devised an analytical method to review earlier research to reconstruct past knowledge regarding gendered insight into women’s bodies. Our analysis method follows the biomedical narrative of the disease’s pattern, cause, and cure to pursue a comprehensive, multi-level understanding of sex, gender, and the disease. We hope that our analytical method can be applied to other oral health topics and contribute to correcting the male bias in dental academia. Another major aim of our research is to shed light on the oral health of Asian women, with a particular focus on South Korea’s oral health database.

In this study, a methodological approach was incorporated into qualitative analysis to review past literature on sex/gender differences in two selected dental disorders. We decided to categorize the studies according to phases of medical research, which is in line with the narrative course of cause, disease pattern, and cure of the disease. According to Röhrig, du Prel, Wachtlin, and Blettner (2009), medical research typically follows three main domains: epidemiology (disease pattern), basic medical research (cause), and clinical trials (cure). Basic medical research includes studies that investigate the underlying causes and mechanisms of the disease, examining cellular, biochemical, genetic, and physiological factors. Epidemiological research has focused on the distribution and chronology of the disease in the population, and clinical studies have demonstrated or observed the effects of the disease or treatment.

These main medical study types can be reorganized into the following analytical method, creating a medical research flow narrative.

Although dentists are quite aware of the fact that all two disorders have a significantly higher female prevalence, research in all three abovementioned levels is lacking, illustrating the absence of a gendered approach in dental academia.

As the results demonstrate, much remains to be studied to understand women’s oral health. The implications of sex/gender variables in health research go beyond existing research protocols and merely acknowledging the existence of non-male patients. Understanding the nature of women’s oral health would reveal how biological and social sex/gender factors shape our bodies. Accurate perceptions of health issues will lead to more effective treatment and prevention regimens tailored to the specific health needs of persons of all genders.

We employed Gendered Innovation’s overarching themes to create a new analytical flow for medical/dental research. Our analytical structure focuses on each disorder, ultimately pushing for better care for women. In this section, we compare our analytical structure with Gendered Innovation’s method and review the literature discussed in our research in line with that method. In particular, the crosssectionality of Korean women’s oral health is described using multilevel sex/gender analysis.

Our paper provides an account of how dental academia has investigated two oral disorders with high female ratios. Although SS and DF impact the quality of women’s lives beyond the reproductive realm, the two illnesses are neglected in medical academia. As scholars overlooked the high female ratio, sex/gender explanations at all levels of the research domains—patient population profile, cause, and cure—are lacking. Aside from sex/gender factors, research on SS and DF in general falls far short of satisfactory; theories on the causes of DF are not far from speculation, and proposed cures for SS only temporarily reduce symptoms.

SS and DF are poorly understood dental disorders with high female ratios. By examining the medical discourse on the two diseases, we reorganized the academic narrative by implementing multi-level analytical methods. The multi-level tool served as a form of reconnaissance to identify missing links in women’s oral health studies, and we determined what particular kinds of knowledge need to be excavated to paint a more comprehensive, detailed picture of women’s oral health. These blank spaces in oral health research are to be filled through Gendered Innovation, which spans multi-level domains including pattern, cause, and cure of diseases. This paper is one of the first attempts to introduce Gendered Innovation or sex and gender analysis into oral health and dental medicine on a full-scale level.

This study also focuses on the social aspects of women’s health. Analysis of sex and gender, their interaction, and intersecting factors forces academia to face the mistreatment of research into women’s health. A multi-level sex and gender analysis can find the solution beginning with women’s diseases and, by encompassing intersectionality, build up public health programs accommodating diverse communities. Intersectionality requires an interdisciplinary approach that combines medicine and social sciences, including studies on gender and women (Schiebinger & Schraudner, 2011). In our study, we call for an active collaboration between dentists and social scientists with the common goal of attaining a fuller grasp of women’s oral health, ultimately expanding to women’s general health.

Gendered Innovation is an unfamiliar yet much needed area in dentistry. Dentistry is a field prime for Gendered Innovation, as oral health can have a major impact on women’s quality of life, hence completing Gendered Innovation’s mission of enhancing women’s health as a whole. Furthermore, recent years have shown a significant increase in the numbers of female dentists, who should work alongside female patients to incorporate women’s perceptions and observations of health into research.