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Tilicia Johnson DH2

Patient: Carter Age: 41 Condition: Profound Deafness in both ears

My patient is deaf, fully impaired in both ears and cannot hear. At 6 months of

age Carter contracted the bacterial infection, Meningitis, and was diagnosed with

profound deafness. Currently the patient has not found a cure. When I asked Carter

about how this has affected him he responded, Well, being deaf makes it harder for me

to be a part of the hearing world, but I am an introvert, so that helps. My boogie board

helps to better communicate.

The terms hearing impairment or profound deafness refer to a condition in which

an individual may be fully, or partially unable to detect some or all frequencies of sound,

that are heard by a person with normal hearing abilities.

It is thought that over 30% of bacterial meningitis cases result in some degree

of hearing loss-from mild impairment to profound deafness. In a 2006 study, the

Gallaudet Research Institute reported that 3.2% of American youth with hearing

loss had suffered meningitis, making the infection the second most common

cause of hearing loss. (1)

He is currently in no forms of therapy, is not taking any medications and has an

allergy to medications containing codeine. The patient has been chewing tobacco for 30

years and has recently, with in the last year, decreased his daily intake to 1 time a day

and goes through a can every 3 to 4 weeks.

A study that was carried out by Department of Preventative Dentistry, Naresuan

University, Phitasanulok, Thialand states that, of the 204 hearing impaired patients that

were screened, 87% had visited a dentist, 74% reported having at least one problem in

communication while receiving dental care and 55% reported that the dentist wore a

mask during the communication, further causing difficulties. (2) Deaf patients are at a

higher risk to periodontal disease due to the lack of education and communications

provided from dental professionals. Hearing impaired patients may be good at reading

lips and so the mask may interfere with better understanding, as a dental professional, I

have also forgot about this seemingly simple issue. Simply knowing some common

signs, or just the alphabet, will put the patient at ease and increase their confidence in

the operator.

In the case with Carter, hearing aids and telephone communications solely

relying on verbal communications are not a reliable compromise. Modified treatment will

consist of the use of a boogie board, used to write and communicate with the patient.

Reducing the amount of time when I wear a mask will allow him to read my lips, so as to

communicate better, will be an option when it is safe to do so. Using pictures to better

explain a procedure that may be needed.

During the procedures, I will be checking in with the patient with a touch on the

right shoulder and have a thumbs up or thumbs down signal before continuing with

treatment. Tell-Show-Do will become Show-Do with the possible Write-Show-Do for oral

hygiene instructions.

Lane Community College provides qualifying students with interpreters upon

request. The student who qualifies must request this service to the Center for
Accessible Resources (CAR) 30 days prior to the beginning of the term. CAR will make

every effort to locate sign language interpreters for qualified deaf students,

(4). An interpreter would be very helpful but is not imperative, as Carter knows how to

read and write and effectively communicates this way without further assistance. The

boogie board is good for communication from patient to clinician, but having to pass it

around may not work that well, and if there was an interpreter it may be more helpful.

It is the law to provide effective communications to patients with hearing

impairment, since the implementation of the AwDA about ten years ago, this includes

supplying supplemental education as necessary to the patient. It is the dentists

responsibility to make an individualized inquiry, based on the persons needs and the

procedures involved, about whether an interpreter is needed to achieve effective

communication ADA, JADA Vol. 132 May 01 pg. 681. (3) This law does not state that

the dentist must have an interpreter on staff but does state that if there is a need for one

the dentist must provide one and pay the costs of the service. This obligation also

extends to the patients family or associates who may be hearing impaired.



2. International Journal of Clinical Preventative Dentistry Vol. 10, No. 4, December


3. ADA, JADA Serving the Hearing-impaired Vol. 132, May 2001 pgs. 681-683


I completed Carter this week on Monday. I had two appointments of Perio

maintenance with him and spent both those appointments going over OHI, doing

the caries and remineralization and the OHI assignment. I think it went very well,

we used the boogie board for communication. It is a small tablet that uses a

magnetic pen to write on. He was very compliant and was easy to communicate

with in writing.

I had an easy time maintaining infection control, but I did find myself

wanting to grab the pad to write on and before I did I removed my gloves. I had to

explain everything on the pad before I got started, not only to maintain infection

control, but so that he knew what I was going to do and nothing would be a


On the second appointment, I had Carter brush and floss and then took

more pictures intra-orally. He improved by 15-20% from the last appointment,

and mainly had plaque on the buccal posterior molars. I again wrote out OHI for

him and had him practice with me. When I asked him how he felt about his teeth

and tissues since the last appointment he replied, They feel better, I cant wait till

the rest are done.

I finished the mandible and applied fluoride varnish. Carter had some

awesome questions about mouthwash and what kind he should get, I suggested

any without alcohol. He also asked about what gum he should chew and I
suggested spry. He is very interested in keeping his oral hygiene up and was

very pleased to have someone answer all his questions.

In the future, it would be very handy to have an interpreter. It was ok

having to write everything down, and he understood me when I was advising him

on techniques, but I think it may add a that little bit more to the interpersonal

relationship between operator and patient to have an interpreter. It would also

take the risk of contamination away, and possibly put the patient at more of ease,

allowing better communication and understanding.