Abordagem do paciente surdo no contexto da Medicina …



RELAT?RIO DE ATIVIDADE CL?NICAMESTRADO INTEGRADO EM MEDICINA DENT?RIAAbordagem do paciente surdo no contexto da medicina dentáriaJo?o Miguel Neiva e Cabral dos SantosPorto 2014Abordagem do paciente surdo no contexto da Medicina DentáriaJo?o Miguel Neiva e Cabral dos Santos(Estudante do 5? ano do Mestrado Integrado em Medicina Dentária)joaoksantos@Monografia de revis?o bibliográfica submetida à Faculdade de Medicina Dentária da Universidade do Porto para a obten??o do grau de Mestre em Medicina DentáriaOrientadoraProfessora Doutora Maria de Lurdes Ferreira Lobo Pereira Professora Auxiliar da FMDUPCoorientadoraProfessora Doutora Isabel Cristina Gon?alves Ro?adas PiresProfessora Auxiliar da FMDUP Faculdade de Medicina Dentária da Universidade do PortoPorto, 2014? minha família, pelo amor, educa??o, apoio e oportunidade de estudar, ? Faculdade de Medicina Dentária da Universidade do Porto, pelo apoio e conhecimentos transmitidos pelos seus docentes e pelo carinho e amizade com que o pessoal n?o-docente sempre me brindou,Aos meus binómios (Maria, V?nia e Ricardo), pela paciência, amizade e momentos partilhados,Aos meus colegas de casa, Rui e Cristiano, por testarem constantemente a minha paciência,Aos elementos do Grupo de Jovens Esperan?a, minha segunda família, por tudo o que me ensinaram e por partilharem comigo a vontade de tornar o Mundo um lugar melhor,? Tuna de Medicina Dentária do Porto, pelas experiências, amizades e conquistas que alcan?amos juntos,? Susana, ao Francisco, à Helena, à Aurelie, ao Reis e ao Mota,Ao Nuno,? Claudia,O meu mais sincero e eterno obrigado.“You may never know what results come of your actions, but if you do nothing, there will be no results.”―?Mahatma GandhiAgradecimentosEm primeiro lugar quero agradecer à minha estimada Orientadora, Professora Doutora Maria de Lurdes Ferreira Lobo Pereira, pela inspira??o, ajuda e motiva??o, sem as quais este trabalho n?o teria sido possível.Quero também agradecer à minha Coorientadora, Professora Doutora Isabel Cristina Gon?alves Ro?adas Pires, pelo seu olhar atento e pela sua disponibilidade.Devo também homenagear aqui a Dr.? Ana Bela Baltazar, pela sua ajuda, disponibilidade, simpatia e trabalho de vanguarda desenvolvido na sua área e por ter coorientado este trabalho, ainda que n?o oficialmente.A todos os que me ajudaram de maneira direta ou indireta a concluir este trabalho, o meu obrigado.Por fim, quero agradecer a todas as institui??es e indivíduos que lutam de forma constante e incansável por uma sociedade melhor.ResumoIntrodu??o: A boa comunica??o entre médico e paciente é essencial para uma boa rela??o entre estes, aumentando o grau de satisfa??o e participa??o do último. Indivíduos surdos ou com dificuldades auditivas deparam-se com dificuldades no acesso a cuidados na Medicina Dentária, entre elas: pobre comunica??o entre médico-paciente, desconhecimento por parte dos prestadores de cuidados de saúde acerca das características próprias da comunidade surda e falta de acesso a intérpretes devidamente treinados. Os médicos dentistas devem adotar formas mais eficazes para uma comunica??o bem-sucedida com este tipo de pacientes para prestar um servi?o de qualidade. Esta monografia pretende sumariar estas particularidades e sugerir técnicas e ferramentas para auxiliar no tratamento e comunica??o com estes pacientes.Material e métodos: Foi analisada bibliografia disponível na base de dados “PubMed?” e em publica??es nacionais e internacionais impressas, escritas em Inglês e Portugês, no intervalo de tempo entre 1999 e 2014.Desenvolvimento: Para uma presta??o de servi?os adequada os médicos dentistas devem registar na história clínica do paciente uma descri??o aprofundada da condi??o deste, sendo isto importante para a compreens?o do seu contexto e dos obstáculos com que se depara. Por desconhecimento, os médicos dentistas criam geralmente uma conce??o errada sobre a comunica??o com estes pacientes, o que se pode dever à falta de instru??o a este nível na sua forma??o. Esta falha pode ser colmatada através de módulos virtuais de aprendizagem ou forma??o básica em Língua Gestual e introdu??o à cultura surda. Conclus?o: O esfor?o e dedica??o dos profissionais e das institui??es de ensino e forma??o na instru??o acerca do atendimento deste tipo de pacientes est?o na base da quebra das barreiras comunicativas. ? recomendado a recolha e produ??o de dados estatísticos a nível nacional que ajudem a aumentar a perce??o acerca do assunto ou melhorar os métodos já implementados.Palavras-chave: comunica??o – metodologia; surdez; língua gestual; competências de comunica??o clínica; Medicina Dentária; cuidados dentáriosAbstractIntroduction: Good communication between doctor and patient is essential for a good relationship between them, increasing the degree of satisfaction and involvement of the latter. Deaf or hard of hearing individuals are faced with difficulties in accessing care in dentistry, including: poor communication between doctor and patient, ignorance by health care providers about the characteristics of the deaf community and lack of access to trained interpreters. The dentist should adopt more effective ways for a successful communication with this type of patients to provide a quality service. This paper aims to summarize these features and suggest techniques and tools to assist in the treatment and communication with these patients. Methods: The bibliography consists of available literature at "PubMed ?" scientific database as well as national and international printed publications, published in English and Portuguese between the years 1999 and 2014. Development: Towards an adequate provision of services dentists should record at the patient’s file a thorough description of his condition, which is important data for understanding the context and the obstacles he faces. Through ignorance, dentists generally create a wrong conception about communicating with these patients, which may be due to lack of instruction at this subject during their training. This drawback can be overcome through virtual learning modules or basic training in sign language and an introduction to the deaf culture. Conclusion: The effort and dedication of professionals and institutions of education and training in the instruction of this type of patient care is fundamental to breakdown communication barriers. The collection and production of statistical data at a national level is recommended to help increase the perception on the subject or improve the methods already implemented.Keywords: communication – methodology; deafness; sign language; clinical communication skills; dentistry; dental care?ndice ?ndice TOC \o "1-3" \h \z \u Introdu??o PAGEREF _Toc393303105 \h 1Materiais e Métodos PAGEREF _Toc393303106 \h 3Desenvolvimento PAGEREF _Toc393303107 \h 4Surdez PAGEREF _Toc393303108 \h 5Surdez em Portugal PAGEREF _Toc393303109 \h 5O paciente surdo PAGEREF _Toc393303110 \h 6Comunicar PAGEREF _Toc393303111 \h 7Utiliza??o de elementos escritos PAGEREF _Toc393303112 \h 8Leitura labial PAGEREF _Toc393303113 \h 9Comunica??o com pacientes que preferem usar a Língua Gestual Portuguesa (LGP) PAGEREF _Toc393303114 \h 12Comunica??o com pacientes que preferem usar a LGP, na presen?a de um intérprete PAGEREF _Toc393303115 \h 13Comunica??o com utilizadores de dispositivos auditivos PAGEREF _Toc393303116 \h 14Comunica??o com crian?as surdas PAGEREF _Toc393303117 \h 15Encontrar um intérprete qualificado PAGEREF _Toc393303118 \h 18Sala de espera PAGEREF _Toc393303119 \h 19Outras técnicas e perspetivas futuras PAGEREF _Toc393303120 \h 20Conclus?o PAGEREF _Toc393303121 \h 21Bibliografia PAGEREF _Toc393303122 \h 22Anexos PAGEREF _Toc393303123 \h 25Anexo A – Brochura PAGEREF _Toc393303124 \h iAnexo B - Parecer e Declara??o PAGEREF _Toc393303141 \h xxxviiIntrodu??oIntrodu??oOs indivíduos surdos ou com dificuldades auditivas deparam-se, de uma forma geral, com várias dificuldades quando tentam aceder a servi?os de saúde, entre os quais a Medicina Dentária. O desconhecimento acerca da cultura surda e a falta de forma??o nesta área pode criar mal-entendidos e obstáculos durante a partilha de informa??o com pacientes desta comunidade, que se sentem frustrados quando perdem a sua autonomia e/ou recebem sentimentos de condescendência por parte de outros.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-4", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-5", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Champion", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Dental Journal", "id" : "ITEM-6", "issue" : "3", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "155-159", "title" : "Dental care for children and young people who have a hearing impairment", "type" : "article-journal", "volume" : "189" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1\u20136)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1–6)Com o objetivo de melhorar o cuidado destes pacientes, o médico dentista deve fazer um esfor?o no sentido de conhecer as suas características e entender as barreiras existentes no processo de comunica??o. Devem, assim, ser adotadas formas mais eficazes de estabelecer uma comunica??o bem-sucedida com este tipo de pacientes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Champion", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Dental Journal", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "155-159", "title" : "Dental care for children and young people who have a hearing impairment", "type" : "article-journal", "volume" : "189" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-5", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-6", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-7", "itemData" : { "DOI" : "10.1002/2327-6924.12087", "ISSN" : "2327-6924", "PMID" : "24259249", "abstract" : "PURPOSE: Deaf adults often experience significant healthcare disparities. This article gives voice to nine Deaf adults as they describe their lifelong experiences with health care. DATA SOURCES: Qualitative, hermeneutic interviews with nine culturally Deaf adults. Each participant was interviewed three times, aided by a certified American Sign Language interpreter. CONCLUSIONS: Participants recalled childhood memories of painful and frightening procedures to investigate the deafness, which frequently overshadowed emotional needs. Communication barriers between Deaf patients and providers left the patients not understanding the diagnosis or treatment, medication use, or side effects. Descriptions included distressing or embarrassing interactions, and cries for help gone unanswered. Consequently, minimal health promotion occurs and most participants rely on the emergency department for health care. IMPLICATIONS FOR PRACTICE: Deaf patients should be screened for physical, sexual, and emotional abuse at every healthcare encounter. Assessments should include social support and social resources. Specific questions about pain, sleep, appetite changes, suicidal thoughts, and interest may help to identify manifestations of illness and health. Certified interpreters may be useful during the healthcare encounter, but ultimately the Deaf patient is best positioned to identify the most comfortable or meaningful means of communication between patient and healthcare provider.", "author" : [ { "dropping-particle" : "", "family" : "Sheppard", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Association of Nurse Practitioners", "id" : "ITEM-7", "issued" : { "date-parts" : [ [ "2013", "11", "21" ] ] }, "page" : "1-7", "title" : "Deaf adults and health care: Giving voice to their stories.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1\u20137)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1–7)A comunica??o é um sistema complexo que envolve a emiss?o e a interpreta??o de mensagens. Na sua forma mais simples é um processo com duas vias, envolvendo um emissor e um recetor. Para existir uma comunica??o adequada o sinal emitido e o sinal recebido têm imperativamente de ser o mesmo, independentemente do sistema utilizado para a transmitir, seja ele por símbolos, linguagem ou imagens.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8)Quando esta comunica??o falha, a rela??o médico-paciente pode ficar comprometida e a validade dos tratamentos pode, nalgumas situa??es, ser posta em causa. N?o se pode esperar que um paciente seja capaz de prestar um consentimento válido relativo aos tratamentos a que vai ser sujeito se n?o for capaz de entender aquilo que lhe é proposto.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.612", "ISSN" : "1476-5373", "PMID" : "18660768", "abstract" : "This article considers what is meant by informed consent and the implications of the Mental Capacity Act in obtaining consent from vulnerable adults. It explores a number of conditions which impact on this task, namely dyslexia, literacy problems and learning disability. The focus on encouraging and facilitating autonomy and the use of the appropriate level of language in the consent giving process ensures that consent is valid. The use of appropriate methods to facilitate communication with individuals in order to be able to assess capacity and ensure that any treatment options that are chosen on their behalf are in their best interests are outlined. The use of physical intervention in special care dentistry in order to provide dental care safely for both the patient and the dental team is also considered.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2008", "7", "26" ] ] }, "page" : "71-81", "title" : "Access to special care dentistry, part 3. Consent and capacity.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1,5,9)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1,5,9) Se a comunica??o n?o for eficaz est?o criadas as condi??es para que ocorram mal-entendidos que podem ter efeitos negativos nos dois sentidos da comunica??o: o prestador de cuidados pode pensar que a sua mensagem ou inten??o foi recebida e entendida pelo paciente e, por outro lado, o paciente pode pensar que apreendeu a mensagem quando, na verdade, nenhuma das situa??es se verificou.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3)Por outro lado, uma comunica??o que envolva a transmiss?o bem-sucedida de informa??o entre os dois interlocutores (paciente e médico) estimula uma boa rela??o entre estes e diminui a sensa??o de isolamento, aumentando o grau de satisfa??o e participa??o do paciente. Pacientes surdos preferem ser atendidos por médicos que sabem Língua Gestual ou médicos que s?o surdos, bem como por médicos que fazem o esfor?o de se aproximar da sua forma de comunica??o. Adicionalmente esperam algum esfor?o por parte destes com vista a melhorar o acesso aos seus servi?os.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1,5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1,5)O Código Deontológico da Ordem dos Médicos Dentistas refere que “Todo o médico dentista tem o dever de assegurar ao seu doente a presta??o dos melhores cuidados de saúde oral ao seu alcance, agindo com correc??o e delicadeza”. Além disso, “o médico dentista deve apoiar e participar nas actividades da comunidade que tenham por fim promover a saúde e o bem-estar da popula??o”.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Ordem dos M\u00e9dicos Dentistas", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1999" ] ] }, "publisher" : "Di\u00e1rio da Rep\u00fablica", "title" : "C\u00f3digo Deontol\u00f3gico (Regulamento interno n\u00ba 2/99, publicado em Di\u00e1rio da Rep\u00fablica \u2013 II Serie, n\u00ba 143, de 22 de Junho, alterado pelo Regulamento interno n\u00ba 4/2006, publicado em DR-II Serie n\u00ba 103, de 29 de Maio)", "type" : "bill" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(10)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(10)Também a legisla??o portuguesa procura a promo??o da acessibilidade, referindo que esta “constitui um elemento fundamental na qualidade de vida das pessoas” e contribui decisivamente “para um maior refor?o dos la?os sociais, para uma maior participa??o cívica de todos aqueles que a integram e, consequentemente, para um crescente aprofundamento da solidariedade no Estado social de direito.”ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Minist\u00e9rio do Trabalho e da Solidariedade Social", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issue" : "152", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "5670-5689", "publisher" : "Di\u00e1rio da Rep\u00fablica", "title" : "Decreto-Lei n.o 163/2006 de 8 de Agosto", "type" : "bill", "volume" : "1.a s\u00e9rie" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(11)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(11) A obten??o de consentimento para os tratamentos a efetuar é indispensável em Medicina Dentária e “O médico dentista deve informar e esclarecer o doente, a família ou quem legalmente o represente, acerca dos métodos de diagnóstico e terapêutica que pretende aplicar, bem como transmitir a sua opini?o sobre o estado de saúde oral do doente.”ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Ordem dos M\u00e9dicos Dentistas", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1999" ] ] }, "publisher" : "Di\u00e1rio da Rep\u00fablica", "title" : "C\u00f3digo Deontol\u00f3gico (Regulamento interno n\u00ba 2/99, publicado em Di\u00e1rio da Rep\u00fablica \u2013 II Serie, n\u00ba 143, de 22 de Junho, alterado pelo Regulamento interno n\u00ba 4/2006, publicado em DR-II Serie n\u00ba 103, de 29 de Maio)", "type" : "bill" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(10)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(10)Segundo vários autores, as maiores dificuldades encontradas pelos pacientes surdos s?o a pobre comunica??o entre médico-paciente, o desconhecimento por parte dos prestadores de cuidados de saúde acerca das características próprias da comunidade surda e a falta de acesso a intérpretes devidamente treinados.