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Dental care for the deaf pediatric patient

Rajat K Singh, Kritika Murawat1, Rahul Agrawal2
Faculty of Dental Sciences, 2Department of Oral Pathology, Faculty of Dental Sciences, Institute of Medical Sciences,
BHU, 1Dental Practicioner, Laxmi Dental Clinic, 40 DIG Colony, Varanasi, Uttar Pradesh, India

Great strides have been accomplished recently in providing better medical services for handicapped children.
As the dentist begins to understand the complexity of each particular form of handicap and its characteristics,
he is able to plan more efficiently for satisfactory treatment. Because many dentists do not understand
deafness and the unique problems that deaf children exhibit, inadequate dental care for deaf children still
ensues. Handicapped persons are at a greater risk for dental disease, for the most part, because of greater
neglect or poor oral hygiene and access to routine dental care. Deaf patients in particular often fail to obtain
needed care because of communication difficulties experienced in the treatment situation.

KEYWORDS: Deaf, Dental care, Handicapped


The deaf are those in whom the sense of hearing is
Deafness has been known to exist since the beginning of nonfunctional for the ordinary purposes of life. This general
recorded history.[1] The deaf were often denied the basic group is made up of two distinct classes based entirely on the
rights and privileges that belonged to them. It is known that time of loss of hearing.
among many early and primitive people, those who could 1. The congenitally deaf: Those who are born deaf. Congenital
not contribute their share to the needs of the tribe due to a deafness can be categorized into three main groups:
handicap were not allowed to survive.[2] Hereditary, due to genetic influences; prenatal, due to a
influences upon the developing embryo; and perinatal of
The long, painful, and arduous struggle of the deaf to a number of accidents at the time of birth itself, or within
emancipate themselves from these biases, prejudices, the earliest hours or days after birth.[6]
persecutions, and inhumanities continues even today.[3] A 2. The adventitiously deaf (acquired): Those who are born
popular existing misconception is that deaf people are all
with normal hearing but in whom the sense of hearing
alike. This is a fallacy since the deaf are as different from
became nonfunctional later through illness or accident.
one another as are any other group of people. Because
Acquired deafness can occur from several sources, such
lack of hearing has always been accompanied by lack of
as viral infection, injury, and drug toxicity. For many
speech, the words “dumb” and “mute” have always had a
years, viruses have been recognized as a cause of acquired
close association with the word “deaf ”.[2] The deaf are often
deafness. Among those viruses known or suspected to
misunderstood—their handicap is less obvious than the
cause deafness are mumps, measles, chicken pox, influenza,
blind and the spastic.
common cold viruses, and poliomyelitis.[7-10] Deafness
may be caused by the effects of certain drugs, and the
DEFINITIONS most common of these are aspirin and quinine.[6,9,11] Other
causative agents include the usage of sulfa drugs and
A “deaf ” child is one who does not have sufficient residual antibiotics.[6]
hearing to enable him to understand speech successfully even
with a hearing aid, without special instruction.[4] In 1938, Access this article online
a standard definition of terms was formulated by a special Quick Response Code:
committee on nomenclature for the Conference of Executives Website:
of American Schools for the Deaf.[2,5]

Address for correspondence: Dr. Rajat Kumar Singh, DOI:

Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi, 10.4103/0971-7749.104791
Uttar Pradesh, India. E-mail:

Indian Journal of Otology | October 2012 | Vol 18 | Issue 4 | 171

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Singh, et al.: Dental care for the deaf pediatric patient

