Original Article Int J Clin Prev Dent 2014;10(4):215-218ㆍhttp://dx.doi.org/10.15236/ijcpd.2014.10.4.

215
ISSN (Print) 1738-8546ㆍISSN (Online) 2287-6197

Dental Cares for Patients Who Have a Hearing Impairment

Patcharaphol Samnieng
Department of Preventive Dentisty, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand

Objective: Hearing impaired 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. The aim was to determine whether there are indications that hear-
ing-impaired patients experience difficulties in accessing dental care and/or in receiving dental treatment.
Methods: Consent for participation in this study was obtained from patients who have a hearing impairment. The study was
carried out by means of a questionnaire. Two hundred four patients (92 male, 112 female, mean ages 39±7.5 years) con-
tacted through the deaf foundation returned completed questionnaires.
Results: Eighty-seven percent of all patients who have a hearing impairment had visited a dentist. Three-fourth of all patients
(77%) were reported to have at least one problem in communication while receiving dental care, this increased significantly
as the severity of the hearing impairment increased. Sixty-two percent reported that the dentist had worn a mask while com-
municating and 55% that there had been background noise in the surgery during appointments.
Conclusion: Deaf patients in particular often fail to obtain needed care because of communication difficulties experienced in
the treatment situation. Removing masks while talking, reducing background noise and learning to use simple signs may im-
prove communication with hearing-impaired patients.

Keywords: dental caries, hearing impairment, deaf, communication, tooth diseases

Introduction hearing loss to total deafness, is 13%. In a recent national oral

Hearing impairment refers to a condition in which in-
dividuals are fully or partially unable to detect some frequencies
of sound that are heard by normal people. The incidence of hear-
ing impairment worldwide is 1 to 2 per 1,000 newborns [1]. In
Thailand, the prevalence of hearing impairment, from mild
Corresponding author Patcharaphol Samnieng
Department of Preventive Dentisty, Faculty of Dentistry,
Naresuan University, Phitsanulok-Nakhon Sawan Road,
Muang, 65000, Thailand. Tel: +66-55966084, Fax: +66-
55966084, E-mail: patcharaphols@yahoo.com
Received March 17, 2014, Revised September 17, 2014,
Accepted December 23, 2014
health survey 55, 29, and 76% of deaf Thai student had perio-
dontal disease, dental caries in deciduous teeth and dental caries
in permanent teeth, respectively [2].
Deaf patients are at risk of having problems due to the inabil-
ity to be educated and communicated from the dental personnel.
A hearing impairment primarily influences communication, on
which it can have a devastating effect [3]. The extent of dis-
turbance also depends on age of onset, training, and acceptance
of disability [3].
Many methods of communication have become available to
enable the hearing-impaired to function in a normal way and
not to be disabled by their hearing loss. Many of those with a
hearing impairment rely wholly or partly on lip reading. Other
methods include sign language, finger spelling. There are many

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International Journal of Clinical Preventive Dentistry
aids to communication for those with some hearing, such as
hearing aids, induction loops and infrared systems and, for tele-
phone communication, text-phones, and typetalk systems. A va-
riety of suggestions have been put forward as to the manage-
ment of hearing-impaired patients including simple measures
such as not calling the patient from the waiting room using sole-
ly verbal means, sing posters, brochures and pictures to help ex-
plain procedures [4]. Dentists need to be sensitive to non-verbal
communication such as facial expressions, postures and move-
ments as a means of conveying feelings [5].
Those with hearing impairments are reported to experience
significant problems in accessing health care and in communi-
cating with doctors/dentists. Lack of sign language and of
awareness training among health service staff and the shortage
or absences of aids to communication have also been pointed
out. Reported dental attendance appears to be good but the ma-
jority of studies have focused on general health services. There
has been little consideration of dental care for patients with hear-
ing impairments. Studies have mostly been carried out through
charitable organizations concerned with helping individuals
with a hearing impairment, perhaps because of the difficulty in
obtaining sufficient sample sizes through more conventional
methods [6].
The aim of the present study was therefore to determine
whether there are indications that patient with hearing impair-
ments experience difficulties in accessing dental care or during
attendance at the dentist.
Materials and Methods
Consent for participation in this study was obtained from pa-
tients who have a hearing impairment. The study was carried
out in partnership with the Thai deaf foundation by means of
a questionnaire. The questionnaire was designed jointly by the
authors and the translator and Interpreter Association of
Thailand. Most questions were closed but open questions were
used to elicit examples of good practice.
In the first section, questions included details of the patient’s
Table 1. Methods of communication used by patient with hearing
impairments
Variable Number of patient
Lip reading 159 (77.94)
Sign language 178 (87.25)
Hearing aids 71 (34.80)
Writing 55 (26.96)
Values are presented as number (%).
216 Vol. 10, No. 4, December 2014
name, date of birth and occupation. The second included ques-
tions on severity of the hearing impairment, method of commu-
nication used. The fourth section was concerned with com-
monly perceived problems in accessing dental care.
Data from completed questionnaires was entered into an
SPSS Statistics ver. 15.0 (SPSS Inc., Chicago, IL, USA). and
analyzed using chi-squared tests to compare frequencies be-
tween those with a profound hearing impairment.
Results
Completed questionnaires were returned 204 patients.
Ninety-two (45%) of the patient were woman, 122 (55%) man.
The number using different communication skills is shown in
Table 1. Methods included lip-reading, sign language, hearing
aids and writing. Other methods included took Interpreter with
when visit dentist.
The types of treatment received are listed in Table 2.
Forty-eight percent of all patients had at least one tooth ex-
tracted and 36% of all had restorative care. Fifty-two percent
of all patients had scaling treatment.
1. Problems experienced at the dentist
Numbers of patient having different types of communication
difficulty at the dentist are shown in Table 3. Eighty-seven per-
cent of all patients were reported to have had a least one of the
difficulties, communicating with the dentist being the most
common.
Difficulties were more commonly reported for patient who
Table 2. Types of treatment received by children with hearing
impairments
Variable Number of patient
Restorations 74 (36.3)
Extractions 98 (48.04)
Scaling 106 (51.96)
Others 28 (13.72)
Values are presented as number (%).
Table 3. Communication difficulties at the dentist
Type of difficulty Number of patient
Communicating with the dental assistant 126 (61.76)
Being called from the waiting room 139 (68.13)
Communicating with the dentist 155 (75.98)
Understanding what will take place at the visit 118 (57.84)
Values are presented as number (%).