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-4", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-5", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Champion", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Dental Journal", "id" : "ITEM-6", "issue" : "3", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "155-159", "title" : "Dental care for children and young people who have a hearing impairment", "type" : "article-journal", "volume" : "189" }, "uris" : [ "" ] }, { "id" : "ITEM-7", "itemData" : { "DOI" : "10.1002/2327-6924.12087", "ISSN" : "2327-6924", "PMID" : "24259249", "abstract" : "PURPOSE: Deaf adults often experience significant healthcare disparities. This article gives voice to nine Deaf adults as they describe their lifelong experiences with health care. DATA SOURCES: Qualitative, hermeneutic interviews with nine culturally Deaf adults. Each participant was interviewed three times, aided by a certified American Sign Language interpreter. CONCLUSIONS: Participants recalled childhood memories of painful and frightening procedures to investigate the deafness, which frequently overshadowed emotional needs. Communication barriers between Deaf patients and providers left the patients not understanding the diagnosis or treatment, medication use, or side effects. Descriptions included distressing or embarrassing interactions, and cries for help gone unanswered. Consequently, minimal health promotion occurs and most participants rely on the emergency department for health care. IMPLICATIONS FOR PRACTICE: Deaf patients should be screened for physical, sexual, and emotional abuse at every healthcare encounter. Assessments should include social support and social resources. Specific questions about pain, sleep, appetite changes, suicidal thoughts, and interest may help to identify manifestations of illness and health. Certified interpreters may be useful during the healthcare encounter, but ultimately the Deaf patient is best positioned to identify the most comfortable or meaningful means of communication between patient and healthcare provider.", "author" : [ { "dropping-particle" : "", "family" : "Sheppard", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Association of Nurse Practitioners", "id" : "ITEM-7", "issued" : { "date-parts" : [ [ "2013", "11", "21" ] ] }, "page" : "1-7", "title" : "Deaf adults and health care: Giving voice to their stories.", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-8", "itemData" : { "DOI" : "10.4103/0972-124X.100923", "ISSN" : "0975-1580", "PMID" : "23162340", "abstract" : "OBJECTIVES: To assess oral hygiene status, oral hygiene practices and periodontal status among 14-17-year-old visually impaired, deaf and dumb, intellectually disabled and physically challenged and normal teenagers in the district of Nalgonda, South India.\n\nMATERIALS AND METHODS: Seven hundred and fifty teenagers in the age group of 14-17 years, constituting visually impaired, deaf and dumb, intellectually disabled, physically challenged and normal teenagers, were studied. Oral hygiene status and periodontal status were assessed using clinical indices and compared.\n\nRESULTS: Among the five groups chosen for the study, the intellectually disabled group had the highest plaque scores and poor oral hygiene. The visually impaired and deaf and dumb had better oral hygiene compared with other disability groups. Physically handicapped showed higher loss of attachment scores and deleterious and parafunctional habits. Normal teenagers had good oral hygiene and lower plaque scores. Oral health status relied basically on proper use of oral hygiene aids and training of the groups by their care takers.\n\nCONCLUSION: Disabled groups showed poor oral hygiene and higher incidence of periodontal disease, which may be attributed to the lack of coordination, understanding, physical disability or muscular limitations. Hence, more attention needs to be given to the dental needs of these individuals through ultimate, accurate and appropriate prevention, detection and treatment.", "author" : [ { "dropping-particle" : "", "family" : "Ameer", "given" : "Nazia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palaparthi", "given" : "Rajababu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Neerudu", "given" : "Madhukar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palakuru", "given" : "Sunil Kumar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Singam", "given" : "Harinath Reddy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Durvasula", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Indian Society of Periodontology", "id" : "ITEM-8", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "7" ] ] }, "page" : "421-5", "title" : "Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1\u20137,12)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1–7,12)Tudo isto pode levar a más interpreta??es do diagnóstico, objetivo dos tratamentos, da medica??o e os seus efeitos secundários por parte dos pacientes, que consequentemente podem sentir frustra??o, exclus?o e incapacidade de transmitir os seus sentimentos, sintomas, história médica e ter controlo sobre a própria saúde. Nestas condi??es é difícil providenciar um tratamento de saúde adequado.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-4", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.4103/0972-124X.100923", "ISSN" : "0975-1580", "PMID" : "23162340", "abstract" : "OBJECTIVES: To assess oral hygiene status, oral hygiene practices and periodontal status among 14-17-year-old visually impaired, deaf and dumb, intellectually disabled and physically challenged and normal teenagers in the district of Nalgonda, South India.\n\nMATERIALS AND METHODS: Seven hundred and fifty teenagers in the age group of 14-17 years, constituting visually impaired, deaf and dumb, intellectually disabled, physically challenged and normal teenagers, were studied. Oral hygiene status and periodontal status were assessed using clinical indices and compared.\n\nRESULTS: Among the five groups chosen for the study, the intellectually disabled group had the highest plaque scores and poor oral hygiene. The visually impaired and deaf and dumb had better oral hygiene compared with other disability groups. Physically handicapped showed higher loss of attachment scores and deleterious and parafunctional habits. Normal teenagers had good oral hygiene and lower plaque scores. Oral health status relied basically on proper use of oral hygiene aids and training of the groups by their care takers.\n\nCONCLUSION: Disabled groups showed poor oral hygiene and higher incidence of periodontal disease, which may be attributed to the lack of coordination, understanding, physical disability or muscular limitations. Hence, more attention needs to be given to the dental needs of these individuals through ultimate, accurate and appropriate prevention, detection and treatment.", "author" : [ { "dropping-particle" : "", "family" : "Ameer", "given" : "Nazia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palaparthi", "given" : "Rajababu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Neerudu", "given" : "Madhukar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palakuru", "given" : "Sunil Kumar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Singam", "given" : "Harinath Reddy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Durvasula", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Indian Society of Periodontology", "id" : "ITEM-5", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "7" ] ] }, "page" : "421-5", "title" : "Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1,3\u20135,12)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1,3–5,12)Esta monografia pretende sumariar as particularidades relacionadas com a abordagem de pacientes surdos, especificamente em Medicina Dentária e sugerir técnicas e ferramentas para auxiliar no tratamento e comunica??o com estes pacientes. Apesar de ser mais difícil, o processo de comunica??o entre um paciente surdo e um prestador de cuidados de saúde n?o é impossível.Materiais e MétodosMateriais e MétodosA pesquisa bibliográfica efetuada durante a elabora??o desta monografia teve como principal objetivo a obten??o de informa??o científica atual. Incluíram-se ( REF _Ref392874501 \h Tabela 1): publica??es nacionais e internacionais que incluíram livros, revistas da especialidade, publica??es avulsas e imprensa escrita. A pesquisa na base de dados indexada “PubMed?” e foi limitada a artigos publicados nos últimos 15 anos, escritos em Inglês e Português. Para evitar a introdu??o de possíveis fatores que pudessem induzir conclus?es erróneas nesta monografia, optou-se por incluir apenas as publica??es que estudassem popula??es humanas surdas ou com dificuldades auditivas e que n?o apresentassem outro tipo de limita??es sensoriais ou psico-motoras. Utilizaram-se os termos de pesquisa: “deaf”, “dentistry”, “special care”, “clinic”, “waiting room”, “hearing impairment” e “patient management”.Tabela SEQ Tabela \* ARABIC 1 – Critérios de inclus?o e exclus?o da bibliografia utilizadaCritérios Inclus?oCritérios exclus?oData de publica??o: últimos 15 anosPopula??o: surda e/ou com dificuldades auditivas associadas a outras incapacidadesLíngua: Português, InglêsPopula??o: apenas pacientes surdos e/ou com dificuldades auditivasDisponibilidade: Livros e artigos “full-text available”DesenvolvimentoDesenvolvimentoO choque cultural e os obstáculos sentidos por pacientes surdos ou com dificuldade auditivas quando tentam aceder a servi?os de saúde geram sentimentos negativos nestes pacientes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-5", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "10.4103/0972-124X.100923", "ISSN" : "0975-1580", "PMID" : "23162340", "abstract" : "OBJECTIVES: To assess oral hygiene status, oral hygiene practices and periodontal status among 14-17-year-old visually impaired, deaf and dumb, intellectually disabled and physically challenged and normal teenagers in the district of Nalgonda, South India.\n\nMATERIALS AND METHODS: Seven hundred and fifty teenagers in the age group of 14-17 years, constituting visually impaired, deaf and dumb, intellectually disabled, physically challenged and normal teenagers, were studied. Oral hygiene status and periodontal status were assessed using clinical indices and compared.\n\nRESULTS: Among the five groups chosen for the study, the intellectually disabled group had the highest plaque scores and poor oral hygiene. The visually impaired and deaf and dumb had better oral hygiene compared with other disability groups. Physically handicapped showed higher loss of attachment scores and deleterious and parafunctional habits. Normal teenagers had good oral hygiene and lower plaque scores. Oral health status relied basically on proper use of oral hygiene aids and training of the groups by their care takers.\n\nCONCLUSION: Disabled groups showed poor oral hygiene and higher incidence of periodontal disease, which may be attributed to the lack of coordination, understanding, physical disability or muscular limitations. Hence, more attention needs to be given to the dental needs of these individuals through ultimate, accurate and appropriate prevention, detection and treatment.", "author" : [ { "dropping-particle" : "", "family" : "Ameer", "given" : "Nazia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palaparthi", "given" : "Rajababu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Neerudu", "given" : "Madhukar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palakuru", "given" : "Sunil Kumar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Singam", "given" : "Harinath Reddy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Durvasula", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Indian Society of Periodontology", "id" : "ITEM-6", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "7" ] ] }, "page" : "421-5", "title" : "Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1\u20135,12)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1–5,12) Chaveiro et al (2009) definem que “a surdez se distingue de outras deficiências, n?o pela deficiência propriamente dita, mas pela dificuldade de estabelecer comunica??o entre pessoas”.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1) Num estudo baseado em entrevistas a pacientes surdos brasileiros, Pereira & Fortes (2010) observaram que os prestadores de cuidados de saúde s?o descritos, geralmente, de forma negativa.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5) Neste estudo, os entrevistados caracterizavam com as seguintes afirma??es o pessoal prestador de cuidados de saúde:“[Eles] têm medo de comunicar.” “[Eles] fogem de você.” “[Eles] n?o sabem como ajudar e n?o sabem como comunicar.” “[Eles] n?o sabem o que fazer.” “[Eles] n?o se conseguem adaptar à pessoa surda.” “[Eles] têm preconceitos.” “[Eles] s?o duros.” “[Eles] n?o gostam de pessoas surdas.” “[Eles] n?o têm respeito.” “[Eles] riem-se da pessoa surda que tem medo” “[Eles] ficam com o dinheiro e dizem adeus.” “[Eles] mostram preocupa??o.”Kritzinger et al (2014), por outro lado, referem que os pacientes relatam mais experiências positivas junto de médicos dentistas que recorriam a intérpretes com experiência clínica, com profissionais capazes de utilizar língua gestual e nos casos onde os prestadores de cuidados de saúde faziam um esfor?o por melhorar a comunica??o.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.pec.2013.12.006", "ISSN" : "1873-5134", "PMID" : "24388666", "abstract" : "OBJECTIVE: To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients.\n\nMETHODS: Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa.\n\nRESULTS: Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services.\n\nCONCLUSION: These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients.\n\nPRACTICE IMPLICATIONS: Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.", "author" : [ { "dropping-particle" : "", "family" : "Kritzinger", "given" : "Janis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "Marguerite", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swartz", "given" : "Leslie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Braathen", "given" : "Stine Hellum", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Patient education and counseling", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "3" ] ] }, "page" : "379-83", "publisher" : "Elsevier Ireland Ltd", "title" : "\"I just answer 'yes' to everything they say\": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.", "type" : "article-journal", "volume" : "94" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5,13)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5,13) Outros autores apontam ainda a falta de sensibilidade e de conhecimento de boas práticas a ter com esta comunidade, expressa frequentemente através de erros básicos como a falta de cuidado em esclarecer claramente quando se dirigem ao paciente surdo, manter contacto visual com este quando o fazem ou quando o excluem de conversas.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,4)Embora haja esfor?os no sentido de promover a saúde oral em crian?as surdas, tem sido relatado por pacientes surdos adultos que sentem que à medida que crescem encontram menos paciência e preocupa??o por parte do pessoal médico.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2014", "1", "30" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Dire\u00e7\u00e3o Geral de Sa\u00fade Portugal", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "\u201cA escovagem \u00e9 importante! A escovagem \u00e9 fixe! - l\u00edngua gestual\u201d", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(14)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(14)Por estas raz?es os pacientes surdos adultos sentem-se frequentemente envergonhados ou inibidos em ambientes clínicos e consequentemente podem evitar os cuidados de saúde com medo de o tratamento correr mal devido à comunica??o má ou insuficiente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.pec.2013.12.006", "ISSN" : "1873-5134", "PMID" : "24388666", "abstract" : "OBJECTIVE: To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients.\n\nMETHODS: Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa.\n\nRESULTS: Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services.\n\nCONCLUSION: These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients.\n\nPRACTICE IMPLICATIONS: Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.", "author" : [ { "dropping-particle" : "", "family" : "Kritzinger", "given" : "Janis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "Marguerite", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swartz", "given" : "Leslie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Braathen", "given" : "Stine Hellum", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Patient education and counseling", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "3" ] ] }, "page" : "379-83", "publisher" : "Elsevier Ireland Ltd", "title" : "\"I just answer 'yes' to everything they say\": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.", "type" : "article-journal", "volume" : "94" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1093/deafed/4.2.73", "ISSN" : "1465-7325", "PMID" : "15579880", "abstract" : "Due to complex individual, interpersonal, and systemic factors, deaf and hard of hearing (d/hoh) individuals often receive inadequate, inappropriate, and unethical health care. This article begins with a review of the relevant socioeconomic and legal issues and the health status of d/hoh individuals. I then review health care starting with the patient's knowledge base, personal experiences, and understanding of health care relationships. I discuss the Deaf community's perspectives, providers' views about disability, communication between providers and deaf patients, and barriers encountered in health care delivery. The article concludes by assessing these factors' effects on health care delivery to d/hoh people, reviewing the ethical implications, and making recommendations for change.", "author" : [ { "dropping-particle" : "", "family" : "Harmer", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of deaf studies and deaf education", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "1999", "1" ] ] }, "page" : "73-110", "title" : "Health care delivery and deaf people: practice, problems, and recommendations for change.", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Reeves", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kokoruwe", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Audiological Medicine", "id" : "ITEM-5", "issue" : "2", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "95-107", "title" : "Communication and communication support in primary care: A survey of deaf patients.", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3,5,13,15,16)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3,5,13,15,16) Estas atitudes por parte dos profissionais de saúde podem levar a que os pacientes surdos desistam e deixem de procurar obter mais informa??o junto dos seus médicos ou, por outro lado, criem o hábito de consultar vários profissionais como forma de lidar com a falta de informa??o que obtêm de cada um.