The hard-of-hearing evaluate the best manner to present himself and the service
Those in whom the sense of hearing, although defective, is he is to render.
functional with or without a hearing aid.
Prior to the deaf patient’s initial visit, the parent should meet
or talk with the dentist so that he can explain exactly what
THE DEAF CHILD AND THE DENTIST will transpire. The parent should be instructed on the positive
methods of preparing the child for his first dental visit. Visual
A deaf child does not develop in the same manner as a
aids, such as an illustrated brochure or a child’s book descriptive
normal, hearing child. Therefore, the child should not be
of the first dental visit, are helpful in painting a realistic picture.
viewed as being like everyone else, except that he has impaired
There is a real incentive for a deaf child to try emulating his
hearing.[12] This is because deafness has definite and unique
siblings, and to succeed in the same things that he sees them
consequences on the personality of a developing child,
accomplishing.[18] When such a familial relationship exists,
resulting from difficulty in communicating with others.[13,14]
the deaf child should observe his brother’s or sister’s behavior
Therefore, the widely held belief is that in overcoming the
during a dental procedure, in hopes that he will duplicate it.
obstacles to communication lies the solution to the problems
of the deaf, both as a means of lessening the susceptibility to
If possible, the dental appointment should be scheduled so that
maladjustment and in aiding the child in the developmental
the patient spends little time in the waiting room. The child is
seated in the dental chair and the dentist, assistant, and parent
are all positioned in order that the patient can easily view
ROLE OF PARENTS them. The parent is visible for interpretation and reassurance.
However, the dentist and assistant can also easily convey ideas
When a child cannot hear what goes on about him, there is to the deaf child through gestures, facial expressions, and
much that he does not understand, and when he is unable slow pronunciation of words. All children like body contact,
to speak, he cannot ask the questions he desires. He is thus such as a pat on the shoulder or handshaking, as positive
forced to depend on an interpreter—a person who knows reinforcement for good performance, and the deaf child is
about the communication problems and who can relay no exception. Once a good rapport is gained between patient
information to him in a manner which he can understand.[16] and dentist, the child gains a sense of security and confidence,
The first interpreters in the life of a deaf child are the parents. causing a decrease in the importance of the parent’s presence.
Parents are significantly the controlling influence on the Eventually, as successive visits continue, the child will gain a
psychological adjustment of their children.[17] If the parents sense of independence and often willfully desires the parent
accept their child’s deafness and realistically try to understand to remain in the waiting room.
and interpret it, the child is more likely to accept and adjust to
deafness constructively. Unfortunately, in sharp contrast to this Unfortunately, in many instances, the parent of the deaf dental
are the parents who magnify the implications of their child’s patient is the overprotective individual. Temper tantrums, lack
deafness.[17] They view deafness as almost totally debilitating of cooperation, and other ploys are often elicited in order to
and react by smothering protection. evoke sympathy from the parent.[13]

DENTAL VISITS The dentist should demonstrate for the deaf child all the
instruments and equipment, that is, the air, water spray, the
The dentist who is aware of this total dependence of the deaf “moving toothbrush,” and others. He should emphasize the
child on his interpreter-parent and the varying extremes vibrations of the equipment which the child will feel, and
that this dependence might elicit, must be willing to alter his explain that this is normal and to be expected in the dental
normal approach to include parents initially. Then when an office. The deaf child is especially fearful of the unknown;
aura of confidence has been reached with both parent and therefore, using a maximum number of demonstrations and
child, the dentist can attempt to gradually wean the child explanations will be most beneficial.
from his parent.
Actual dental treatment for deaf children closely parallels that
The presence of a child’s hearing disability should usually performed with hearing children. An extensive preventive
be elicited by the parent in the initial inquiry. The astute program should be initiated, as deaf children often exhibit poor
receptionist, upon learning of a handicap, should request a oral hygiene. The significance of daily home care measures and
complete medical history from the parent. Ideally, this should the importance of their part in maintaining them should be
be obtained prior to the child’s first appointment for several emphasized to the parents. Parents often appease their children
reasons. One reason is that extended appointments quite by rewarding them with excessive candy and sweets, and the
often cause needless restlessness, leading to an increase in parents of the deaf are no exception. Therefore, a dietary
apprehension. Also, the advance information gives the dentist analysis should be performed, and corrective nutritional
a preview of the new patient and his handicap, and helps him guidance be described to the parents.

