|Year : 2012 | Volume
| Issue : 4 | Page : 171-173
Dental care for the deaf pediatric patient
Rajat K Singh1, Kritika Murawat2, Rahul Agrawal3
1 Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
2 Dental Practicioner, Laxmi Dental Clinic, 40 DIG Colony, Varanasi, Uttar Pradesh, India
3 Department of Oral Pathology, Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
|Date of Web Publication||19-Dec-2012|
Rajat K Singh
Faculty of Dental Sciences, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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
|How to cite this article:|
Singh RK, Murawat K, Agrawal R. Dental care for the deaf pediatric patient. Indian J Otol 2012;18:171-3
| Introduction|| |
Deafness has been known to exist since the beginning of recorded history.  The deaf were often denied the basic rights and privileges that belonged to them. It is known that among many early and primitive people, those who could not contribute their share to the needs of the tribe due to a handicap were not allowed to survive. 
The long, painful, and arduous struggle of the deaf to emancipate themselves from these biases, prejudices, persecutions, and inhumanities continues even today.  A popular existing misconception is that deaf people are all alike. This is a fallacy since the deaf are as different from one another as are any other group of people. Because lack of hearing has always been accompanied by lack of speech, the words "dumb" and "mute" have always had a close association with the word "deaf".  The deaf are often misunderstood-their handicap is less obvious than the blind and the spastic.
| Definitions|| |
A "deaf" child is one who does not have sufficient residual hearing to enable him to understand speech successfully even with a hearing aid, without special instruction.  In 1938, a standard definition of terms was formulated by a special committee on nomenclature for the Conference of Executives of American Schools for the Deaf. ,
The deaf are those in whom the sense of hearing is nonfunctional for the ordinary purposes of life. This general group is made up of two distinct classes based entirely on the time of loss of hearing.
- The congenitally deaf: Those who are born deaf. Congenital deafness can be categorized into three main groups: Hereditary, due to genetic influences; prenatal, due to a influences upon the developing embryo; and perinatal of a number of accidents at the time of birth itself, or within the earliest hours or days after birth. 
- The adventitiously deaf (acquired): Those who are born with normal hearing but in whom the sense of hearing became nonfunctional later through illness or accident. Acquired deafness can occur from several sources, such as viral infection, injury, and drug toxicity. For many years, viruses have been recognized as a cause of acquired deafness. Among those viruses known or suspected to cause deafness are mumps, measles, chicken pox, influenza, common cold viruses, and poliomyelitis. ,,, Deafness may be caused by the effects of certain drugs, and the most common of these are aspirin and quinine. ,, Other causative agents include the usage of sulfa drugs and antibiotics. 
Those in whom the sense of hearing, although defective, is functional with or without a hearing aid.
| The Deaf Child and the Dentist|| |
A deaf child does not develop in the same manner as a normal, hearing child. Therefore, the child should not be viewed as being like everyone else, except that he has impaired hearing.  This is because deafness has definite and unique consequences on the personality of a developing child, resulting from difficulty in communicating with others. , Therefore, the widely held belief is that in overcoming the obstacles to communication lies the solution to the problems of the deaf, both as a means of lessening the susceptibility to maladjustment and in aiding the child in the developmental process. 
| Role of Parents|| |
When a child cannot hear what goes on about him, there is much that he does not understand, and when he is unable to speak, he cannot ask the questions he desires. He is thus forced to depend on an interpreter-a person who knows about the communication problems and who can relay information to him in a manner which he can understand.  The first interpreters in the life of a deaf child are the parents. Parents are significantly the controlling influence on the psychological adjustment of their children.  If the parents accept their child's deafness and realistically try to understand and interpret it, the child is more likely to accept and adjust to deafness constructively. Unfortunately, in sharp contrast to this are the parents who magnify the implications of their child's deafness.  They view deafness as almost totally debilitating and react by smothering protection.
| Dental Visits|| |
The dentist who is aware of this total dependence of the deaf child on his interpreter-parent and the varying extremes that this dependence might elicit, must be willing to alter his normal approach to include parents initially. Then when an aura of confidence has been reached with both parent and child, the dentist can attempt to gradually wean the child from his parent.
The presence of a child's hearing disability should usually be elicited by the parent in the initial inquiry. The astute receptionist, upon learning of a handicap, should request a complete medical history from the parent. Ideally, this should be obtained prior to the child's first appointment for several reasons. One reason is that extended appointments quite often cause needless restlessness, leading to an increase in apprehension. Also, the advance information gives the dentist a preview of the new patient and his handicap, and helps him evaluate the best manner to present himself and the service he is to render.
Prior to the deaf patient's initial visit, the parent should meet or talk with the dentist so that he can explain exactly what will transpire. The parent should be instructed on the positive methods of preparing the child for his first dental visit. Visual aids, such as an illustrated brochure or a child's book descriptive of the first dental visit, are helpful in painting a realistic picture. There is a real incentive for a deaf child to try emulating his siblings, and to succeed in the same things that he sees them accomplishing.  When such a familial relationship exists, the deaf child should observe his brother's or sister's behavior during a dental procedure, in hopes that he will duplicate it.