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,5) Pacientes no Reino Unido reportaram dificuldades em entender o diagnóstico ou instru??es dos medicamentos, consequentemente tomando doses erradas; um deles chegou a relatar acordar de uma cirurgia e surpreender-se ao aperceber-se que tinha sido amputado.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Reeves", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kokoruwe", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Audiological Medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "95-107", "title" : "Communication and communication support in primary care: A survey of deaf patients.", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(16)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(16)SurdezSegundo a OMS a surdez pode ser congénita ou adquirida. Pode ent?o estar presente ao nascimento nos casos em que tem origem hereditária e noutros com origem n?o-hereditária como quando é causada por doen?as maternas (e.g.: rubéola, sífilis) ou complica??es durante o parto. Pode ser posteriormente causada por certas doen?as infeciosas tais como a meningite, infe??es crónicas dos ouvidos ou desenvolver-se devido ao contacto com subst?ncias ototóxicas (aminoglicosídeos, fármacos citotóxicos, medica??o antimalárica e diuréticos), exposi??o a níveis sonoros elevados e ao processo fisiológico do envelhecimento.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Organiza\u00e7\u00e3o Mundial de Sa\u00fade", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Fact Sheet N\u00ba300", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "title" : "Deafness and Hearing Impairment", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(17)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(17) A OMS refere que existem 360 milh?es de pessoas no mundo com perda auditiva incapacitante, o que quer dizer que no adulto existe uma perda auditiva superior a 40dB no ouvido que ouve melhor e em crian?as que existe uma perda auditiva superior a 30dB no ouvido que ouve melhor.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Organiza\u00e7\u00e3o Mundial de Sa\u00fade", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Fact Sheet N\u00ba300", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "title" : "Deafness and Hearing Impairment", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(17)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(17)Aproximadamente um ter?o dos indivíduos com idade superior a 65 anos encontram-se afetados por perda auditiva incapacitante.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "This study examines the issues surrounding access to primary health care services for deaf individuals resident in the NE Essex area. Two groups of deaf participants were interviewed about their experiences accessing primary care services in the area: individuals whose primary method of communication was British Sign Language (BSL) and individuals whose primary method of communication was English. Furthermore, in order to obtain a comprehensive overview of the situation in NE Essex, a number of individuals involved in treating and working with deaf individuals were also interviewed, namely health professionals and BSL interpreters. The main issues facing deaf individuals in accessing primary care services in the local area were lack of deaf awareness, difficulty in booking appointments via telephone and difficulty in communicating with health professionals. This study shows that the PCT needs to consider providing comprehensive deaf awareness training and clear guidelines for staff on communicating and treating deaf patients. This would lead to an improved and more homogenous primary care service for deaf individuals in the NE Essex area. 3", "author" : [ { "dropping-particle" : "", "family" : "Earis", "given" : "Helen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reynolds", "given" : "Sally", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1-64", "publisher-place" : "North East Essex", "title" : "Deaf and hard-of-hearing people \u2019 s access to primary health care services in North East Essex A report for North East Essex Primary Care Trust", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(18)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(18)Surdez em PortugalA Associa??o Portuguesa de Surdos estima que existem cerca de 30 000 surdos (na sua maioria portadores de surdez grave e profunda) que praticam Língua Gestual Portuguesa no nosso país. A mesma associa??o estima ainda que existam cerca de 120 000 pessoas com algum grau de perda auditiva (incluindo aqui os idosos que v?o perdendo a audi??o gradualmente).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2014", "1", "28" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Associa\u00e7\u00e3o Portuguesa de Surdos", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "\u201cInforma\u00e7\u00e3o \u2013 Comunidade\u201d", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(19)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(19) Ana Bela Baltazar, autora do Dicionário de Língua Gestual Portuguesa editado em 2010, refere no seu Prefácio que a comunidade surda representa cerca de 100 000 indivíduos em Portugal.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "978-972-0-05282-7", "author" : [ { "dropping-particle" : "", "family" : "Baltazar", "given" : "Ana Bela", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "1", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher" : "Porto Editora", "title" : "Dicion\u00e1rio de L\u00edngua Gestual Portuguesa", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(20)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(20)Segundo dados recolhidos entre Setembro de 1993 e Junho de 1995 publicados pelo ent?o Secretariado Nacional de Reabilita??o residiam em Portugal, num universo de 142 112 indivíduos, 19 172 (cerca de 13,5%) eram surdos ou tinham redu??o grave da capacidade auditiva. Destes, 39,42% declararam n?o possuir nenhum nível de instru??o; apenas 2,34% referiram o nível secundário, 1,72% a instru??o politécnica e 1,54% o ensino universitário.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Secretariado Nacional de Reabilita\u00e7\u00e3o", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1995" ] ] }, "title" : "Inqu\u00e9rito nacional \u00e0s incapacidades, defici\u00eancias e desvantagens", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(21)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(21)Os Resultados Definitivos dos Censos 2011 n?o fazem referência específica à popula??o surda ou com dificuldades auditivas.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2014", "7", "2" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Instituto Nacional de Estat\u00edstica", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Censos 2011", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1-41", "title" : "Resultados Definitivos", "type" : "webpage", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(22)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(22)Pereira & Fortes (2010) referem que a dificuldade em fazer um retrato fiel da realidade do problema no Brasil se deve à inexistência de dados produzidos de forma sistemática à escala nacional, o que também acontece no nosso país.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Martins", "given" : "Maria do Ros\u00e1rio Oliveira", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Instituto Nacional para a Reabilita\u00e7\u00e3o", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1-3", "publisher-place" : "Lisboa", "title" : "Conclus\u00f5es do Encontro sobre Indicadores de Defici\u00eancia/Incapacidade", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5,23)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5,23)O paciente surdoO médico dentista deve reconhecer que cada paciente é um indivíduo único e que os pacientes surdos podem apresentar uma grande heterogeneidade de características. O médico dentista deve, em primeiro lugar, procurar saber como o paciente comunica normalmente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,4) Se o paciente é uma crian?a, pode perguntar aos pais ou ao cuidador. Também deve procurar observar como o paciente se comunica com os pais ou encarregados de educa??o. No caso de adultos, o médico dentista pode fazer a pergunta diretamente ou o paciente pode antecipar a quest?o e explicar como a devemos tratar.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(4)Os três primeiros anos de vida s?o críticos para o desenvolvimento da crian?a ao nível percetivo, das capacidades motoras, da inteligência e da linguagem, segundo Alsmark e colegas.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(4) Outros autores estimam que o período ideal para desenvolver esta última se situe algures entre os 5 e os 9 anos de idade.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3) Quando a surdez tem origem anterior ao desenvolvimento da fala, diz-se surdez pré-lingual. Por outro lado, quando é adquirida após o desenvolvimento desta habilidade, diz-se surdez pós-lingual.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1060-3441", "PMID" : "18274509", "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the Deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Dermatology nursing / Dermatology Nurses' Association", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007", "12" ] ] }, "page" : "541-4, 549-51", "title" : "Communication strategies for nurses interacting with patients who are deaf.", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(24)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(24)Algumas famílias podem privar a crian?a surda de aprender Língua Gestual numa atitude de nega??o face à realidade e motivadas pelo medo de perder a crian?a para uma comunidade que n?o conhecem.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3) A perce??o de pacientes surdos adultos indica que alguns podem ter um nível de stress mais elevado do que a popula??o geral. A presen?a de fatores como o difícil acesso ao emprego, dificuldades de comunica??o no quotidiano e stress associado a fazer parte de uma minoria linguística e cultural podem justificar este facto.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "THE PRESENT ARTICLE describes the effectiveness of stress management classes in decreasing perceived stress among Deaf adults. Deaf adults may experience unique stressors, in addition to circumstances associated with increased stress in the general population. The Perceived Stress Scale (S. Cohen, Kamarck, and Mermelstein, 1983) was used as a pretest and posttest measure for participants in a study of the Deaf Heart Health Intervention. Results indicated that (a) some Deaf adults may have higher levels of perceived stress than the general population, and (b) culturally appropriate stress management interventions are promising as a means of assisting Deaf adults to decrease levels of perceived stress, and hence decrease risk for stress-related illnesses. Future research will focus on obtaining a larger, more diverse sample of Deaf adults and refining the intervention for maximum effectiveness.", "author" : [ { "dropping-particle" : "", "family" : "Jones", "given" : "Elaine G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ouellette", "given" : "Sue E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kang", "given" : "Youngmi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "25-31", "title" : "Perceived stress among deaf adults.", "type" : "article-journal", "volume" : "151" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(25)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(25) Vários autores e equipas de investigadores referem ter encontrado piores condi??es de higiene oral em pacientes surdos quando comparado com pacientes ouvintes, o que é preocupante.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4103/0972-124X.100923", "ISSN" : "0975-1580", "PMID" : "23162340", "abstract" : "OBJECTIVES: To assess oral hygiene status, oral hygiene practices and periodontal status among 14-17-year-old visually impaired, deaf and dumb, intellectually disabled and physically challenged and normal teenagers in the district of Nalgonda, South India.\n\nMATERIALS AND METHODS: Seven hundred and fifty teenagers in the age group of 14-17 years, constituting visually impaired, deaf and dumb, intellectually disabled, physically challenged and normal teenagers, were studied. Oral hygiene status and periodontal status were assessed using clinical indices and compared.\n\nRESULTS: Among the five groups chosen for the study, the intellectually disabled group had the highest plaque scores and poor oral hygiene. The visually impaired and deaf and dumb had better oral hygiene compared with other disability groups. Physically handicapped showed higher loss of attachment scores and deleterious and parafunctional habits. Normal teenagers had good oral hygiene and lower plaque scores. Oral health status relied basically on proper use of oral hygiene aids and training of the groups by their care takers.\n\nCONCLUSION: Disabled groups showed poor oral hygiene and higher incidence of periodontal disease, which may be attributed to the lack of coordination, understanding, physical disability or muscular limitations. Hence, more attention needs to be given to the dental needs of these individuals through ultimate, accurate and appropriate prevention, detection and treatment.", "author" : [ { "dropping-particle" : "", "family" : "Ameer", "given" : "Nazia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palaparthi", "given" : "Rajababu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Neerudu", "given" : "Madhukar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palakuru", "given" : "Sunil Kumar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Singam", "given" : "Harinath Reddy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Durvasula", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Indian Society of Periodontology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "7" ] ] }, "page" : "421-5", "title" : "Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.ridd.2012.02.025", "ISSN" : "1873-3379", "PMID" : "22502855", "abstract" : "The present cross-sectional study was conducted to assess and compare the prevalence of dental caries of 229 deaf adolescents in a special senior high school and to identify factors related to dental caries, with a match group of 196 healthy adolescents in a normal senior high school, in Jiangsu province of East China. In this study the prevalence of dental caries was 55.9%, Decayed, Missing and Filled Teeth (DMFT) index in deaf students was 1.40\u00b11.89; in healthy students was 13.8% and 1.36\u00b11.72, respectively. Relatively lower proportion of awareness on dental health knowledge and lower proper practice of dental health behavior have been observed among deaf students compared with the control group. Multiple logistic regressions showed that the risk factors of dental caries in deaf students involved high frequency of consuming dessert and carbonated beverage. Poor oral health, lack of oral health knowledge and proper oral health practice could be found in deaf students. The dental treatment for the two groups was urgently needed. The dental health education concerning dietary behavior and prevention program to the deaf students and their parents should be reinforced; the supervision of oral health behavior for deaf and healthy students needs to be strengthened.", "author" : [ { "dropping-particle" : "", "family" : "Wei", "given" : "Hong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Yan-Ling", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cong", "given" : "Xiao-Na", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tang", "given" : "Wan-Qin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "Ping-Min", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Research in developmental disabilities", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1279-86", "publisher" : "Elsevier Ltd", "title" : "Survey and analysis of dental caries in students at a deaf-mute high school.", "type" : "article-journal", "volume" : "33" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(12,26)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(12,26) Há também indícios que sugerem que a taxa de infe??o por VIH em algumas popula??es surdas é maior quando comparada com a popula??o ouvinte e que há uma maior incidência de doen?as sexualmente transmissíveis (DSTs). Tais achados poder?o ser justificados pela maior dificuldade de acesso a informa??o de saúde e preven??o de DSTs reportada por estas popula??es.