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Singh, et al.: Dental care for the deaf pediatric patient

It is often difficult, prior to initiating restorative procedures, to that performing dental care for the deaf child is a most
explain the concept of local anesthesia to the deaf child. Parents rewarding and satisfying experience.
may be helpful in interpreting this procedure to their child
by describing the fact that the teeth will be asleep. The word
“hurt” is an important one to the deaf child, and the usage of
a substitute word has often proved ineffective. Once the local 1. Myklebust HR. Your deaf child. Springfield, Ill.: Charles C Thomas;
anesthetic has been administered, it is imperative that the 1950.
dentist be absolutely positive that it has taken effect. In cases 2. Bender RE. The conquest of deafness. Cleveland: The Press of
observed where restorative procedures have been performed Case Western Reserve University; 1970. p. 11-8.
without complete anesthesia, the deaf child has often regressed 3. DiCarlo LM. The deaf. Englewood Cliffs, NJ: Prentice-Hall Inc.;
in behavior, feeling betrayed, and occasionally has become a 1968.
4. Davis H, Silverman SR. Hearing and deafness. New York, Holt:
management problem.
Rinehart and Winston Inc.; 1960.
5. Rapp R, Kanar HL, Nagler B. Pedodontic care for the deaf and
The use of the rubber dam during restorative procedures blind. Dent Clin North Am, March 1966, p. 21-34.
may also result in negative behavior patterns, if not handled 6. Ballantyne JC. Deafness. Boston: Little, Brown, and Co.; 1960.
properly. The close proximity of the rubber dam and holder p. 124-35.
to the patient’s eyes may threaten the deaf child’s main area 7. Bordley JE, Hardy WG. The etiology of deafness in young
of communication, perhaps causing an adverse reaction. children. Acta Otolaryngol 1951;40:72-9.
However, with confidence and familiarity gained between 8. Kinney CE. Hearing impairment in children. Laryngoscope
dentist and child, this obstacle may be overcome. 1963;63:220-6.
9. Whetnall E, Fry DB. The deaf child. London: William Heinemann
Premedication can be a useful adjunct in children who are Medical Books Ltd.; 1964.
10. Zonderman B. The preschool nerve-deaf child; study of etiologic
hyperactive or extremely nervous. Many times, however, it
factors. Laryngoscope 1959;69:54-89.
has been shown to have a deleterious effect on the deaf child, 11. McConnell F, Ward PH. Deafness in childhood. Nashville:
causing a more acute behavior problem than was exhibited Vanderbilt Press; 1967.
prior to medication. This could be due to the dulling of the 12. Myklebust HR. Auditory disorders in children. New York: Grune
deaf child’s remaining communication centers, leading to and Stratton; 1954.
increase in confusion and a decrease in reasoning ability. 13. Miller JB. Dental care for the deaf child. J Okla State Dent Assoc
General anesthesia can be utilized as the method of treatment 1970;60:38-42.
when dental treatment is necessary, and all other avenues of 14. Rapp R, Kanar HL, Nagler B. Pedodontic care for the deaf and
treatment have been unsuccessfully attempted. blind. Dent Clin North Am 1966;10:21-34.
15. Getz S. Environment and the deaf child. Springfield, Ill.:
Charles C Thomas; 1956.
CONCLUSION 16. Levine DS. The psychology of deafness. New York: Columbia
University Press; 1960.
A knowledge of the etiology and consequences of deafness is 17. Vernon M, Mindel E. Psychological and psychiatric aspects of
invaluable to the dentist administering dental care to the deaf profound hearing loss. In: Rose DE, editor. Audiological assessment.
child. The practitioner must be aware of the psychological Englewood Cliffs, NJ: Prentice-Hall Inc.; 1971. Ch. 4.
aspects of the child’s handicap and the strong dependence that 18. Dale DM. Deaf children at home and at school. Springfield, Ill.:
the child has on the parent. When the dentist understands Charles C Thomas; 1967. p. 37.
these aspects, he will be attuned to the situation facing him,
and will more readily be able to close the communication gap How to cite this article: Singh RK, Murawat K, Agrawal R. Dental
between the patient and him. Once this occurs and complete care for the deaf pediatric patient. Indian J Otol 2012;18:171-3.
confidence is gained by the patient, the dentist will discover Source of Support: Nil. Conflict of Interest: None declared.

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