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REVIEW ARTICLE

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.
ABSTRACT
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

INTRODUCTION The deaf

Deafness has been known to exist since the beginning of
recorded history.[1] 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.[2]
The long, painful, and arduous struggle of the deaf to
emancipate themselves from these biases, prejudices,
persecutions, and inhumanities continues even today.[3] 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 ”.[2] 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.[4] 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.[2,5]
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.
1. 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.[6]
2. 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.[7-10] Deafness
may be caused by the effects of certain drugs, and the
most common of these are aspirin and quinine.[6,9,11] Other
causative agents include the usage of sulfa drugs and
antibiotics.[6]
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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: rajatsingh81@yahoomail.co.in

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Singh, et al.: Dental care for the deaf pediatric patient
The hard-of-hearing
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.[12] This is because deafness has definite and unique
consequences on the personality of a developing child,
resulting from difficulty in communicating with others.[13,14]
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.[15]
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.[16]
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.[17] 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.[17] 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
172
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.[18] 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.[13]
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.
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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
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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.
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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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