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/09540120412331291751", "ISSN" : "0954-0121", "PMID" : "16036248", "abstract" : "This study investigated knowledge about HIV/AIDS and barriers to HIV/AIDS education and prevention among deaf and hard of hearing people. Focus groups and individual interviews were used to elicit information from various groups of people with a hearing loss in different regions of New York State. Themes elicited in the interviews suggested that deaf sign language users are less knowledgeable about HIV/AIDS than oral deaf and hard of hearing participants, and that deaf adolescents have more knowledge than deaf adults. These findings likely reflect differences in levels of education and English proficiency. In addition, participants living in urban areas and in sizeable deaf communities are more exposed to information about HIV/AIDS than other participants. All participants reported difficulties in communication with medical providers, limiting their access to health information and proper medical care. Recommendations for the design and dissemination of educational materials and greater access to services for deaf and hard of hearing people are provided.", "author" : [ { "dropping-particle" : "", "family" : "Bat-Chava", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kosciw", "given" : "J G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "AIDS care", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2005", "7" ] ] }, "page" : "623-34", "publisher" : "Routledge", "title" : "Barriers to HIV/AIDS knowledge and prevention among deaf and hard of hearing people.", "type" : "article-journal", "volume" : "17" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(27)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(27) Tabela SEQ Tabela \* ARABIC 2 – Graus de surdez e possível impacto no pacienteADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8)Grau de surdezSons ouvidos mais leves, em decibéisPossível impactoLeve25-39Dificuldade em acompanhar conversas em situa??es ruidosas.Moderado40-69Dificuldade em acompanhar conversas sem um dispositivo auditivo.Grave70-94Dependente de leitura de lábios mesmo com um dispositivo auditivo;Língua Gestual pode ser o meio preferencial de comunica??o.Profundo>95Língua Gestual pode ser o meio preferencial de comunica??o.O médico dentista deve registar na história clínica do paciente a fase de desenvolvimento em que surgiu a surdez (pré ou pós-lingual, por exemplo), o grau de surdez (leve, moderado, grave ou profundo) ( REF _Ref393366566 \h Tabela 2), o nível de forma??o escolar ou académica e tipo de educa??o recebida (oral, bilingue, integrada, especial), problemas associados (dificuldades de aprendizagem, por exemplo) e fatores familiares (atitude dos pais face à surdez, pais ouvintes ou surdos). Estes dados s?o importantes de modo a compreender o contexto do paciente e os obstáculos com que se deparou previamente e que influenciam a sua atitude perante os outros.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(4) ComunicarPor falta de conhecimento, o médico dentista pode criar a conce??o errada de que para comunicar com pacientes surdos ou com dificuldades auditivas basta recorrer à linguagem escrita, leitura de lábios ou confiar em terceiros relacionados com o paciente que fa?am o papel de intérprete. ? certo que existe uma falha generalizada na forma??o dos profissionais de saúde relativamente aos cuidados a ter com a popula??o surda, pois s?o raras as institui??es de ensino que incluem no seu programa curricular algum tipo de forma??o específica nesta área. Está provado que a utiliza??o, por exemplo, de um módulo de aprendizagem através de um paciente virtual interativo pode ser uma ferramenta eficaz para introduzir o contato clínico com pacientes com anomalias de desenvolvimento a estudantes de medicina dentária.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1754-4505.2008.00038.x", "ISSN" : "0275-1879", "PMID" : "18782198", "abstract" : "An interactive, virtual-patient module was produced on compact disc (CD-ROM) in response to the critical need to increase dental students' clinical exposure to patients with developmental disabilities. A content development team consisting of dental faculty members, parents of children with developmental disabilities, an individual with a developmental disability, and educational specialists developed the interactive, virtual-patient module. The module focused on a young man with congenital deafblindness presenting as a new patient with a painful molar. Students were required to make decisions regarding clinical interactions throughout the module. Differences in both comfort and knowledge level were measured pre- and post-module completion, as well as the dental students' overall satisfaction with the learning experience. Significant results were obtained in students' perceived comfort and knowledge base. Participants reported overall satisfaction using the modules. This study demonstrated that an interactive, multi-media (CD-ROM), virtual patient learning module for dental students could be an effective tool in providing students needed clinical exposure to patients with developmental disabilities.", "author" : [ { "dropping-particle" : "", "family" : "Sanders", "given" : "Carla", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kleinert", "given" : "Harold L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boyd", "given" : "Sara E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herren", "given" : "Chris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Theiss", "given" : "Lynn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mink", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "205-13", "title" : "Virtual patient instruction for dental students: can it improve dental care access for persons with special needs?", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(28)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(28)Um facto que pode passar despercebido e que deve ser mencionado é que pode haver transmiss?o de informa??o sem que se diga uma única palavra através, por exemplo, da linguagem expressa facial ou corporalmente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3,5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3,5) Segundo Dougall e Fiske (2008), esta representa cerca 60% de responsabilidade na transmiss?o da mensagem.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8) Os pacientes surdos interpretam n?o só o que é dito mas principalmente o modo como o médico se comporta enquanto transmite a informa??o.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5)Pereira e Fortes (2010) referem que os prestadores de cuidados de saúdem tendem a melhorar a sua postura e eficácia de comunica??o assim que se apercebem da import?ncia da linguagem corporal, aumentando a proximidade física, postura e contacto visual com o paciente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5)Pacientes surdos aprendem por observa??o e repeti??o. Apresentar e demonstrar como utilizar equipamentos ou medica??o tem melhores resultados do que a mera explica??o.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2\u20134)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2–4)Nos tópicos seguintes apresentam-se e discutem-se os vários métodos que podem ser utilizados para veicular a informa??o aos pacientes surdos ou com dificuldades auditivas no ambiente clínico.Os protocolos apresentados s?o baseados no trabalho de Alsmark e colegas em 2007, tendo sido completados com informa??es e conselhos publicados por outros autores.Utiliza??o de elementos escritosOs programas de educa??o para a saúde oral s?o frequentemente produzidos e divulgados sob a forma de informa??o escrita (panfletos, brochuras) ou áudio (vídeo), caso sejam dirigidos a um público infantil, por exemplo.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Ordem dos M\u00e9dicos Dentistas", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "title" : "Folhetos Educativos", "type" : "webpage" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Minist\u00e9rio da Sa\u00fade", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Programa Nacional de Promo\u00e7\u00e3o de Sa\u00fade Oral", "type" : "webpage" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2014", "1", "30" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Dire\u00e7\u00e3o Geral de Sa\u00fade Portugal", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "\"A escovagem \u00e9 importante! A escovagem \u00e9 fixe! - legendas\"", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(29\u201331)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(29–31)A utiliza??o de elementos escritos apresenta vantagens e desvantagens. Apesar de poder fornecer um meio imediato de transmiss?o de informa??o entre paciente e médico, pode criar novas barreiras ao processo de comunica??o.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(4,5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(4,5)A Língua Portuguesa n?o é a língua nativa de todos os pacientes surdos. Muitos tiveram de o aprender como uma língua secundária, geralmente se a surdez está presente numa fase precoce. Acrescentando o facto de que muitos pacientes surdos podem ter encontrado barreiras no acesso a oportunidades de educa??o é compreensível que desconhe?am inclusivamente a própria anatomia e nomenclatura associada, preven??o e tratamento de doen?as. ? normal também que o vocabulário possa ser reduzido o que complica a transmiss?o de mensagens complexas através deste meio.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "N on-verbal communication is important when caring for deaf patients, fostering excellence in health care. Aim: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. Methods: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords \u201cpatient\u201d, \u201cdeaf person\u201d, \u201ccommunication\u201d and \u201chealth\u201d were used. A non-systematic search was made in scientific publications. Results: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. Conclusions: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.", "author" : [ { "dropping-particle" : "", "family" : "Chaveiro", "given" : "Neuma", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Porto", "given" : "Celmo Celeno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barbosa", "given" : "Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Revista Brasileira de Otorrinolaringologia", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2007-2010", "title" : "The Relation Between Deaf Patients and the Doctor", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(1,4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(1,4) A informa??o escrita pode ser complementada com desenhos simples, imagens ou até pequenos vídeos.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2\u20134)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2–4)Na tentativa de fornecer uma base para a educa??o destes pacientes, criou-se uma brochura (Anexo A) que simplifica os Folhetos Educativos da Ordem dos Médicos Dentistas e que aborda a generalidade das áreas da Medicina Dentária.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Ordem dos M\u00e9dicos Dentistas", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "title" : "Folhetos Educativos", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(29)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(29) Contém informa??o relevante para o paciente, desde a preven??o de várias patologias orais até às op??es de tratamento mais comuns e está redigida num Português simples, podendo ser impressa e entregue aos pacientes que a poder?o levar consigo para estudar e familiarizar-se com alguns termos e conceitos até ent?o desconhecidos. Leitura labialA leitura labial é praticada pela maioria das pessoas com deficiência auditiva e pode por isso ser utilizada em combina??o com as outras técnicas. ? apenas totalmente eficiente quando as condi??es s?o ideais. Muitas vezes há obstáculos como bigodes, falta de ilumina??o, localiza??o e posi??o errada do falante, falar excessivamente rápido, sotaques estrangeiros, alguns sons que n?o pode ser vistos (por exemplo, sons guturais), palavras homófonas (mam?, papá, etc.), a falta de conhecimento do vocabulário habitual do destinatário e a dist?ncia entre os interlocutores. Na clínica dentária, podem existir outros obstáculos, tais como a máscara facial do dentista, o uso de termos técnicos, a posi??o supina do paciente na cadeira, ansiedade, etc. O médico dentista deve tentar comunicar nas melhores condi??es possíveis para que o paciente o possa compreender.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1093/deafed/4.2.73", "ISSN" : "1465-7325", "PMID" : "15579880", "abstract" : "Due to complex individual, interpersonal, and systemic factors, deaf and hard of hearing (d/hoh) individuals often receive inadequate, inappropriate, and unethical health care. This article begins with a review of the relevant socioeconomic and legal issues and the health status of d/hoh individuals. I then review health care starting with the patient's knowledge base, personal experiences, and understanding of health care relationships. I discuss the Deaf community's perspectives, providers' views about disability, communication between providers and deaf patients, and barriers encountered in health care delivery. The article concludes by assessing these factors' effects on health care delivery to d/hoh people, reviewing the ethical implications, and making recommendations for change.", "author" : [ { "dropping-particle" : "", "family" : "Harmer", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of deaf studies and deaf education", "id" : "ITEM-3", "issue" : "2", "issued" : { "date-parts" : [ [ "1999", "1" ] ] }, "page" : "73-110", "title" : "Health care delivery and deaf people: practice, problems, and recommendations for change.", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.612", "ISSN" : "1476-5373", "PMID" : "18660768", "abstract" : "This article considers what is meant by informed consent and the implications of the Mental Capacity Act in obtaining consent from vulnerable adults. It explores a number of conditions which impact on this task, namely dyslexia, literacy problems and learning disability. The focus on encouraging and facilitating autonomy and the use of the appropriate level of language in the consent giving process ensures that consent is valid. The use of appropriate methods to facilitate communication with individuals in order to be able to assess capacity and ensure that any treatment options that are chosen on their behalf are in their best interests are outlined. The use of physical intervention in special care dentistry in order to provide dental care safely for both the patient and the dental team is also considered.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-4", "issue" : "2", "issued" : { "date-parts" : [ [ "2008", "7", "26" ] ] }, "page" : "71-81", "title" : "Access to special care dentistry, part 3. Consent and capacity.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1002/2327-6924.12087", "ISSN" : "2327-6924", "PMID" : "24259249", "abstract" : "PURPOSE: Deaf adults often experience significant healthcare disparities. This article gives voice to nine Deaf adults as they describe their lifelong experiences with health care. DATA SOURCES: Qualitative, hermeneutic interviews with nine culturally Deaf adults. Each participant was interviewed three times, aided by a certified American Sign Language interpreter. CONCLUSIONS: Participants recalled childhood memories of painful and frightening procedures to investigate the deafness, which frequently overshadowed emotional needs. Communication barriers between Deaf patients and providers left the patients not understanding the diagnosis or treatment, medication use, or side effects. Descriptions included distressing or embarrassing interactions, and cries for help gone unanswered. Consequently, minimal health promotion occurs and most participants rely on the emergency department for health care. IMPLICATIONS FOR PRACTICE: Deaf patients should be screened for physical, sexual, and emotional abuse at every healthcare encounter. Assessments should include social support and social resources. Specific questions about pain, sleep, appetite changes, suicidal thoughts, and interest may help to identify manifestations of illness and health. Certified interpreters may be useful during the healthcare encounter, but ultimately the Deaf patient is best positioned to identify the most comfortable or meaningful means of communication between patient and healthcare provider.", "author" : [ { "dropping-particle" : "", "family" : "Sheppard", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Association of Nurse Practitioners", "id" : "ITEM-5", "issued" : { "date-parts" : [ [ "2013", "11", "21" ] ] }, "page" : "1-7", "title" : "Deaf adults and health care: Giving voice to their stories.", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Champion", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Dental Journal", "id" : "ITEM-6", "issue" : "3", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "155-159", "title" : "Dental care for children and young people who have a hearing impairment", "type" : "article-journal", "volume" : "189" }, "uris" : [ "" ] }, { "id" : "ITEM-7", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-7", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2\u20134,6,7,9,15)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2–4,6,7,9,15)Existem algumas regras básicas que devem ser levadas em conta antes e durante a conversa: Antes da conversa: Fale com calma, devagar e agradavelmente. Se estiver com pressa, cansado ou irritado, isso vai afetar a sua comunica??o com o paciente. Uma atitude paciente relaxa o doente e melhora a sua concentra??o e confian?a. Entenda que a ida a uma consulta médica envolve geralmente um grande esfor?o por parte do paciente surdo e este precisa de ultrapassar o medo de que algo corra mal devido a problemas de comunica??o.