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

When it comes to dentistry, those with hearing impairment make up a substantial proportion of the total patient population. Unfortunately, the COVID-19 pandemic has only elevated the challenges these individuals face in receiving proper oral healthcare.

By Genni Burkhart

In the United States, approximately 30 million people over the age of 12 report having 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, those with hearing impairment 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.

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

UCLA Facilitates Better Communication

Andrew Moore has been deaf since birth. Taking the role of an advocate, he's devoted his life and career towards removing barriers between the hearing world and 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 out 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 aimed at increasing 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 hearing impaired, ask if they'll need an interpreter, or if they'll be bringing someone with them. The Americans with Disabilities Act requires dentists to provide effective communication to deaf or hearing-impaired patients at no additional charge, this includes the use of 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) and therefore 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 make sure 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 for conversations between hearing people and people who are deaf or have hearing loss. The regulations give covered entities the choice of using VRI or on-site interpreters in situations where either would be effective."

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 his or her body position; 
  • "A clear, audible transmission of voices; and
  • "Adequate staff training to ensure quick set-up and proper operation." (“ADA Requirements: Effective Communication”)

Communicating with Deaf and Hard of Hearing Patients

It seems rather simple, but effective communication means everyone involved understands one another. When someone is deaf or hearing impaired, 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.

Start from the First Point of Contact

Make patients with hearing loss aware that you'll allow them to check in via text messaging or email, or via a designated spot on your website. Use digital booking platforms and text messages services for updating patients booking and scheduling. This universal tool facilitates easy communication from the initial point of contact, so be sure to 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. Remember also that since dentist offices are public accommodations, accessibility for the hearing impaired is required by law and failure to provide can result in large fines.

Go for Clear Face Coverings

Many Deaf patients rely on reading lips, facial expressions, and facial cues to communicate. Wear clear face coverings and keep them on hand should there be a patient with hearing impairment that you're not aware of in advance.

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.

Speaking Awareness

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

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 hearing impaired, background noise, such as music can be a distraction. Turn down any music the office might be playing and try to avoid loud disruptive noises.

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

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 hearing impaired 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 and desire to treat Deaf and hearing impaired patients with compassionate care that directly impact 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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