A Substantial Portion of Dental Patients are Hearing Impaired. Here's What You Can Do to Help.

The Deaf community makes up a substantial proportion of the dental patient population. Unfortunately, the COVID-19 pandemic has elevated the challenges they face in receiving oral healthcare.

By Genni Burkhart

In the United States, approximately 30 million people over the age of 12 report hearing loss in both ears. The World Health Organization (WHO) reports that hearing loss is the third most common physical condition behind heart disease and arthritis, affecting approximately 15 percent of the global population.

When it comes to dentistry, patients with varying levels of hearing loss make up a substantial proportion of the total patient population. Unfortunately, the COVID-19 pandemic has elevated the challenges these individuals face in receiving dental care. Legally, dentist offices are considered public accommodations. Therefore, accessibility for the deaf and hard of hearing is required by law, and failure to provide it can result in hefty fines. 

This article will address how dental professionals can better understand and treat Deaf and hard of hearing patients and offer practical, legally compliant solutions.  By understanding the specific communication needs of this population, dentists can provide the best possible care while adhering to important regulations and laws.

Expanding Education 

According to the National Association for the Deaf, most medical training programs don't adequately prepare medical professionals to communicate with Deaf patients effectively. The University of California, Los Angeles (UCLA) School of Dentistry has taken up this cause and is working to increase awareness, understanding, and empathy toward Deaf and hard of hearing patients. 

Andrew Moore has been deaf since birth. Taking the role of an advocate, he's devoted his life and career to removing barriers between the hearing world and the Deaf world. "Without communication, you don't have trust," reports Moore in a Denver 7 news report by Amanda Brandeis. Moore, who works as a Deaf interpreter and American Sign Language (ASL) Instructor, spoke with dental students at the UCLA School of Dentistry about this issue. Inspired by Moore, the former president of the Special Patient Care Club, Jonina Capino, sought ways to increase sign language knowledge at the UCLA School of Dentistry.

The motivation behind this new course lies within the students and teachers at the UCLA School of Dentistry and the values found in the Special Patient Care Club to "increase awareness, understanding, and empathy with the special needs population with educational workshops and community service events in hopes of encouraging UCLA dental students to treat this community in their future."

After funding was secured, Benjamin Kurnick, a third-year student at the UCLA School of Dentistry, partnered with Moore to launch a five-part course for dental students to increase communication with Deaf patients. While the course only received funding for one run, the response was overwhelmingly positive, and further courses are currently "in discussion."

In the meantime, their free one-hour course lecture, ASL for Dentists, is open to anyone interested and can be accessed here.

What are the Legal Obligations in Providing an Interpreter?

If you know ahead of time that a patient is Deaf or hard of hearing, ask if they'll need an interpreter or if they'll bring someone with them. The Americans with Disabilities Act requires dentists to communicate effectively with Deaf or hard of hearing patients at no additional charge, including using an interpreter when needed. As a subcontractor with access to Protected Health Information (PHI), ASL interpreters are Business Associates under HITECH (the federal legislation implementing aspects of HIPAA). Therefore, they must execute Business Associate Agreements (BAAs) with the dentist. Disclosing PHI to an ASL interpreter (or any other non-employee) without a BAA can result in significant fines to the dentist by the federal government.

Some patients might choose (but dentists cannot require) a family member or friend to act as their interpreter. Staff should accommodate this and ensure that everyone in the operatory understands the patient's rights to confidentiality and that care and treatment decisions remain that of the patient.

Video Remote Interpretation

According to ADA.gov, remote interpreting (VRI) is a fee-based service that uses video conferencing technology to access an off-site interpreter to provide real-time sign language or oral interpreting services to enhance communication between hearing people and people who are Deaf or hard of hearing. The regulations allow covered entities to use VRI or on-site interpreters in appropriate situations.

If VRI is used, all the following standards must be met:

  • "Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;
  • "A sharply delineated image that is large enough to display the interpreter's face, arms, hands, and fingers, and the face, arms, hands, and fingers of the person using sign language, regardless of their body position; 
  • "A clear, audible transmission of voices; and
  • "Adequate staff training to ensure quick set-up and proper operation." ("ADA Requirements: Effective Communication")

How to Facilitate Better Communication

It seems relatively simple, but effective communication means everyone understands one another. When someone is deaf or hard of hearing, communication (that which is easily taken for granted by hearing individuals) can become extremely challenging. But that's only if active listening strategies aren't implemented. For the dental team, it's vital to understand the barriers Deaf and hard of hearing patients face and incorporate active listening strategies to meet their needs.

1. Start from the First Point of Contact

Make patients with hearing loss aware that you'll allow them to check in via text messaging, email, or a designated spot on your website. Use digital booking platforms and text message services for updating patients' bookings and scheduling. This universal tool facilitates accessible communication from the initial point of contact, so explain this on your website, where it's easy to find and always available. This can go a long way in showing compassion and easing patient anxiety.

Legally, dentist offices are considered public accommodations. Therefore, accessibility for the deaf and hard of hearing is required by law, and failure to provide it can result in hefty fines.

2. Go for Clear Face Coverings

Many Deaf patients rely on reading lips, facial expressions, and facial cues to communicate. Therefore, wear clear face coverings and keep them on hand should there be a patient with a hearing impairment that you're unaware of in advance.

3. Lighting

Face your patient and speak directly to them. Position yourself so the lighting isn't in the eyes of the listener while you're speaking. This requires more manipulation of the objects (such as lighting) around you from when you're working on, speaking, or listening to the patient or their interpreter.

4. Speaking Awareness

Smile! It can mean a lot to break any tension in the room and ease the patient's anxiety. Be aware of how you're speaking. Such as, are you speaking clearly and distinctly without shouting or exaggerating mouth movements?

5. Decrease Distractions

Perhaps most relevant to non-operatory communications - keep your hands away from your face and avoid placing anything over your face when talking. For the hard of hearing, background noise, such as music can be a distraction. Turn down any music the office might be playing and avoid loud, disruptive noises.

When giving specific information – such as appointment times, medications, or follow-up care instructions – put it into a printout and ensure they acknowledge their understanding before they leave.

6. Pay Attention to the Listener

Look for facial expressions as a visual cue to understanding. If the patient looks puzzled, scared, or unsure, use tact and ask them or their interpreter if they understand. Take turns in speaking and listening to avoid cues you might miss if you're not actively paying attention.

In Conclusion

Perhaps the most important thing to remember in treating the Deaf or hard of hearing is that their disability doesn't indicate a lack of intelligence – quite the contrary. While advanced preparation is required in treating Deaf or hard of hearing patients, most of the steps require listening skills that are easy to implement in a dental office. The new ASL for Dentists program at UCLA's School of Dentistry further heightens the need to treat the Deaf community with compassionate care that ultimately impacts their wellness and quality of life. 


Author: With over 12 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound, where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.

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