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5) Nunca comece a falar se o paciente n?o está a olhar. Chame a sua aten??o com um leve toque no bra?o ou ombro, uma pancada ligeira na estrutura ou superfície onde o paciente está apoiado para criar vibra??es, um sinal discreto antes de come?ar a falar ou até acendendo/apagando as luzes da sala onde o paciente se encontra. Tenha isso em mente ao chamar o paciente a partir da sala de espera. Encare o paciente de frente e, de preferência, ao mesmo nível (especialmente para crian?as). Tente manter a mesma posi??o durante a conversa.Se quiser explicar alguma coisa, deve parar o procedimento e dirigir-se ao paciente. N?o mova a sua cabe?a para qualquer lado no final de uma frase; n?o olhe para baixo, etc. N?o se mova para muito longe ou muito perto do paciente. Deve manter-se numa posi??o confortável para o paciente e em que é totalmente visível. Evite ficar em pé atrás do encosto de cabe?a, pois nesse caso o paciente deve assumir uma posi??o desconfortável de modo a conseguir ver os seus lábios. Certifique-se o seu rosto está bem iluminado. Nunca fique em frente a uma janela ou luz (se o fizer o rosto vai estar na escurid?o). Durante a conversa: Certifique-se que n?o tem nada entre os lábios (cigarro, caneta), nem na boca (pastilha elástica, doces).Evite colocar a m?o ou qualquer objeto em frente à sua boca. A máscara facial é uma barreira para a leitura labial. Quaisquer procedimentos devem ser explicados antes de aplicar a máscara facial. Se quiser explicar alguma coisa a meio do processo, o dentista n?o se deve esquecer de remover a máscara.Pronuncie claramente, sem exagerar ou gritar. Os movimentos labiais devem ser claros, mas n?o exagerados. Com isso evita distorcer os lábios, tornando-se mais fácil de ler. Isso também acontece com gritos, que s?o desagradáveis para os deficientes auditivos, especialmente em público e que afetam a sua dignidade e privacidade. Falar claramente é muito mais eficaz do que falar alto. No entanto, pode ser útil para alguns pacientes com perda auditiva levantar ligeiramente a sua voz ou falar num tom mais grave na medida em que as pessoas perdem primeiro a audi??o de sons agudos.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1553-6467", "PMID" : "21655407", "abstract" : "OBJECTIVE: To implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing patients.\n\nDESIGN: Volunteers from the local deaf community conducted Deaf Strong Hospital, a role-reversal exercise in which students were the \"patients.\" Students navigated through a reception area, encounter with a physician, and having a prescription filled at a pharmacy without receiving or using any spoken language.\n\nASSESSMENT: A debriefing session was held in which small groups of students had the opportunity to ask questions of a panel of deaf and hard-of-hearing volunteers. On a survey administered to assess students' learning, 97% agreed or strongly agreed that the experience would likely impact their attitudes and behavior in future interactions with patients who did not speak English.\n\nCONCLUSIONS: The role-reversal exercise was an effective method of teaching students that the delivery of health care is dependent on adequate communication between health care providers and the patient.", "author" : [ { "dropping-particle" : "", "family" : "Mathews", "given" : "Jennifer L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkhill", "given" : "Amy L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schlehofer", "given" : "Deirdre a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Starr", "given" : "Matthew J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barnett", "given" : "Steven", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of pharmaceutical education", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2011", "4", "11" ] ] }, "note" : "resumos\nguidelines", "page" : "53", "title" : "Role-reversal exercise with Deaf Strong Hospital to teach communication competency and cultural awareness.", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8,32)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8,32) Fale sempre usando a sua voz. Fale naturalmente, nem muito rápido nem muito devagar. N?o simplifique demasiado a frase nem utilize termos técnicos, pois o paciente surdo, ao contrário de ouvintes que est?o constantemente a receber informa??es e aprender novas palavras e termos, pode n?o entender. De modo a facilitar a integra??o do deficiente auditivo, é importante explicar o que está a acontecer e dito em torno dele ou dela. Como médico dentista deve ensinar novas palavras relacionadas com a saúde oral (cárie, restaura??o, etc.) a crian?as ou adultos com deficiência auditiva Evite conversa excessiva, porque a leitura labial é cansativa.Use linguagem simples e frases curtas, especialmente com crian?as pequenas, sem as tratar, contudo, como se tenham uma dificuldade de aprendizagem. Simplifique a frase mas n?o as palavras. O contexto da frase é muitas vezes importante.Há certas palavras homófonas que s?o difíceis de distinguir unicamente através de leitura labial.Se n?o se conseguir fazer entender, repita a sua mensagem (cerca de 3 vezes). Se ainda n?o conseguir ser compreendido, reconstrua a frase ou use sinónimos. Se necessário, use gestos naturais ou algumas palavras escritas. ? possível comunicar por escrito com pacientes com deficiência auditiva que têm dificuldade de entender, pelo que deve ter sempre lápis e papel à m?o. Os inconvenientes da escrita manual s?o que algumas pessoas com deficiência auditiva podem n?o ser bons leitores e isso leva tempo, especialmente se a informa??o para ser transmitida é complexa (como quando se descreve um tratamento endod?ntico radical) e a caligrafia n?o é a melhor. Uma alternativa é ter algumas folhas escritas preparadas com antecedência (ver Anexo A), explicando os principais procedimentos dentários, instru??es, etc.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2)Desenhos simples podem também ser úteis.Este material poupa tempo e permite que o paciente leve consigo uma cópia para casa e o estude à vontade. A linguagem corporal (postura e movimento) e as express?es faciais desempenham um papel muito importante na comunica??o com o deficiente auditivo na clínica dentária e pode ser especialmente importante no ensino de crian?as surdas. Deve saber como usar o seu rosto e corpo para expressar sentimentos (de felicidade, tristeza, raiva, medo, interesse, etc.), para facilitar a compreens?o para a crian?a surda. Se a crian?a n?o se comportar corretamente e for repreendida de forma inexpressiva, pode n?o entender. Use express?es faciais agradáveis e calmas. Outros conselhos: Vá perguntando ao longo da consulta se a comunica??o está a funcionar ou se pode ser melhorada. As perguntas devem ser de forma aberta para evitar respostas do tipo sim-n?o e assegurar que tudo foi compreendido. O paciente com deficiência auditiva pode anuir mesmo que n?o tenha compreendido inteiramente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.pec.2013.12.006", "ISSN" : "1873-5134", "PMID" : "24388666", "abstract" : "OBJECTIVE: To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients.\n\nMETHODS: Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa.\n\nRESULTS: Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services.\n\nCONCLUSION: These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients.\n\nPRACTICE IMPLICATIONS: Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.", "author" : [ { "dropping-particle" : "", "family" : "Kritzinger", "given" : "Janis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "Marguerite", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swartz", "given" : "Leslie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Braathen", "given" : "Stine Hellum", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Patient education and counseling", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "3" ] ] }, "page" : "379-83", "publisher" : "Elsevier Ireland Ltd", "title" : "\"I just answer 'yes' to everything they say\": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.", "type" : "article-journal", "volume" : "94" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3,13)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3,13)N?o se iniba de repetir qualquer frase quando for necessáunica??o com pacientes que preferem usar a Língua Gestual Portuguesa (LGP)A Língua Gestual é uma forma de comunica??o que se baseia em sinais que s?o reconhecidos a nível nacional e regional (mas n?o internacionalmente), e tem a sua própria estrutura que é diferente da linguagem oral e escrita.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "978-972-0-05282-7", "author" : [ { "dropping-particle" : "", "family" : "Baltazar", "given" : "Ana Bela", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "1", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher" : "Porto Editora", "title" : "Dicion\u00e1rio de L\u00edngua Gestual Portuguesa", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(20)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(20)Esta língua é realizada recorrendo a diferentes configura??es, locais de articula??o e orienta??o das m?os, bem como a diferentes express?es faciais e movimentos corporais que acompanham os gestos criados pelas m?os. A sua estrutura é muito específica e diferente da que é utilizada habitualmente na Língua Portuguesa, predominando a sequência sujeito-objeto-verbo.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "978-972-0-05282-7", "author" : [ { "dropping-particle" : "", "family" : "Baltazar", "given" : "Ana Bela", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "1", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher" : "Porto Editora", "title" : "Dicion\u00e1rio de L\u00edngua Gestual Portuguesa", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(20)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(20)Os membros da família ou amigos capazes de usar língua gestual acompanham por vezes o paciente e ajudam a dar explica??es ou fazer perguntas. Por outro lado, apesar de estas pessoas serem capazes de comunicar com o paciente surdo, o médico dentista deve reconhecer que é improvável que estejam familiarizados com a amplitude de sinais necessários para transmitir conceitos médicos complexos. O recurso a amigos ou familiares como intérpretes pode criar problemas quanto à garantia de confidencialidade do paciente e levá-lo a guardar informa??es de natureza pessoal ou sensível. Podem ainda alterar inconscientemente as observa??es referidas pelo paciente ou transmitir informa??o tendenciosa acerca deste para o proteger.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Champion", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Dental Journal", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "155-159", "title" : "Dental care for children and young people who have a hearing impairment", "type" : "article-journal", "volume" : "189" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/S0140-6736(11)61670-X", "ISSN" : "1474-547X", "PMID" : "22423872", "author" : [ { "dropping-particle" : "", "family" : "Alexander", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ladd", "given" : "Paddy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "Steve", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-3", "issue" : "9820", "issued" : { "date-parts" : [ [ "2012", "3", "17" ] ] }, "page" : "979-81", "publisher" : "Elsevier Ltd", "title" : "Deafness might damage your health.", "type" : "article-journal", "volume" : "379" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1097/01.NURSE.0000435197.65529.cd", "ISSN" : "1538-8689", "PMID" : "24096599", "author" : [ { "dropping-particle" : "", "family" : "Shuler", "given" : "Gregory K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mistler", "given" : "Lisa a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torrey", "given" : "Kathleen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Depukat", "given" : "Rayne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nursing", "id" : "ITEM-4", "issue" : "11", "issued" : { "date-parts" : [ [ "2013", "11" ] ] }, "page" : "24-30; quiz 30-1", "title" : "Bridging communication gaps with the deaf.", "type" : "article-journal", "volume" : "43" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1002/2327-6924.12087", "ISSN" : "2327-6924", "PMID" : "24259249", "abstract" : "PURPOSE: Deaf adults often experience significant healthcare disparities. This article gives voice to nine Deaf adults as they describe their lifelong experiences with health care. DATA SOURCES: Qualitative, hermeneutic interviews with nine culturally Deaf adults. Each participant was interviewed three times, aided by a certified American Sign Language interpreter. CONCLUSIONS: Participants recalled childhood memories of painful and frightening procedures to investigate the deafness, which frequently overshadowed emotional needs. Communication barriers between Deaf patients and providers left the patients not understanding the diagnosis or treatment, medication use, or side effects. Descriptions included distressing or embarrassing interactions, and cries for help gone unanswered. Consequently, minimal health promotion occurs and most participants rely on the emergency department for health care. IMPLICATIONS FOR PRACTICE: Deaf patients should be screened for physical, sexual, and emotional abuse at every healthcare encounter. Assessments should include social support and social resources. Specific questions about pain, sleep, appetite changes, suicidal thoughts, and interest may help to identify manifestations of illness and health. Certified interpreters may be useful during the healthcare encounter, but ultimately the Deaf patient is best positioned to identify the most comfortable or meaningful means of communication between patient and healthcare provider.", "author" : [ { "dropping-particle" : "", "family" : "Sheppard", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Association of Nurse Practitioners", "id" : "ITEM-5", "issued" : { "date-parts" : [ [ "2013", "11", "21" ] ] }, "page" : "1-7", "title" : "Deaf adults and health care: Giving voice to their stories.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,6,7,33,34)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,6,7,33,34) Pereira e Fortes (2010) referem que a utiliza??o de um intérprete n?o qualificado pode ter consequências t?o ou mais negativas como a n?o-utiliza??o do intérprete.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(5) Deve ent?o ser utilizado um intérprete profissional com experiência clínica sempre que possível e quando aceite pelo paciente; no entanto, isto pode aumentar os custos da consulta ou criar quest?es de confian?a entre o paciente e o intérprete caso este lhe seja desconhecido.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/2327-6924.12087", "ISSN" : "2327-6924", "PMID" : "24259249", "abstract" : "PURPOSE: Deaf adults often experience significant healthcare disparities. This article gives voice to nine Deaf adults as they describe their lifelong experiences with health care. DATA SOURCES: Qualitative, hermeneutic interviews with nine culturally Deaf adults. Each participant was interviewed three times, aided by a certified American Sign Language interpreter. CONCLUSIONS: Participants recalled childhood memories of painful and frightening procedures to investigate the deafness, which frequently overshadowed emotional needs. Communication barriers between Deaf patients and providers left the patients not understanding the diagnosis or treatment, medication use, or side effects. Descriptions included distressing or embarrassing interactions, and cries for help gone unanswered. Consequently, minimal health promotion occurs and most participants rely on the emergency department for health care. IMPLICATIONS FOR PRACTICE: Deaf patients should be screened for physical, sexual, and emotional abuse at every healthcare encounter. Assessments should include social support and social resources. Specific questions about pain, sleep, appetite changes, suicidal thoughts, and interest may help to identify manifestations of illness and health. Certified interpreters may be useful during the healthcare encounter, but ultimately the Deaf patient is best positioned to identify the most comfortable or meaningful means of communication between patient and healthcare provider.", "author" : [ { "dropping-particle" : "", "family" : "Sheppard", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Association of Nurse Practitioners", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2013", "11", "21" ] ] }, "page" : "1-7", "title" : "Deaf adults and health care: Giving voice to their stories.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3,7)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3,7) Nos Estados Unidos da América a legisla??o contempla esta situa??o e o prestador de cuidados de saúde é responsável por providenciar e suportar os custos relacionados com o intérprete especializado e registado.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Fiskas", "given" : "Peter M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Dental Association", "id" : "ITEM-2", "issue" : "May", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "681-683", "title" : "Serving the hearing-impaired - An update on the use of sign-language interpreters for dental patients and their families", "type" : "article-journal", "volume" : "132" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,8,35)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,8,35)Alguns médicos podem recear que o recurso a um intérprete possa representar perigo para eles na medida em que poderá tornar-se uma testemunha de defesa caso o paciente alguma vez decida processar o profissional devido a má-prática.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/deafed/4.2.73", "ISSN" : "1465-7325", "PMID" : "15579880", "abstract" : "Due to complex individual, interpersonal, and systemic factors, deaf and hard of hearing (d/hoh) individuals often receive inadequate, inappropriate, and unethical health care. This article begins with a review of the relevant socioeconomic and legal issues and the health status of d/hoh individuals. I then review health care starting with the patient's knowledge base, personal experiences, and understanding of health care relationships. I discuss the Deaf community's perspectives, providers' views about disability, communication between providers and deaf patients, and barriers encountered in health care delivery. The article concludes by assessing these factors' effects on health care delivery to d/hoh people, reviewing the ethical implications, and making recommendations for change.", "author" : [ { "dropping-particle" : "", "family" : "Harmer", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of deaf studies and deaf education", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1999", "1" ] ] }, "page" : "73-110", "title" : "Health care delivery and deaf people: practice, problems, and recommendations for change.", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(15)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(15) Os avan?os tecnológicos permitem o desenvolvimento de áreas como a telemedicina nalguns países. Esta área tem especial interesse neste assunto, uma vez que o paciente ou o médico dentista podem aceder em tempo real aos servi?os de um intérprete utilizando uma webcam e uma liga??o à Internet.