feel they are not going to understand what is being asked of them. The child may not
hear what has been said but pretends they have done so to avoid embarrassment. In
this situation visual aids assume an even greater importance. It is important for
optimizing hearing that all extraneous background noise is removed when
communicating with the hearing-impaired child. Piped music in the surgery, noise
from the reception area, as well as internal noises from aspirators and scavenging
systems should be reduced or eliminated.
Many deaf or hearing-impaired children will wear aids (1172HFig. 17.24) to enable them to
pick up more sounds, and older children may have become skilled not only in lip-
reading but also in signing. However, there is now a trend towards discouraging the
use of signing and to positively encourage a child to acquire some speech, utilizing
any residual vocal potential.
1173H
Fig. 17.24 A child with William's
syndrome wearing hearing aids.17.8.2 Oral health
There is a paucity of data concerning the oral health of children with hearing
impairment. As with visually impaired children, residence away from home in special
boarding schools sometimes means that eating patterns are more desirable dentally,
with less opportunity for between-meal snacking compared to day pupils. Supervision
of oral hygiene measures can also be better in children living in institutions and is
reflected in their oral hygiene scores, but this is very variable. Like many other
impaired children, hearing-impaired patients are initially wary of powered
toothbrushes because of the sensation they produce intraorally. But, although these
brushes have not been shown to be better in terms of plaque removal than a well-