The oral and dental health of children with a visual impairment is no different from
the normal population and with good home care this can be maintained. In the United
Kingdom many children are educated in boarding schools and their supervision, with
regard to personal hygiene and diet (restraint from between-meal snacking), often
means that their oral health is good.
17.7.2 Operative procedures
Consideration should be given to the design and format of written material available
for use by patients who may be visually impaired, for example, instructions for the
wearing of orthodontic appliances and diet history sheets. Highly stylized type should
be avoided and a mix of upper and lower case should be used. Letters should be at
least one-eighth of an inch high (about 3 mm; 14 point) and be on uncoated (non-
glare) paper. The best contrast for ease of reading is black type on white or off-white
paper.
It is important to assist the visually impaired person according to their individual
needs. Patients with a sight defect object to being forcefully guided around by a nurse
or dentist who is enthusiastic to help. Many sight-impaired patients will have an
increased sensitivity to bright lights and perhaps touch. The operating light should
therefore be used with caution and the latter should be utilized to enhance the patients'
perception of what is being done; for example, being allowed to feel the instruments
and the dental chair.
It is not unusual for people to shout at those with a visual impairment. Sight-impaired
children are not usually deaf as well and should therefore be addressed in a normal
voice. It is important to the patient, and not only those with visual impairments, that
conversation is addressed to them and not to the person with them⎯the so-called
'Does he take sugar?' approach. Because vision is impaired and the sense of touch
may be heightened, it can be startling suddenly to feel a cold mirror in your mouth
without warning. A 'tell-feel-then-do' approach is important for these children who
may be unnerved by contact without forewarning. With these considerations in mind,
there are no areas of dental treatment that are unsuitable for the child with a visual
impairment, provided that they, or their parent or carer, can maintain an adequate
standard of oral hygiene. Insertion of orthodontic appliances may initially be difficult
and techniques like flossing take time to master.
17.8 DEAFNESS AND HEARING IMPAIRMENT
17.8.0 Introduction
Loss of hearing is an impairment acquired by many with increasing age. However,
some children are born with either a partial or total loss of hearing and this can occur
in isolation or in combination with other impairments, for example, rubella syndrome
(auditory, visual, intellectual, and cardiac defects). The prevalence is 3 per 1000
children.
17.8.1 General considerations
Patients who have hearing impairment may be fearful, or even hostile, because they