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3) Comunica??o com pacientes que preferem usar a LGP, na presen?a de um intérpreteQuando se recorre aos servi?os de um intérprete de LGP (membro profissional, familiar ou amigo paciente), é importante olhar mais para o paciente do que para o intérprete.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "ISSN" : "1553-6467", "PMID" : "21655407", "abstract" : "OBJECTIVE: To implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing patients.\n\nDESIGN: Volunteers from the local deaf community conducted Deaf Strong Hospital, a role-reversal exercise in which students were the \"patients.\" Students navigated through a reception area, encounter with a physician, and having a prescription filled at a pharmacy without receiving or using any spoken language.\n\nASSESSMENT: A debriefing session was held in which small groups of students had the opportunity to ask questions of a panel of deaf and hard-of-hearing volunteers. On a survey administered to assess students' learning, 97% agreed or strongly agreed that the experience would likely impact their attitudes and behavior in future interactions with patients who did not speak English.\n\nCONCLUSIONS: The role-reversal exercise was an effective method of teaching students that the delivery of health care is dependent on adequate communication between health care providers and the patient.", "author" : [ { "dropping-particle" : "", "family" : "Mathews", "given" : "Jennifer L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkhill", "given" : "Amy L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schlehofer", "given" : "Deirdre a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Starr", "given" : "Matthew J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barnett", "given" : "Steven", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of pharmaceutical education", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2011", "4", "11" ] ] }, "note" : "resumos\nguidelines", "page" : "53", "title" : "Role-reversal exercise with Deaf Strong Hospital to teach communication competency and cultural awareness.", "type" : "article-journal", "volume" : "75" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Champion", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Dental Journal", "id" : "ITEM-4", "issue" : "3", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "155-159", "title" : "Dental care for children and young people who have a hearing impairment", "type" : "article-journal", "volume" : "189" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-5", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,4,6,8,32)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,4,6,8,32)Os únicos momentos em que se deve dirigir ao intérprete durante a consulta s?o no início e no fim, para lhe agradecer o servi?o prestado. Pode ser útil encontrar-se previamente com o intérprete para discutirem terminologia médico-dentária e necessidades especiais de interpreta??o.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8) O intérprete deve estar presente em todas as consultas, garantindo (caso seja um intérprete profissional com experiência na área) que o médico dentista é capaz de compreender as queixas do paciente, que se consegue obter um consentimento informado, que o tratamento prestado é o mais seguro e eficiente e que se promove o entendimento e a colabora??o do paciente, funcionando de modo vantajoso para ambas as partes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Fiskas", "given" : "Peter M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Dental Association", "id" : "ITEM-1", "issue" : "May", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "681-683", "title" : "Serving the hearing-impaired - An update on the use of sign-language interpreters for dental patients and their families", "type" : "article-journal", "volume" : "132" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/2327-6924.12087", "ISSN" : "2327-6924", "PMID" : "24259249", "abstract" : "PURPOSE: Deaf adults often experience significant healthcare disparities. This article gives voice to nine Deaf adults as they describe their lifelong experiences with health care. DATA SOURCES: Qualitative, hermeneutic interviews with nine culturally Deaf adults. Each participant was interviewed three times, aided by a certified American Sign Language interpreter. CONCLUSIONS: Participants recalled childhood memories of painful and frightening procedures to investigate the deafness, which frequently overshadowed emotional needs. Communication barriers between Deaf patients and providers left the patients not understanding the diagnosis or treatment, medication use, or side effects. Descriptions included distressing or embarrassing interactions, and cries for help gone unanswered. Consequently, minimal health promotion occurs and most participants rely on the emergency department for health care. IMPLICATIONS FOR PRACTICE: Deaf patients should be screened for physical, sexual, and emotional abuse at every healthcare encounter. Assessments should include social support and social resources. Specific questions about pain, sleep, appetite changes, suicidal thoughts, and interest may help to identify manifestations of illness and health. Certified interpreters may be useful during the healthcare encounter, but ultimately the Deaf patient is best positioned to identify the most comfortable or meaningful means of communication between patient and healthcare provider.", "author" : [ { "dropping-particle" : "", "family" : "Sheppard", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Association of Nurse Practitioners", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2013", "11", "21" ] ] }, "page" : "1-7", "title" : "Deaf adults and health care: Giving voice to their stories.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(7,35)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(7,35) Deve falar-se diretamente com o paciente usando a segunda pessoa e prestar aten??o quando o paciente responde. A generalidade da bibliografia refere que o intérprete deve estar posicionado ligeiramente atrás do prestador de cuidados de saúde de modo a que estejam ambos no campo de vis?o do paciente. No entanto, a orienta??o dos intervenientes segundo um tri?ngulo equilátero conseguindo contato visual direto entre todos poderá ser mais favorável. A pessoa surda pode ser bilingue, isto é, pode ser capaz de utilizar ambos os tipos de linguagem (oral/gestual). ? útil aprender o alfabeto da Língua Gestual Portuguesa. Participando num curso de Língua Gestual Portuguesa pode, pelo menos, familiarizar-se com a sua estrutura básica e alguns gestos simples. Fale devagar e com clareza. Use frases simples porque a língua gestual tem uma estrutura diferente daquela usada na linguagem oral e escrita, por exemplo: “O aluno deu uma flor à professora” (Língua Portuguesa)./ “Aluno flor professora dar” (Língua Gestual Portuguesa).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "978-972-0-05282-7", "author" : [ { "dropping-particle" : "", "family" : "Baltazar", "given" : "Ana Bela", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "1", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher" : "Porto Editora", "title" : "Dicion\u00e1rio de L\u00edngua Gestual Portuguesa", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(20)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(20) ? muito importante o uso de linguagem corporal e express?es faciais. As express?es faciais fazem parte da língua gestual. Podem ser usados para expressar felicidade, tristeza, raiva, dúvida, ignor?ncia, desapontamento, etc.As mudan?as de tópico devem ser claramente identificadas. Deve verificar-se periodicamente que o paciente está a perceber e que se consegue perceber o paciente. Deve confirmar-se com paciente, n?o com o intéunica??o com utilizadores de dispositivos auditivosMuitos pacientes desligam os seus dispositivos auditivos devido à expectativa de encontrarem no ambiente clínico ruídos agudos ou que causem interferência com os dispositivos. Deve assegurar-se que o dispositivo está ligado durante os períodos de comunica??o sempre que for possível.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8)Caso n?o haja um aparelho auditivo disponível, uma alternativa possível e acessível para conseguir aumentar o som sem grandes custos económicos associados é a utiliza??o de um aparelho de comunica??o um-para-um. Com este dispositivo, o médico dentista fala para um microfone ligado a um amplificador que envia ent?o o sinal para auscultadores usados pelo paciente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1040-2446", "PMID" : "12114142", "abstract" : "Some physicians may be insufficiently prepared to work with the many patients who have hearing loss. People with hearing loss constitute approximately 9% of the U.S. population, and the prevalence is increasing. Patients with hearing loss and their physicians report communication difficulties; physicians also report feeling less comfortable with these patients. Although communication with patients plays a major role in determining diagnoses and management, little attention is given to teaching medical students and residents the skills necessary to facilitate communication when hearing loss is involved. The need for these skills will increase with the expected rise in the number of such patients. The author presents the rationale for including information about hearing loss in curricula on patient-doctor communication, and suggests curricular content, including background regarding hearing loss and techniques that can enhance the physician's ability to listen to (that is, \"hear\") and learn about the stories of these patients.", "author" : [ { "dropping-particle" : "", "family" : "Barnett", "given" : "Steven", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Academic medicine : journal of the Association of American Medical Colleges", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2002", "7" ] ] }, "page" : "694-700", "title" : "Communication with deaf and hard-of-hearing people: a guide for medical education.", "type" : "article-journal", "volume" : "77" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(36)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(36) N?o deve assumir que o paciente vai conseguir entender simplesmente porque usa um aparelho auditivo uma vez que este pode ser utilizado apenas para conseguir distinguir sons ambientais como por exemplo alarmes de incêndio ou buzinas de automóveis e n?o serem capazes de ajudar o paciente a compreender o discurso oral.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/01.NURSE.0000435197.65529.cd", "ISSN" : "1538-8689", "PMID" : "24096599", "author" : [ { "dropping-particle" : "", "family" : "Shuler", "given" : "Gregory K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mistler", "given" : "Lisa a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torrey", "given" : "Kathleen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Depukat", "given" : "Rayne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nursing", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2013", "11" ] ] }, "page" : "24-30; quiz 30-1", "title" : "Bridging communication gaps with the deaf.", "type" : "article-journal", "volume" : "43" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(34)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(34) A utiliza??o de instrumentos elétricos em pacientes portadores de implantes cocleares pode causar algumas preocupa??es no médico dentista. Um estudo realizado por Roberts e colegas (2002) em tecidos cadavéricos sugere que a utiliza??o de equipamento dentário como o cauterizador elétrico, localizador de ápice ou o ortopantomógrafo é segura; no entanto, a utiliza??o de equipamentos como o bisturi elétrico pode causar danos irreversíveis no implante coclear a partir de um certo nível de potência (nível 5).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00004770-200201000-00010", "ISSN" : "0099-2399", "PMID" : "11806648", "abstract" : "A cochlear implant (CI) converts mechanical sound energy into electrical signals that can be delivered to the cochlear nerve of profoundly deaf patients. The purpose of this study was to investigate whether electromagnetic interference with the CI occurs during the operation of the electric pulp tester, apex locator, electrocautery unit, electrosurgery unit, or panoramic radiograph machine. A mastoidectomy and cochleostomy were performed on a cadaver, and a CI was implanted. The dental devices were used intraorally, and the implant's circuitry was tested after each trial. A second CI was implanted in a human skull, which was then exposed to 50 panoramic radiographs, testing the implant's circuitry after each exposure. The probability of damage to the CI by any of the devices was negligible, except for the electrosurgery unit operated at level 7, which destroyed the CI's circuitry. Therefore, although the other devices seem safe, it is recommended that the electrosurgery unit not be used on a CI patient.", "author" : [ { "dropping-particle" : "", "family" : "Roberts", "given" : "Steven", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "West", "given" : "Lesley a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liewehr", "given" : "Frederick R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rueggeberg", "given" : "Frederick a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharpe", "given" : "Donna E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Potter", "given" : "Brad J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of endodontics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2002", "1" ] ] }, "page" : "40-3", "title" : "Impact of dental devices on cochlear implants.", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(37)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(37) Recomenda??es para melhorar a comunica??o com pacientes que usem aparelhos auditivos Elimine qualquer ruído de fundo (música, tr?nsito, etc.) durante a conversa. Os aparelhos auditivos digitais mais modernos fazem isso automaticamente.Evite ruídos repentinos que podem afetar mais o paciente com dificuldades auditivas do que um ouvinte normal. Crian?as com deficiência auditiva podem assustar-se com barulhos vindo de trás. Tente n?o fazer muito barulho.Se a pessoa com deficiência auditiva prefere desligar o aparelho auditivo enquanto o médico dentista está a utilizar instrumentos rotatórios ou o sistema de suc??o, deve avisá-lo antes de come?ar a usar esses equipamentos. Deve recordar-se que, se o aparelho auditivo está desligado, a conversa deve ser muito limitada e, durante o tratamento, o assistente deve assegurar que as instru??es e a??es s?o claras. Evite passar as m?os perto do aparelho auditivo ou inclinar o seu bra?o ou corpo contra ele durante o tratamento uma vez que pode causar interferêunica??o com crian?as surdasA crian?a surda deve ser tratada na clínica dentária como um ser único na sua individualidade. O médico dentista deve reunir informa??o sobre o grau de comprometimento, quando foi adquirida, o tipo de tratamento de reabilita??o a que a crian?a está sujeita, o tipo de educa??o e da comunica??o preferida, o tratamento familiar e qualquer problema associado. Recomenda??es especialmente apropriadas para crian?as surdasO mais importante é saber como a crian?a comunica. Pode ser útil observar como os pais ou educadores falam com a crian?a, usando uma linguagem que seja o mais semelhante possível. Uma reuni?o marcada previamente com os responsáveis pela crian?a pode servir para explicar exatamente o que vai acontecer durante a consulta e informá-los de como a podem preparar para a visita ao médico dentista. Podem ser entregues folhetos ou fotos aos educadores para que a crian?a possa ter uma ideia do que é a clínica e o que vai acontecer aí. As visitas devem ser cuidadosamente programadas para que a crian?a n?o tenha que esperar muito tempo na sala de espera, evitando assim a ansiedade excessiva e medo características da situa??o.Uma vez que a crian?a se encontre na cadeira de observa??o, o dentista, assistente e os seus acompanhantes devem permanecer dentro do seu campo de vis?o. O dentista deve olhar para a crian?a mais do que para os seus intérpretes ao explicar coisas ou responder perguntas. Durante as primeiras visitas, os responsáveis pela crian?a podem preferir estar presentes para a ajudar a sentir-se mais segura. A partir desse momento deve ser feita uma tentativa para falar com a crian?a através da sua forma de comunica??o e estimular a sua autonomia. Quando há confian?a por parte dos adultos e da crian?a, a crian?a pode gradualmente ser separada dos seus responsáveis. Isto ajudará a aumentar a sua independência.A equipa clínica deve estar treinada para utilizar comunica??o n?o-verbal, com linguagem corporal e express?es faciais e estar consciente da sua import?ncia. ? importante para dar uma impress?o agradável, a fim de relaxar a crian?a e promover a confian?a. Os pais ou educadores, primeiros intérpretes da crian?a, podem determinar a atitude da crian?a para novas experiências. As atitudes da família podem ser positivas ou negativas (excesso de prote??o, n?o aceita??o da deficiência, carga excessiva num membro da família, pais exigentes, etc.) Se os pais forem realistas e compreenderem e aceitarem as limita??es da crian?a, v?o ajudar a crian?a a lidar com a nova situa??o de forma independente. Por outro lado, se forem super-protetores e considerarem o comprometimento auditivo como uma deficiência incapacitante, v?o limitar a participa??o da crian?a na nova experiência e tornar a crian?a muito dependente deles, caso em que a crian?a vai prestar pouca aten??o ao médico dentista e procurar constantemente a aten??o dos adultos, deixando-os comunicar por si. Quando explicar as coisas, use frases claras, curtas. Se a crian?a n?o entendeu completamente, repita a frase e se ainda n?o é se conseguiu fazer compreender, deve reconstruir a frase com sinónimos ou usando uma estrutura mais simples. Se há algo que o paciente ainda n?o entende bem, uma palavra