DENTAL CARE FOR HEARING IMPAIRMENT: CASE STUDY
Demographics
Patient: John
Age: 75 years old
Gender: Male
Race: Caucasian
Age: 75 years old
Gender: Male
Race: Caucasian
Physical Assessment
Height: 5'10"
Weight: 180 lbs
Healthy, fit, fast gait
John is avid about fitness. He used to participate in triathlons, but now jogs 4 mile a day and swims 25 laps in an indoor pool each day. He believes in eating healthy and having an active lifestyle. He believes that "you are only as old as you feel."
Weight: 180 lbs
Healthy, fit, fast gait
John is avid about fitness. He used to participate in triathlons, but now jogs 4 mile a day and swims 25 laps in an indoor pool each day. He believes in eating healthy and having an active lifestyle. He believes that "you are only as old as you feel."
Mental Assessment
John is a retired high school U.S. history teacher. Now, he loves to spend his retirement exercising and volunteering his time at the local library as well as gardening. Having impaired hearing hasn't stopped him from enjoying what he loved the most, which is teaching kids. As much as possible he still tries to volunteer at the school that he used to work for.
Social Assessment
John loves to talk and has a loud voice. He is very jolly and loves to tell stories, especially when it is about US History. He used to do impressions of former presidents to help entertain his students in the past. He is just recently discovered how to use social media and purchased an Ipad.
Medical Assessment
John is moderately deaf in his right hear. He wears a hearing aid. He lost his hearing from excessive surfing when he was 17 years old. From surfing he frequently had ear infections and developed "surfer's ear." He has been wearing a hearing aid since he was a teenager. John also takes 10 mg of Hydrochlorthiazide a day for maintenance for his blood pressure.
Dental Assessment
John has a lower removable partial denture. He also has many amalgam fillings and moderate plaque build up to his posterior teeth and underneath his lower partial dentures. He also exhibits some slight gingival recession, but no mobile teeth. John also has some staining from tea and coffee.
EO/IO Assessment
Bilateral presence of fordyce granules to his buccal mucosa was found. There is also a slight maxillary torus palatinus and bilateral linea alba. John's right TMJ exhibits slight clicking. All lymph nodes are non palpable and muscles are smooth. All other parameters have no significant findings.
Communication
The client wears a hearing aid on his right ear. First and foremost, it is important to make sure that it is on and working properly. It is important that one speaks clearly without shouting, to the side of the ear that is good. It is also important to face the client when communicating so that they can see or make out what you are saying as well as see your facial expressions. Speaking without the mask on will help to make the sounds more distinct and with clarity.
Speaking slowly and clearly is very important. Because the patient is elderly, it may take more time for patient to process what you are saying. If the patient has difficulty understanding what was just said, it is advisable to rephrase your sentence.
Lastly, it is important to confirm whether or not the patient was able to hear you correctly and whether they were able to follow you. If communicate is still difficult, writing out the information is also very helpful. Asking the patient or getting a feel of what feels the most comfortable for the patient in terms of communication is also important to establish.
Speaking slowly and clearly is very important. Because the patient is elderly, it may take more time for patient to process what you are saying. If the patient has difficulty understanding what was just said, it is advisable to rephrase your sentence.
Lastly, it is important to confirm whether or not the patient was able to hear you correctly and whether they were able to follow you. If communicate is still difficult, writing out the information is also very helpful. Asking the patient or getting a feel of what feels the most comfortable for the patient in terms of communication is also important to establish.
Appointment Planning
Patient prefers early appointments so that he has time to do all the activities he does on a daily basis. He usually likes to be the first patient in the office because a lot of background noise is distracting and his hearing aid actually amplifies some of those sounds. These extra sounds are irritating for the patient.
Confirming appointments for these patients would also be best in writing or via email.
Confirming appointments for these patients would also be best in writing or via email.
Positioning
Patient is comfortable in the supine position and does not request any special positioning. But patient does request that all instructions be given to him while he is sitting down and looking at the hygienist.
Dental Hygiene Procedures
For all procedures, because background noise can be amplified with the hearing aid, background music should be turned off and and ejectors should be turned off as well when not in use.
When using an ultrasonic scaler, it is important to notify the patient and ask them to turn off their hearing aid. After the ultrasonic scaling and when giving OHI, ask the patient to turn on their hearing aid.
When performing the dental hygiene procedure, explain what you will do slowly, and clearly using a normal tone of voice.
When using an ultrasonic scaler, it is important to notify the patient and ask them to turn off their hearing aid. After the ultrasonic scaling and when giving OHI, ask the patient to turn on their hearing aid.
When performing the dental hygiene procedure, explain what you will do slowly, and clearly using a normal tone of voice.
Safety Precautions
Ask the patient to turn off hearing aid when using ultrasonic scalers. Avoid having the suction on if it is not necessary to do. Extra sounds from instrumentation should be kept to a minimum and all background noise should be minimized. It is also necessary to be aware of where the hearing aid is. As a hygienist, it is important that while instrumenting we do not lean against or touch the hearing aid. In addition when taking a panoramic x-ray, ask the patient to take off the hearing aid.
OHI
For this type of patient, it is important to show the patient what to do in the mirror. Patient has a lot of plaque build up around his denture and especially in the back of his mouth. It is important that the patient be shown how much plaque they have after disclosing. Showing the patient in the mirror proper brushing and flossing techniques is important because their poor oral hygiene can be due to not having the proper tutorial or information on dental care. Pamphlets and brochures will help to reinforce what they learn. Because patients wears a hearing aid, it is important to face the patient as well when speaking so that they may hear you clearly as well as pick up on any visual cues you give.
Personal Reflection
I chose to do this topic because one of my favorite history teachers in high school was like this mock patient. He was a surfer and the water getting into his ears traumatized his ears. I fondly recall that although he had a hearing aid, his hearing was still not very clear and he spoke very loud. He was always smiling when he was teaching and always made jokes and impressions of historical figures. I don't think I was mature enough then to realize the type of handicap hearing impairment was. I never realized some of the limitations or special considerations that people living with this, need to take. I remember laughing in class because sometimes my classmates would answer the question correctly but my instructor would hear the answer incorrectly. Looking back I realize how important communicating properly with deaf patients at any level of severity are.
Additional Information
Links to different sites:
All Photos Taken from Google Images
Some information taken from Darby and Walsh Dental Hygiene Theory and Practice, 3rd Ed. 2010
Some information taken from Darby and Walsh Dental Hygiene Theory and Practice, 3rd Ed. 2010