Challenges in the Dental Management of Deaf Patients

02-04-2024

According to the World Health Organization (WHO), about 20% of the European population has some hearing loss or deafness.1 Some providers may feel anxious when interacting with a deaf patient due to a lack of training and preparedness. 

Effective communication is important to help improve a patient's oral health and prevent future dental complications. Deaf patients may require specific strategies to overcome communication challenges. Continue reading to learn more about challenges in managing deaf patients and how to overcome them.  
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Types of Hearing Loss 

The extent of hearing loss can range from mild to profound. There are two main types of hearing loss — conductive and sensorineural.2 Hearing loss can also be a mix of the two types.3  

Conductive Hearing Loss  

Conductive hearing loss affects how sound is transmitted between the outer and middle ear. Examples of different causes of conductive hearing loss include:2,3 

  • Impacted ear wax 
  • Ear infections 
  • Tumors in the outer or middle ear 
  • Bone growths in the outer or middle ear 
  • Tympanic membrane perforation 
  • Congenital deformations of the ear canal 
  • Foreign objects stuck in the ear canal  

In some cases of conductive hearing loss, normal hearing can return after treatment.2  

 

Sensorineural Hearing Loss 

Sensorineural hearing loss occurs due to damage to the inner ear (cochlea). Examples of potential causes of sensorineural hearing loss include:2,3 

  • Illness 
  • Ototoxic drugs (such as aminoglycoside antibiotics and platinum-based chemotherapy drugs)4 
  • Aging 
  • Head trauma 
  • Hereditary disorders  
  • Loud noises or explosions 

 Sensorineural hearing loss is often permanent and does not respond to treatment.2,3  

 

Oral Health in Deaf Patients 

A 2020 review found that deaf and hard-of-hearing patients had poorer oral hygiene and an increased incidence of caries compared to the general population.5  

The reasons for poorer oral health in patients with hearing loss may be related to problems accessing and understanding dental care in this population. Studies have found multiple barriers to providing dental care to the deaf community, including:5 

  • Ineffective communication between patient and dentist 
  • Lack of access 
  • Discrimination reported by patients  
  • High prevalence of dental anxiety  

One study found that almost 70% of dentists surveyed did not feel qualified to work with deaf patients.5  

 

Five Tips for Overcoming Communication Challenges 

The following tips can help providers overcome communication challenges and help improve the dental health outcomes of deaf patients. 

  1. Ask About the Patient’s Preferred Method of Communication

The best way to find out how a deaf patient would like to communicate is just to ask. Patients with hearing loss can communicate in many different ways, including:6 

  • Spoken language 
  • Sign language 
  • Lip-reading 
  • Sign systems 
  • A combination of any of the above systems  

It is important to determine how the patient prefers to communicate and document it in the patient’s chart.7  

 

  1. Use an Interpreter

If the patient’s preferred method of communication is sign language, the use of an interpreter can help to enhance understanding.7 It is common to use a family member as an interpreter. However, some patients may feel uncomfortable sharing sensitive health information through a family member. Additionally, children should never be used as interpreters.8  

Whenever possible, use a certified interpreter familiar with medical terminology. Providers can check with local deaf-related organisations for resources available in the area.7  

 

  1. Plan Extra Time

A survey found that about 70% of dentists felt appointments with deaf patients required more time than other patients.5 The use of alternate forms of communication, such as using an interpreter, may require a longer appointment than patients without hearing impairment.7  

Planning extra time for an appointment with a deaf patient can help keep appointments on time while still allowing the time needed to provide appropriate care.  

 

  1. Check for Understanding

Deaf patients may have poor health literacy, leading to worse outcomes.5   

The strategies proven to improve a patient’s understanding of their care — such as the teach-back method — traditionally use verbal communication. The use of an interpreter can help ensure important points are understood. It is important to remember that speaking loudly or shouting does not help with comprehension. Using body language and observing the patient’s body language can also help with comprehension.5  

Alternate forms of communication, such as pictures or written information, may also help increase the patient’s understanding. Research has found that limiting key points to just 3 to 5 important things can help avoid information overload and improve patient comprehension.9 

 

  1. Get Educated

If your dental office has or plans to have deaf patients, learning just a few words or phrases in sign language can help you build a strong relationship with your patients.  

Staff training is also important so everyone in the office knows how to make deaf patients feel welcome.  

 

 

References: 

1. World Health Organization. Ear and hearing care. Updated January 30, 2023. Accessed November 22, 2023. https://www.who.int/europe/news-room/questions-and-answers/item/ear-and-hearing-care#: 

2. BetterHealth Channel. Deafness - a range of causes. Updated November 4, 2017. Accessed November 22, 2023. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/deafness-a-range-of-causes  

3. Mayo Clinic. Hearing loss: Symptoms & causes. Updated March 30, 2023. Accessed November 22, 2023. https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-20373072  

4. American Speech-Language-Hearing Association. Ototoxic medications (medication effects). Accessed November 22, 2023. https://www.asha.org/public/hearing/ototoxic-medications/  

5. Cannobbio VC, Cartes-Velásquez R, McKee M. Oral health and dental care in deaf and hard of hearing population: A scoping review. Oral Health Prev Dent. 2020;18(1):417-425. doi: 10.3290/j.ohpd.a44687. PMID: 32515411.  

6. National Deaf Children’s Society. Communication approaches. Accessed November 22, 2023. https://www.ndcs.org.uk/information-and-support/professionals/activities/resources/communication/ 

7. Akeely YY, Alenezi AQ, Albishr NN, et al. Communication challenges while dealing with a deaf patient in the emergency department and suggested solutions. Cureus. 2022 Nov 4;14(11):e31091. doi: 10.7759/cureus.31091. PMID: 36475183; PMCID: PMC9719717. 

8. Agency for Healthcare Research and Quality. Health literacy universal precautions toolkit, 2nd edition: Address language differences: Tool #9. Updated October, 2023. Accessed November 22, 2023. https://www.ahrq.gov/health-literacy/improve/precautions/tool9.html  

9. Agency for Healthcare Research and Quality. Health literacy: Hidden barriers and practical strategies. Updated September 2020. Accessed November 22, 2023. https://www.ahrq.gov/health-literacy/improve/precautions/1stedition/tool3.html