ou frase pode ser escrita, ou explicada com um desenho. Como todas as crian?as, a crian?a surda ou com dificuldades auditiva vai se sentir mais relaxada com uma carícia ou um aperto de m?o. A crian?a surda tem especialmente medo do desconhecido e precisa por isso de muitas explica??es e demonstra??es. Os instrumentos e equipamentos devem ser mostrados e todos os que vibram devem ser apresentados e explicados para que a crian?a possa entender que é normal e preparar-se. A técnica “dizer-mostrar-fazer” pode ser alterada nestes pacientes para “mostrar-fazer”; no entanto, deve ter em conta a idade do paciente, o grau de comprometimento, o tipo de comunica??o principal, habilidades, etc. As técnicas de modela??o podem ser muito úteis, permitindo que a crian?a observe o irm?o ou outra crian?a a ser tratado ou enquanto está na cadeira de observa??o ou assistindo vídeos sobre consultas dentárias. Outra forma de explicar os atos clínicos dentários é usar panfletos, fotografias e desenhos. Devem ser utilizados estímulos visuais para promover a aprendizagem e melhorar o comportamento. Lembre-se que a visibilidade total é essencial para a comunica??o com a crian?a surda. Deve retirar a máscara facial quando algo para dizer e n?o fazer nada fora do campo de vis?o da crian?a pois pode criar uma fonte de frustra??o.Se a crian?a usa um aparelho auditivo, siga as instru??es anteriormente descritas (reduzir o ruído de fundo, desligar dispositivos de rota??o que perturbem a crian?a, etc.) Se a crian?a geralmente usa a língua de sinais, os pais podem agir como intérpretes. Se o dentista n?o for capaz de utilizar a LGP, os pais ou um intérprete profissional adequado ter?o que estar presentes em todos os momentos durante a consulta. Recomenda-se que o médico dentista aprenda pelo menos a estrutura básica da Língua Gestual e alguns sinais simples, bem como a utiliza??o de linguagem corporal e express?es faciais.O tratamento dentário propriamente dito para uma crian?a surda é semelhante à das crian?as ouvintes, mas é importante realizar tratamento preventivo para essas crian?as, pois pode haver falta de higiene devido principalmente a uma educa??o pobre ou mal-sucedida e falta de motiva??o. O tratamento requer uma boa comunica??o entre o médico dentista e a crian?a e os pais ou educadores devem estar envolvidos na educa??o para a saúde oral. N?o é fácil explicar o conceito de anestesia local a uma crian?a surda, mas com a ajuda dos seus intérpretes, pode ser útil dizer que os dentes s?o postos "a dormir". A palavra "dor" é importante para estas crian?as, por isso n?o é aconselhável utilizar uma palavra diferente. Uma vez que a anestesia local for administrada, é importante testar se está a funcionar; caso contrário pode levar à falta de confian?a no dentista. A utiliza??o do dique de borracha deve ser introduzida lentamente de modo a evitar o comportamento negativo na crian?a. N?o se deve bloquear o campo de vis?o da crian?a enquanto o aplica, pois irá afetar a comunica??o entre a crian?a e o médico dentista. Havendo uma rela??o de confian?a, a maior parte das dificuldades será resolvida. Encontrar um intérprete qualificadoO paciente deve ser informado das vantagens e necessidade de recorrer a um intérprete profissional e as vantagens/desvantagens de recorrer a um familiar devem ser bem esclarecidas. Assim que isto esteja clarificado deve ser dada oportunidade ao paciente para se pronunciar e tomar uma op??o. Segundo o Artigo 2.? da Lei n.? 89/99 de 5 de Julho, “consideram-se intérpretes de língua gestual portuguesa os profissionais que interpretam e traduzem a informa??o de língua gestual para a língua oral ou escrita e vice-versa, por forma a assegurar a comunica??o entre pessoas surdas e ouvintes.” A mesma Lei define que para se considerar profissional, o indivíduo deve ter frequentado com aproveitamento um curso superior de tradutor-intérprete de língua gestual, com a dura??o mínima de três anos. Os intérpretes de língua gestual, no exercício da sua atividade devem respeitar e cumprir o código de ética e linhas de conduta do intérprete de língua gestual portuguesa. Assim, est?o obrigados a: guardar sigilo de tudo o que interpretam; realizar uma interpreta??o fiel, respeitando o conteúdo e o espírito da mensagem do emissor; utilizar uma linguagem compreensível para os destinatários da interpreta??o; n?o influenciar ou orientar nenhuma das partes interlocutoras; n?o tirar vantagem pessoal de qualquer informa??o conhecida durante o seu trabalho.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Assembleia da Rep\u00fablica", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "I S\u00e9rie -", "container-title" : "Di\u00e1rio da Rep\u00fablica", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "4186", "publisher" : "Di\u00e1rio da Rep\u00fablica", "title" : "Lei n.o 89/99 de 5 de Julho", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(38)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(38)N?o há ainda em Portugal um registo nacional oficial acessível que inclua todos os intérpretes profissionais de Língua Gestual Portuguesa. Para requisitar os servi?os de um profissional, os médicos dentistas interessados devem entrar em contato com a associa??o de surdos federada mais próxima da área. Através da página web da Federa??o Portuguesa das Associa??es de Surdos é possível aceder aos contatos das Associa??es Filiadas.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2014", "7", "12" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Federa\u00e7\u00e3o Portuguesa das Associa\u00e7\u00f5es de Surdos", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Associa\u00e7\u00f5es Filiadas", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(39)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(39) Atualmente s?o as que se seguem:Associa??o Cultural de Surdos da AmadoraAssocia??o Cultural de Surdos do BarreiroAssocia??o Cultural dos Surdos de ?guedaAssocia??o de Surdos da Alta EstremaduraAssocia??o de Surdos da Linha de CascaisAssocia??o de Surdos de Guimar?es e Vale do AveAssocia??o de Surdos do AlgarveAssocia??o de Surdos do Concelho da AlmadaAssocia??o de Surdos do OesteAssocia??o de Surdos do PortoAssocia??o Portuguesa de SurdosSala de esperaTradicionalmente, os médicos dentistas baseiam-se no método oral para informar os seus pacientes que est?o prontos para o receber, chamando o paciente pelo nome. Essa tarefa pode ser sua ou estar a cargo do pessoal assistente ou rececionista. Alguns pacientes surdos referem ter dificuldades com este sistema pelas raz?es óbvias e referem que a alternativa passa pela implementa??o de mostradores eletrónicos, mais comuns em meios hospitalares ou ent?o por ter alguém a vir informá-los diretamente e que esteja treinado para lidar com pacientes surdos, de preferência.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.", "author" : [ { "dropping-particle" : "", "family" : "Lieu", "given" : "Christine Chong-hee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadler", "given" : "Georgia Robins", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fullerton", "given" : "Judith T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stohlmann", "given" : "Paulette Deyo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "239-245", "title" : "Communication strategies for nurses interacting with deaf patients.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "This study examines the issues surrounding access to primary health care services for deaf individuals resident in the NE Essex area. Two groups of deaf participants were interviewed about their experiences accessing primary care services in the area: individuals whose primary method of communication was British Sign Language (BSL) and individuals whose primary method of communication was English. Furthermore, in order to obtain a comprehensive overview of the situation in NE Essex, a number of individuals involved in treating and working with deaf individuals were also interviewed, namely health professionals and BSL interpreters. The main issues facing deaf individuals in accessing primary care services in the local area were lack of deaf awareness, difficulty in booking appointments via telephone and difficulty in communicating with health professionals. This study shows that the PCT needs to consider providing comprehensive deaf awareness training and clear guidelines for staff on communicating and treating deaf patients. This would lead to an improved and more homogenous primary care service for deaf individuals in the NE Essex area. 3", "author" : [ { "dropping-particle" : "", "family" : "Earis", "given" : "Helen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reynolds", "given" : "Sally", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1-64", "publisher-place" : "North East Essex", "title" : "Deaf and hard-of-hearing people \u2019 s access to primary health care services in North East Essex A report for North East Essex Primary Care Trust", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(2,18)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2,18) Outra op??o pode ser entregar aos pacientes um pager ou um dispositivo eletrónico que vibre assim que forem chamados.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3) De modo a facilitar e simplificar este processo, o tempo de espera dos pacientes surdos deve ser minimizado ao máximo; para isso, as consultas devem ser previamente organizadas e agendadas de modo a proporcionar um ambiente calmo e um tempo de espera adequado.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc.", "author" : [ { "dropping-particle" : "", "family" : "Alsmark", "given" : "Silvia San Bernardino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garc\u00eda", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mart\u00ednez", "given" : "Mar\u00eda Rosa Mourelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "L\u00f3pez", "given" : "Nuria Esther Gallardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicina oral, patologia oral y cirugia bucal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "E576-E581", "title" : "How to improve communication with deaf children in the dental clinic.", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(4) Importa também minimizar o stress que o paciente surdo possa apresentar e que é normalmente provocado pelo medo de haver problemas na comunica??o, ansiedade normal da ida ao dentista ou até medo de se sentir exposto perante outros.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.", "author" : [ { "dropping-particle" : "", "family" : "Pereira", "given" : "Patr\u00edcia Cristina Andrade", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fortes", "given" : "Paulo Antonio De Carvalho", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American annals of the deaf", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "31-37", "title" : "Communication and information barriers to health assistance for deaf patients.", "type" : "article-journal", "volume" : "155" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "This study examines the issues surrounding access to primary health care services for deaf individuals resident in the NE Essex area. Two groups of deaf participants were interviewed about their experiences accessing primary care services in the area: individuals whose primary method of communication was British Sign Language (BSL) and individuals whose primary method of communication was English. Furthermore, in order to obtain a comprehensive overview of the situation in NE Essex, a number of individuals involved in treating and working with deaf individuals were also interviewed, namely health professionals and BSL interpreters. The main issues facing deaf individuals in accessing primary care services in the local area were lack of deaf awareness, difficulty in booking appointments via telephone and difficulty in communicating with health professionals. This study shows that the PCT needs to consider providing comprehensive deaf awareness training and clear guidelines for staff on communicating and treating deaf patients. This would lead to an improved and more homogenous primary care service for deaf individuals in the NE Essex area. 3", "author" : [ { "dropping-particle" : "", "family" : "Earis", "given" : "Helen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reynolds", "given" : "Sally", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1-64", "publisher-place" : "North East Essex", "title" : "Deaf and hard-of-hearing people \u2019 s access to primary health care services in North East Essex A report for North East Essex Primary Care Trust", "type" : "report" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1093/deafed/4.2.73", "ISSN" : "1465-7325", "PMID" : "15579880", "abstract" : "Due to complex individual, interpersonal, and systemic factors, deaf and hard of hearing (d/hoh) individuals often receive inadequate, inappropriate, and unethical health care. This article begins with a review of the relevant socioeconomic and legal issues and the health status of d/hoh individuals. I then review health care starting with the patient's knowledge base, personal experiences, and understanding of health care relationships. I discuss the Deaf community's perspectives, providers' views about disability, communication between providers and deaf patients, and barriers encountered in health care delivery. The article concludes by assessing these factors' effects on health care delivery to d/hoh people, reviewing the ethical implications, and making recommendations for change.", "author" : [ { "dropping-particle" : "", "family" : "Harmer", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of deaf studies and deaf education", "id" : "ITEM-4", "issue" : "2", "issued" : { "date-parts" : [ [ "1999", "1" ] ] }, "page" : "73-110", "title" : "Health care delivery and deaf people: practice, problems, and recommendations for change.", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3,5,15,18)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3,5,15,18) Na eventualidade de o paciente se mostrar demasiado tenso ou ansioso devido a fobias relacionadas com a clínica dentária poderá ser vantajoso efetuar uma primeira consulta de apresenta??o ou avalia??o num ambiente ou espa?o diferente.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.533", "ISSN" : "1476-5373", "PMID" : "18617935", "abstract" : "This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "7", "12" ] ] }, "page" : "11-21", "title" : "Access to special care dentistry, part 2. Communication.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(8) Outras técnicas e perspetivas futurasAlguns autores sugerem utilizar outras técnicas e materiais para facilitar ou melhorar a comunica??o entre o médico dentista e os pacientes surdos ou com dificuldades auditivas. Aparelhos de mensagens instant?neas, software tradutor informatizado ou o recurso a interpreta??o online em tempo real poder?o ser cada vez mais utilizados no futuro.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(11)61670-X", "ISSN" : "1474-547X", "PMID" : "22423872", "author" : [ { "dropping-particle" : "", "family" : "Alexander", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ladd", "given" : "Paddy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "Steve", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issue" : "9820", "issued" : { "date-parts" : [ [ "2012", "3", "17" ] ] }, "page" : "979-81", "publisher" : "Elsevier Ltd", "title" : "Deafness might damage your health.", "type" : "article-journal", "volume" : "379" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "This study examines the issues surrounding access to primary health care services for deaf individuals resident in the NE Essex area. Two groups of deaf participants were interviewed about their experiences accessing primary care services in the area: individuals whose primary method of communication was British Sign Language (BSL) and individuals whose primary method of communication was English. Furthermore, in order to obtain a comprehensive overview of the situation in NE Essex, a number of individuals involved in treating and working with deaf individuals were also interviewed, namely health professionals and BSL interpreters. The main issues facing deaf individuals in accessing primary care services in the local area were lack of deaf awareness, difficulty in booking appointments via telephone and difficulty in communicating with health professionals. This study shows that the PCT needs to consider providing comprehensive deaf awareness training and clear guidelines for staff on communicating and treating deaf patients. This would lead to an improved and more homogenous primary care service for deaf individuals in the NE Essex area. 3", "author" : [ { "dropping-particle" : "", "family" : "Earis", "given" : "Helen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reynolds", "given" : "Sally", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1-64", "publisher-place" : "North East Essex", "title" : "Deaf and hard-of-hearing people \u2019 s access to primary health care services in North East Essex A report for North East Essex Primary Care Trust", "type" : "report" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.", "author" : [ { "dropping-particle" : "", "family" : "Scheier", "given" : "Donna B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the New York State Nurses Association", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "4-10", "title" : "Barriers to health care for people with hearing loss: a review of the literature", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1093/deafed/enj003", "ISSN" : "1081-4159", "PMID" : "16192405", "abstract" : "In recent years, research has progressed steadily in regard to the use of computers to recognize and render sign language. This paper reviews significant projects in the field beginning with finger-spelling hands such as \"Ralph\" (robotics), CyberGloves (virtual reality sensors to capture isolated and continuous signs), camera-based projects such as the CopyCat interactive American Sign Language game (computer vision), and sign recognition software (Hidden Markov Modeling and neural network systems). Avatars such as \"Tessa\" (Text and Sign Support