## 8 Discussion  
The present work summarized the primary differential measures in which each risk factor for oral cancer and periodontitis impacts according to biological sex and gender-oriented variables. It resulted in differences in the epidemiology and the weight of various determinants that may influence the incidence and prognosis of oral cancer and periodontitis (Figure 2). Figure 2: The onset, course, evolution, prognosis, and therapeutic approach of periodontitis and oral cancer are affected by biological and environmental factors that are inevitably interrelated. In this sharing, each factor is reciprocally influenced by sex-related biological differences (hormones, oral microbiota composition, genetics, inflammatory and immune system, epigenetic factors) and behavioral differences related to gender orientation differing according to the sociocultural matrix in which each person lives. The effects on extra-oral health or, conversely, the influences of extra-oral diseases on oral health give further degrees of complexity and variability so that medicine and dentistry need to move more and more toward a personalized gender perspective to treat each case according to its uniqueness. As a paradigmatic example, oral cancer--for which more robust studies account for these differences--seems to affect men twofold more than women, with higher alcohol- and tobacco-related deaths in the first [Table 1]. Nevertheless, regarding smokeless tobacco, the proportion responsible for oral cancer in women is 2.5 times more than in men, although men are the highest consumer of smokeless products [128]. Hence, these data are not only justifiable by the broader prevalence of smoking and drinking habits among men than women but also influenced by biological, metabolic, microbiological, hormonal, and genetic differences between the biological sexes. With regard to periodontitis, it seems to manifest more severely in men than in women. This difference may be globally explained by the protective role of estrogens in fertile women on one side, and the higher vasodilation levels in men. Conversely, comorbidities more prevalent in the female sex, such as osteoporosis in postmenopausal women or rheumatoid arthritis, may also influence the epidemiological indices of periodontitis. Last, one cannot ignore the complex and still not fully known metabolic and biological interactions between oral and host microbiota, made even more complex by the variability with which inflammatory, immune, and metabolic mechanisms, which are also affected by hormonal differences, as well as by the sharing of smoke and alcohol. Furthermore, gender-related cultural and socioeconomic factors must also be considered. As a prominent example, in many countries, being a woman/girl still brings sociocultural disadvantages, manifesting as discrimination and poor access to schooling, cures, and preventive health programs. In this scenario, women do not know or cannot choose healthy behavior or do not have free access to treatment and screening programs. Last, inequities are also related to poverty, an essential barrier to positive health outcomes, which according to WHO, \"tends to yield a higher burden on women and girls' health\" [129]. Other than being of the female sex, other groups of discriminated people are those whose gender orientation is different from their biological sex. Bisexual, gays, lesbians, non-binary, and transgender people still suffer from marginalization and prejudice that directly and indirectly limit their access to treatment and undermine their health, and