Marilyn L. Weber

One aspect of dentistry that dental schools may not fully prepare you for is how to best interact with deaf and hard-of-hearing people. Even if you haven’t yet had a deaf or hard-of-hearing person as a patient, the chances are pretty good that you will at some point in your career. Two or three children out of 1,000 are born with a detectable level of hearing loss in one or both ears. That may not sound like a lot, but if you’re in a relatively small city with a population of 100,000, it still means the deaf community is 200 to 300 strong. And when you throw in the hard-of-hearing, the population is much larger still — 

 to the Department of Health and Human Services, almost 1 in 10 people could benefit from having a hearing aid. That number will only grow in coming years due simply to our nation’s aging population: 25% of those aged 65 to 74, and 50% of those who are 75 and older, suffer from disabling hearing loss. 

As with all patients, it’s important to welcome and engage deaf and hard-of-hearing people as fully-involved patients who understand and participate in their own dental health. Some common questions dentists have include: How can I best communicate with a deaf person? Do all or most deaf people read lips? Is writing notes back and forth sufficient? When is an interpreter necessary, or even legally required? Here are some answers: 

Provide multiple methods of communication. 

Make booking an appointment as easy as possible. Many deaf people use Video Relay Service (VRS) to make phone calls, using sign language to speak to a third-party interpreter via video, who in turn makes a call to the destination party to speak on the deaf person’s behalf.  But setting up an appointment via email or an Instant Messenger service on your website is even easier for deaf people than that, so think about offering that option. Some physicians and dentists even provide deaf patients with their cell phone numbers so that the deaf can text them in case of after-hours emergencies. 

 Some dentists have a description of various common procedures, with illustrations, available on their websites and in printed form in their lobbies. These are great for deaf or hard-of-hearing people. You can also provide before and after procedure photos for your deaf patients to use along with nonverbal, graphic explanations of treatments and procedures to make sure that your deaf patient is fully informed.

Be sensitive to the technology you use, and when you start working. 

Deaf people may not pick up on cues that hearing people do, such as the sound of a drill being turned on that indicates you’re about to start a procedure, so be sure to communicate explicitly so that no one is surprised. Deaf patients also tend to be more 

 to vibration, so some dentists use a laser or air abrasion instead of a conventional drill.

When you are interacting with a patient just once and for a routine procedure, you may not need an interpreter. This is particularly true if you’re using an assistive device. But for complex conversations or an extensive interview, the Americans with Disabilities Act (ADA) 

 that you provide deaf persons with an interpreter at no charge as long as this doesn’t put an “undue burden” on your practice (check with a lawyer if you have questions; 

 smaller practices are exempt from some requirements, and in certain cases reimbursement is available). This 

, put together by The National Association of the Deaf, has more specifics on laws and statutes that apply to healthcare providers serving the deaf. If you do need an interpreter, be sure you know what sort of interpreter your patient requires. American Sign Language (ASL) and Signed English are the two most common languages used in the US.  

Avoid relying on friends or family members as interpreters. 

As a rule, avoid using friends and family members as interpreters, since they may not be fully fluent in sign language, and moreover, speaking to them could breach required medical confidentiality. Also, a friend or family member is likely to have an emotional connection with the deaf person, and this could inhibit their ability to communicate effectively if you need to talk to your patient about a serious condition. 

Don’t count on writing notes as a communications solution. 

Don’t make the mistake of assuming everyone who can speak sign language can also speak English. Writing notes might be effective for very short exchanges. But note writing isn’t an effective substitute for an interpreter during longer discussions, since ASL has its own rules, grammar, and structure that are quite different than English, particularly when it comes to complex details and nuance. 

Know the limits of lip-reading — and don’t expect it. 

Some deaf and hard-of-hearing people can lip read, but many can’t, and among those who can read lips, most can only do it in a limited fashion. Only about one-third of spoken words can be understood by lip reading, since many words are formed in the back of the mouth, and look the same on the lips. Lip-reading shouldn’t be relied upon as effective means of communication. 

Be aware of your body language and attend to other communication cues. 

Before speaking, get the deaf person’s attention by a gentle tap on the shoulder, or a wave of your hand. If an interpreter is there, don’t address the interpreter, but instead address your patient directly. Be sure your mask is off, and that you’re situated in a location that’s well-lit and where there’s minimal background noise (turn off the saliva ejector) and other distractions. Do not turn your back while speaking. Speak carefully, distinctly and slowly, but not too slowly or in an unnatural fashion. Use simple words and short sentences. If you can use a visual aid to illustrate your point — such as pointing to a picture or illustration of a common procedure – do it. 

Because of the obvious language barrier, many deaf people may be a bit more anxious to be understood than the average patient. Usually just a bit of back-and-forth communication in the beginning is enough for dentists and deaf patients to establish a good rapport, and a long-lasting, happy professional relationship. 

Marilyn L. Weber, president and CEO of DIS, is a certified sign language interpreter and has an adult daughter who is deaf. Marilyn has been working for more than 25 years promoting accessible communication, and advocating for the rights of the deaf community. She has interpreted in thousands of professional situations, and conducts deaf awareness workshops, cultural diversity training, and ADA Compliance Consulting. Marilyn has over 2,900 hours of related professional training. 

Marilyn has received several awards from various local and national organizations recognizing her work and dedication to the deaf community. 

Articles

It's important for a dentist to be able to welcome and engage all patients. These tips will help dentists accommodate patients who are deaf and hard-of-hearing.