If possible, the dental appointment should be scheduled so that 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 them. The parent is visible for interpretation and reassurance. However, the dentist and assistant can also easily convey ideas to the deaf child through gestures, facial expressions, and slow pronunciation of words. All children like body contact, such as a pat on the shoulder or handshaking, as positive reinforcement for good performance, and the deaf child is no exception. Once a good rapport is gained between patient and dentist, the child gains a sense of security and confidence, causing a decrease in the importance of the parent's presence. Eventually, as successive visits continue, the child will gain a sense of independence and often willfully desires the parent to remain in the waiting room.
Unfortunately, in many instances, the parent of the deaf dental patient is the overprotective individual. Temper tantrums, lack of cooperation, and other ploys are often elicited in order to evoke sympathy from the parent. 
The dentist should demonstrate for the deaf child all the instruments and equipment, that is, the air, water spray, the "moving toothbrush," and others. He should emphasize the vibrations of the equipment which the child will feel, and explain that this is normal and to be expected in the dental office. The deaf child is especially fearful of the unknown; therefore, using a maximum number of demonstrations and explanations will be most beneficial.
Actual dental treatment for deaf children closely parallels that performed with hearing children. An extensive preventive program should be initiated, as deaf children often exhibit poor oral hygiene. The significance of daily home care measures and the importance of their part in maintaining them should be emphasized to the parents. Parents often appease their children by rewarding them with excessive candy and sweets, and the parents of the deaf are no exception. Therefore, a dietary analysis should be performed, and corrective nutritional guidance be described to the parents.
It is often difficult, prior to initiating restorative procedures, to explain the concept of local anesthesia to the deaf child. Parents 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 anesthetic has been administered, it is imperative that the dentist be absolutely positive that it has taken effect. In cases observed where restorative procedures have been performed without complete anesthesia, the deaf child has often regressed in behavior, feeling betrayed, and occasionally has become a management problem.
The use of the rubber dam during restorative procedures may also result in negative behavior patterns, if not handled properly. The close proximity of the rubber dam and holder to the patient's eyes may threaten the deaf child's main area of communication, perhaps causing an adverse reaction. However, with confidence and familiarity gained between dentist and child, this obstacle may be overcome.
Premedication can be a useful adjunct in children who are hyperactive or extremely nervous. Many times, however, it has been shown to have a deleterious effect on the deaf child, causing a more acute behavior problem than was exhibited prior to medication. This could be due to the dulling of the deaf child's remaining communication centers, leading to increase in confusion and a decrease in reasoning ability. General anesthesia can be utilized as the method of treatment when dental treatment is necessary, and all other avenues of treatment have been unsuccessfully attempted.
| Conclusion|| |
A knowledge of the etiology and consequences of deafness is invaluable to the dentist administering dental care to the deaf child. The practitioner must be aware of the psychological aspects of the child's handicap and the strong dependence that the child has on the parent. When the dentist understands these aspects, he will be attuned to the situation facing him, and will more readily be able to close the communication gap between the patient and him. Once this occurs and complete confidence is gained by the patient, the dentist will discover that performing dental care for the deaf child is a most rewarding and satisfying experience.
| References|| |
|1.||Myklebust HR. Your deaf child. Springfield, Ill.: Charles C Thomas; 1950. |
|2.||Bender RE. The conquest of deafness. Cleveland: The Press of Case Western Reserve University; 1970. p. 11-8. |
|3.||DiCarlo LM. The deaf. Englewood Cliffs, NJ: Prentice-Hall Inc.; 1968. |
|4.||Davis H, Silverman SR. Hearing and deafness. New York, Holt: Rinehart and Winston Inc.; 1960. |
|5.||Rapp R, Kanar HL, Nagler B. Pedodontic care for the deaf and blind. Dent Clin North Am, March 1966, p. 21-34. |
|6.||Ballantyne JC. Deafness. Boston: Little, Brown, and Co.; 1960. p. 124-35. |
|7.||Bordley JE, Hardy WG. The etiology of deafness in young children. Acta Otolaryngol 1951;40:72-9. |
|8.||Kinney CE. Hearing impairment in children. Laryngoscope 1963;63:220-6. |
|9.||Whetnall E, Fry DB. The deaf child. London: William Heinemann Medical Books Ltd.; 1964. |
|10.||Zonderman B. The preschool nerve-deaf child; study of etiologic factors. Laryngoscope 1959;69:54-89. |
|11.||McConnell F, Ward PH. Deafness in childhood. Nashville: Vanderbilt Press; 1967. |
|12.||Myklebust HR. Auditory disorders in children. New York: Grune and Stratton; 1954. |
|13.||Miller JB. Dental care for the deaf child. J Okla State Dent Assoc 1970;60:38-42. |
|14.||Rapp R, Kanar HL, Nagler B. Pedodontic care for the deaf and blind. Dent Clin North Am 1966;10:21-34. |
|15.||Getz S. Environment and the deaf child. Springfield, Ill.: Charles C Thomas; 1956. |
|16.||Levine DS. The psychology of deafness. New York: Columbia University Press; 1960. |
|17.||Vernon M, Mindel E. Psychological and psychiatric aspects of profound hearing loss. In: Rose DE, editor. Audiological assessment. Englewood Cliffs, NJ: Prentice-Hall Inc.; 1971. Ch. 4. |
|18.||Dale DM. Deaf children at home and at school. Springfield, Ill.: Charles C Thomas; 1967. p. 37. |