were profoundly deaf than those less severely impaired. Patient
said that the dentist always wore a mask (62%) when communi-
cating with them. In the case of 55 percent of all patients there
was always background noise.
Discussion
The aim of this study was to look for indications that patient
with hearing impairments experience difficulties in access to
dental care or when they visited a dentist. Overall, patient re-
ported little difficulty in access to care. The great majority of
children (98%) were reported to have visited a dentist.
Eighty-seven percent of all patients were reported to have had
a least one of the difficulties, communicating with the dentist
being the most common. Adults with hearing impairments have
also reported a high level of dental attendance [7,8]. Adults who
are hard-of-hearing are more likely to experience difficulties
and delays in accessing health care as compared to those who
are not hard-of-hearing [9].
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. As the dentist begins to under-
stand the complexity of each particular form of handicap and
its characteristics, he is able to plan more efficiently for sat-
isfactory treatment. Because many dentists do not understand
deafness and the unique problems that deaf patient exhibit, in-
adequate dental care for deaf patient still ensues. Deaf patients
in particular often fail to obtain needed care because of commu-
nication difficulties experienced in the treatment situation [10].
A hearing impaired patient’s ability to learn, socialize, com-
municate and develop cognitively may be delayed or blunted
when compared to normal patient. Aids specifically designed
for the population, such as books in Braille for visually impaired
patient, clear picture instructions foe autistic children and oral
hygiene instructions using sign language for hearing impaired
patient improve oral hygiene care [11,12].
Problems experienced while receiving dental care appeared
to be common. Nearly three-fourth of patient was reported to
have difficulties in communicating with the dentist/nurse, be-
ing called from the waiting room or understanding what will
take place during the appointment. Problems were common
across the sample as a whole but problems at all, and in commu-
nicating with the dental nurse in particular, were reported more
often for children who were profoundly hearing-impaired than
for those who were less severely affected. That these difficulties
are not isolated is shown by the fact that over two-thirds of chil-
dren were reported to experience similar difficulties at doctors’
surgeries. As at the dentists’, the likelihood of experiencing
problems communicating with the nurse at the doctors’ surgery
Patcharaphol Samnieng：Dental Cares for Hearing Impaired Patient
was increased among those with a profound hearing loss [6].
These patients need quiet surroundings and a clear view of
the speaker’s face to maximise their understanding but nearly
two-thirds of respondents reported that the dentist had worn a
mask while communicating with their child and over half re-
ported that there had been background noise such as music or
traffic during the appointment. Wearing a mask may be justified
as a measure to control cross infection, but pulling the mask
down from over the lips during speech, allowing a child to
lip-read, would help to improve understanding. Reducing noise
by turning off background music or closing windows is another
simple means to help [6].
Dentists should routinely enquire about a child’s preferred
means of communication. For many children, simple measures
such as removing masks and reducing noise may be sufficient
but in the present study nearly a third (30%) of the patients need-
ed special communication techniques such as sign language. It
has been suggested that all dentists should learn simple sign lan-
guage and principles of communication with those who have
hearing impairments [13]. Recommendations that staff should
be more aware of deaf issues as well as being able to use some
basic sign language. These suggestions are very similar to rec-
ommendations emerging from other studies [8,14]. They also
have only limited resource implications.
There was indication of problems in access to care but find-
ings have highlighted the fact that at least some patient with
hearing impairments experience difficulties during care. The
difficulties are not unique to dentistry but in many cases they
could be easily reduced or resolved.
Conclusion
Deaf patients in particular often fail to obtain needed care be-
cause of communication difficulties experienced in the treat-
ment situation. Removing masks while talking, reducing back-
ground noise and learning to use simple signs may improve
communication with hearing-impaired patients.
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