Assistant; three-dimensional imaging) and spoken language to sign language translation systems such as Poland's project entitled \"THETOS\" (Text into Sign Language Automatic Translator, which operates in Polish; natural language processing) are addressed. The application of this research to education is also explored. The \"ICICLE\" (Interactive Computer Identification and Correction of Language Errors) project, for example, uses intelligent computer-aided instruction to build a tutorial system for deaf or hard-of-hearing children that analyzes their English writing and makes tailored lessons and recommendations. Finally, the article considers synthesized sign, which is being added to educational material and has the potential to be developed by students themselves.", "author" : [ { "dropping-particle" : "", "family" : "Parton", "given" : "Becky Sue", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Deaf Studies and Deaf Education", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2006", "1" ] ] }, "page" : "94-101", "title" : "Sign language recognition and translation: A multidisciplined approach from the field of artificial intelligence", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1038/sj.bdj.2008.612", "ISSN" : "1476-5373", "PMID" : "18660768", "abstract" : "This article considers what is meant by informed consent and the implications of the Mental Capacity Act in obtaining consent from vulnerable adults. It explores a number of conditions which impact on this task, namely dyslexia, literacy problems and learning disability. The focus on encouraging and facilitating autonomy and the use of the appropriate level of language in the consent giving process ensures that consent is valid. The use of appropriate methods to facilitate communication with individuals in order to be able to assess capacity and ensure that any treatment options that are chosen on their behalf are in their best interests are outlined. The use of physical intervention in special care dentistry in order to provide dental care safely for both the patient and the dental team is also considered.", "author" : [ { "dropping-particle" : "", "family" : "Dougall", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiske", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British dental journal", "id" : "ITEM-5", "issue" : "2", "issued" : { "date-parts" : [ [ "2008", "7", "26" ] ] }, "page" : "71-81", "title" : "Access to special care dentistry, part 3. Consent and capacity.", "type" : "article-journal", "volume" : "205" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(3,9,18,33,40)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(3,9,18,33,40)Em Portugal, existe pelo menos um projeto em execu??o que busca criar um software de tradu??o de Língua Portuguesa para Língua Gestual recorrendo a um avatar virtual. Conclus?oConclus?oOs Médicos Dentistas, à semelhan?a de outros prestadores de cuidados de saúde, têm geralmente uma conce??o errada de como abordar e comunicar com pacientes surdos e podem, por isso, provocar graves mal-entendidos quando esta comunica??o falha, perpetuando a ideia negativa que estes pacientes têm acerca desta classe profissional. Estes profissionais podem também desconhecer algumas particularidades destes pacientes, como por exemplo patologias ou dispositivos médicos associados à surdez.De modo a ultrapassar esta falha, as institui??es de ensino superior devem incluir no seu programa curricular a contextualiza??o sobre regras de conduta perante a cultura surda e, se possível, algum grau de forma??o básica em língua gestual. Os profissionais já formados devem procurar obter estes conhecimentos junto das institui??es ou organiza??es que lhes fornecem forma??o contínua de modo a poder proporcionar os melhores cuidados possíveis aos seus pacientes.Existe ainda alguma dificuldade em retratar fielmente a realidade sobre este tema em Portugal, fato que pode ser mitigado pela aplica??o de ferramentas estatísticas ou de recenseamento que incluam dados sobre a popula??o surda portuguesa e a sua experiência no acesso aos servi?os de saúde. Há ainda muito trabalho que pode ser feito na área da Medicina Dentária com vista a facilitar o acesso destes pacientes aos seus servi?os e garantir tratamentos de qualidade. Esta monografia pode ser um ponto de partida para os interessados em desenvolver este tema.Por último, é importante esclarecer ou relembrar que havendo esfor?o da parte dos intervenientes (médico dentista e paciente), é possível estabelecer uma comunica??o adequada e prestar um tratamento informado e esclarecido.BibliografiaBibliografiaADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Chaveiro N, Porto CC, Barbosa A. The Relation Between Deaf Patients and the Doctor. Rev Bras Otorrinolaringol. 2009;75(1):2007–10. 2. Lieu CC, Sadler GR, Fullerton JT, Stohlmann PD. Communication strategies for nurses interacting with deaf patients. Medsurg Nurs. 2007;16(4):239–45. 3. Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J New York State Nurses Assoc. 2009;40(1):4–10. 4. Alsmark SSB, García J, Martínez MRM, López NEG. How to improve communication with deaf children in the dental clinic. Med Oral Patol Oral Cir Bucal. 2007;12(8):E576–E581. 5. Pereira PCA, Fortes PADC. Communication and information barriers to health assistance for deaf patients. Am Ann Deaf. 2010;155(1):31–7. 6. Champion J, Holt R. Dental care for children and young people who have a hearing impairment. Br Dent J. 2000;189(3):155–9. 7. Sheppard K. Deaf adults and health care: Giving voice to their stories. J Am Assoc Nurse Pract. 2013 Nov 21;1–7. 8. Dougall A, Fiske J. Access to special care dentistry, part 2. Communication. Br Dent J. 2008 Jul 12;205(1):11–21. 9. Dougall A, Fiske J. Access to special care dentistry, part 3. Consent and capacity. Br Dent J. 2008 Jul 26;205(2):71–81. 10. Ordem dos Médicos Dentistas. Código Deontológico (Regulamento interno no 2/99, publicado em Diário da República – II Serie, no 143, de 22 de Junho, alterado pelo Regulamento interno no 4/2006, publicado em DR-II Serie no 103, de 29 de Maio). Diário da República; 1999. 11. Ministério do Trabalho e da Solidariedade Social. Decreto-Lei n.o 163/2006 de 8 de Agosto. Diário da República; 2006 p. 5670–89. 12. Ameer N, Palaparthi R, Neerudu M, Palakuru SK, Singam HR, Durvasula S. Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India. J Indian Soc Periodontol. 2012 Jul;16(3):421–5. 13. Kritzinger J, Schneider M, Swartz L, Braathen SH. “I just answer ‘yes’ to everything they say”: access to health care for deaf people in Worcester, South Africa and the politics of exclusion. Patient Educ Couns. Elsevier Ireland Ltd; 2014 Mar;94(3):379–83. 14. Dire??o Geral de Saúde Portugal. “A escovagem é importante! A escovagem é fixe! - língua gestual” [Internet]. [cited 2014 Jan 30]. Available from: . Harmer L. Health care delivery and deaf people: practice, problems, and recommendations for change. J Deaf Stud Deaf Educ. 1999 Jan;4(2):73–110. 16. Reeves D, Kokoruwe B. Communication and communication support in primary care: A survey of deaf patients. Audiol Med. 2005;3(2):95–107. 17. Organiza??o Mundial de Saúde. Deafness and Hearing Impairment [Internet]. Fact Sheet No300. 2014. Available from: . Earis H, Reynolds S. Deaf and hard-of-hearing people ’ s access to primary health care services in North East Essex A report for North East Essex Primary Care Trust. North East Essex; 2009 p. 1–64. 19. Associa??o Portuguesa de Surdos. “Informa??o – Comunidade” [Internet]. [cited 2014 Jan 28]. Available from: . Baltazar AB. Dicionário de Língua Gestual Portuguesa. 1st ed. Porto Editora; 2010. 21. Secretariado Nacional de Reabilita??o. Inquérito nacional às incapacidades, deficiências e desvantagens. 1995. 22. Instituto Nacional de Estatística. Resultados Definitivos [Internet]. Censos 2011. 2012 [cited 2014 Jul 2]. p. 1–41. Available from: . Martins M do RO. Conclus?es do Encontro sobre Indicadores de Deficiência/Incapacidade. Instituto Nacional para a Reabilita??o. Lisboa; 2009 p. 1–3. 24. Lieu CC, Sadler GR, Fullerton JT, Stohlmann PD. Communication strategies for nurses interacting with patients who are deaf. Dermatol Nurs. 2007 Dec;19(6):541–4, 549–51. 25. Jones EG, Ouellette SE, Kang Y. Perceived stress among deaf adults. Am Ann Deaf. 2006;151(1):25–31. 26. Wei H, Wang Y-L, Cong X-N, Tang W-Q, Wei P-M. Survey and analysis of dental caries in students at a deaf-mute high school. Res Dev Disabil. Elsevier Ltd; 2012;33(4):1279–86. 27. Bat-Chava Y, Martin D, Kosciw JG. Barriers to HIV/AIDS knowledge and prevention among deaf and hard of hearing people. AIDS Care. Routledge; 2005 Jul;17(5):623–34. 28. Sanders C, Kleinert HL, Boyd SE, Herren C, Theiss L, Mink J. Virtual patient instruction for dental students: can it improve dental care access for persons with special needs? Spec Care Dentist. 2008;28(5):205–13. 29. Ordem dos Médicos Dentistas. Folhetos Educativos [Internet]. 2014. Available from: . Ministério da Saúde. Programa Nacional de Promo??o de Saúde Oral [Internet]. Available from: . Dire??o Geral de Saúde Portugal. “A escovagem é importante! A escovagem é fixe! - legendas” [Internet]. [cited 2014 Jan 30]. Available from: . Mathews JL, Parkhill AL, Schlehofer D a, Starr MJ, Barnett S. Role-reversal exercise with Deaf Strong Hospital to teach communication competency and cultural awareness. Am J Pharm Educ. 2011 Apr 11;75(3):53. 33. Alexander A, Ladd P, Powell S. Deafness might damage your health. Lancet. Elsevier Ltd; 2012 Mar 17;379(9820):979–81. 34. Shuler GK, Mistler L a, Torrey K, Depukat R. Bridging communication gaps with the deaf. Nursing (Lond). 2013 Nov;43(11):24–30; quiz 30–1. 35. Fiskas PM. Serving the hearing-impaired - An update on the use of sign-language interpreters for dental patients and their families. J Am Dent Assoc. 2001;132(May):681–3. 36. Barnett S. Communication with deaf and hard-of-hearing people: a guide for medical education. Acad Med. 2002 Jul;77(7):694–700. 37. Roberts S, West L a, Liewehr FR, Rueggeberg F a, Sharpe DE, Potter BJ. Impact of dental devices on cochlear implants. J Endod. 2002 Jan;28(1):40–3. 38. Assembleia da República. Lei n.o 89/99 de 5 de Julho. Diário da República. Diário da República; 1999;4186. 39. Federa??o Portuguesa das Associa??es de Surdos. Associa??es Filiadas [Internet]. [cited 2014 Jul 12]. Available from: . Parton BS. Sign language recognition and translation: A multidisciplined approach from the field of artificial intelligence. J Deaf Stud Deaf Educ. 2006 Jan;11(1):94–101. AnexosAnexosxe "Anexos"Anexo AAnexo A – Brochura ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Ordem dos M\u00e9dicos Dentistas", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "title" : "Folhetos Educativos", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(29)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(29)?ndice TOC \o "1-3" \h \z \u Preven??o e Higiene Oral PAGEREF _Toc393371386 \h ivCárie Dentária e Dentisteria PAGEREF _Toc393371387 \h viBranqueamento dentário PAGEREF _Toc393371388 \h viiiPeriodontologia PAGEREF _Toc393371389 \h xMau hálito PAGEREF _Toc393371390 \h xiiEndodontia PAGEREF _Toc393371391 \h xvCirurgia Oral PAGEREF _Toc393371392 \h xviiCancro Oral PAGEREF _Toc393371393 \h xixPróteses dentárias PAGEREF _Toc393371394 \h xxiPróteses removíveis PAGEREF _Toc393371395 \h xxiPróteses fixas PAGEREF _Toc393371396 \h xxivImplantes dentários PAGEREF _Toc393371397 \h xxviiOrtodontia PAGEREF _Toc393371398 \h xxxSaúde oral na grávida e no bebé PAGEREF _Toc393371399 \h xxxiiSaúde oral na crian?a PAGEREF _Toc393371400 \h xxxivSaúde oral sénior PAGEREF _Toc393371401 \h xxxviPreven??o e Higiene OralQuais as vantagens da higiene oral diária para a saúde?Ajuda a manter os dentes e gengivas com saúde e evitar a maior parte das doen?as da boca;Ajuda a mastigar bem todos os alimentos;Ajuda a dizer bem todas as palavras;Pode manter um sorriso bonito.Quando devo ser consultado pelo médico dentista?Pelo menos uma vez por ano;Assim que o primeiro dente nascer;Prevenir é sempre mais fácil que tratar.Qual a melhor dieta para continuar com os dentes mais saudáveis?Deve ser simples, variada e equilibrada;Evitar comer doces fora das horas das refei??es – de preferência só à sobremesa.Sabe um truque para manter os seus dentes saudáveis?Técnica 2x2x22 vezes por dia2 minutos a escovar2 horas sem comer a seguir à escovagem e às refei??es principais.Quando devo mudar a minha escova dos dentes?A cada 3 meses ou quando os “pêlos” da escova perderem a forma.Que instrumentos devo usar para escovar os dentes?Escova e pasta;Fio ou fita dentária;Escovilh?o fazer a higiene da boca?Primeiro deve usar o fio/fita dentária ou o escovilh?o para tirar os restos de comida que podem ter ficado presos entre os dentes;Depois colocar na escova uma quantidade pequena de pasta (do tamanho de uma ervilha);Escovar todos os dentes, de trás para a frente, em cima e em baixo;Fazer movimentos em círculo com a escova por todo o dente e fazer o mesmo com o dente a seguir indo de um lado da boca até ao lado contrário;No fim deve escovar a parte de cima da língua com a escova de trás para a frente. Como usar o fio dentário?Deve usar cerca de 40cm de fio;Enrole as pontas à volta dos dedos do meio das suas m?os;Deve segurar o fio com os polegares e os indicadores;Com a ajuda desses dedos, passar o fio no espa?o entre os dentes e retirar os restos de comida e placa bacteriana desse espa?o.Conselhos muito importantes!Quando n?o tem saúde oral, n?o está de perfeita saúde;Manter a saúde oral em bom estado ajuda a ter uma vida melhor e mais longa;A preven??o é sempre a forma mais barata de preven??o dos problemas;Quanto mais adiar o tratamento, mas difícil este se torna;Ter os dentes bem alinhados ajuda a manter uma postura do corpo equilibrada.Cárie Dentária e DentisteriaO que é a cárie dentária?Quase 9 em 10 pessoas têm esta doen?a;Causada por bactérias;Pode destruir a parte ou a totalidade de um dente;As bactérias s?o ajudadas pela alimenta??o má (muitos doces) e por lavar mal os dentes; Pode causar infe??es que afetam saúde das o aparece a cárie dentária?Quando a comida tem a?úcar simples (doces, bolos, chocolates, gomas, etc..) as bactérias v?o comer este a?úcar e fazer ácido que destrói os dentes.Este processo é mais rápido quando comemos estes a?úcares fora das refei??es ou à noite antes de deitar.Os dentes s?o afetados todos da mesma forma?N?o. Os dentes s?o mais sensíveis quando aparecem na boca porque ainda s?o jovens. Os dentes de trás têm vales onde a comida fica presa com mais facilidade e por mais tempo e s?o mais difíceis de limpar.Porque é que as cáries podem causar dores fortes nos dentes?? normal a cárie come?ar devagar e quando come?a aparece uma mancha branca na parte de fora dos dentes (o esmalte). Com o tempo esta mancha pode transformar-se num pequeno buraco (cavidade). Através desta cavidade as bactérias entram na parte intermédia do dente – a dentina. A dentina é mais mole e menos resistente às bactérias e facilita o avan?o da cá cavidades pequenas pode n?o haver dor. Com cavidades mais fundas pode haver desconforto, mau hálito e dor: causada (pelo frio, calor ou alimentos doces) ou doer de repente com muita o posso saber se tenho cárie dentária?Se é capaz de sentir uma cavidade ou falta de parte do dente é provável que tenha uma les?o de cárie avan?ada.Cáries em fase inicial s?o difíceis de descobrir e normalmente só os médicos dentistas s?o capazes.Deve estar atento a altera??es de cor como manchas de cor branca, amarela, castanha ou preta nos vales dos dentes. Cáries entre os dentes podem ser descobertas caso o fio dentário fique preso ou se estrague ao passar entre esses dentes.Que cuidados devo ter para prevenir a cárie dentária?Escovar corretamente os dentes duas vezes por dia depois de comer.A escovagem da noite é a mais importante e n?o deve comer depois desta escovagem.Deve usar o fio dentário pelo menos uma vez por dia – de preferência à noite antes de dormir.Fazer refei??es equilibradas e evitar petiscar entre refei??es.Se n?o conseguir escovar a seguir à refei??o pode mastigar uma pastilha elástica sem a?úcar mas isto nunca vai substituir a escovagem!Visite o seu médico dentista frequentemente.O que é a Dentisteria?? a área da medicina dentária que trata as les?es dos dentes.Utiliza materiais que substituem a estrutura do dente perdido (materiais restauradores).Que tipos de materiais restauradores existem?Materiais da cor dos dentes (resinas compostas) – que têm a vantagem de ser estéticos (bonitos) e aplicados diretamente, numa só consulta.Em dentes de trás pode usar-se amálgama de prata, que é uma liga metálica.Se o dente estiver muito destruído, o melhor tratamento pode ser uma prótese feita em laboratório, fixa, que envolve mais consultas para a sua conclus?o.O amálgama dentário pode fazer mal à saúde?N?o. Já se usa há mais de 100 anos e nunca se encontrou uma rela??o direta entre restaura??es de amálgama e desenvolvimento de doen?as sistémicas.Devo substituir as restaura??es escuras em amálgama por outras mais estéticas?Depende. Apenas é obrigatório se a restaura??o tiver problemas (fratura, cárie). Pode ser trocada por motivos estéticos.Um dente escurecido por restaura??o em amálgama pode ficar melhor se trocar a restaura??o por uma em resina composta? Uma restaura??o antiga em amálgama pode escurecer o dente.Ao trocar essa restaura??o por uma em resina composta pode melhorar o problema.Pode ser preciso desgastar muito o dente para remover algumas manchas, o que n?o é adequado muitas vezes.Uma restaura??o em resina composta dura o mesmo que uma em amálgama?Restaura??es em amálgama ou ouro podem durar 10 a 20 anos.Restaura??es em resina composta podem durar cerca de 8 o cuidar das restaura??es? Deve controlar diariamente a higiene oral.Visitar o seu médico dentista regularmente.Alguma comida ou bebida pode mudar a cor dos materiais estéticos?Os pigmentos existentes nas comidas ou bebidas podem mudar a cor destes materiais. O café, o chá, as colas (refrigerantes) e o tabaco podem acelerar este processo.Devemos evitar estes produtos, principalmente nas horas a seguir a realizar uma restaura??o destas.Branqueamento dentárioO branqueamento dentárioA área da dentisteria estética é uma das formas mais equilibradas e com melhor rela??o custo/benefício, podendo tratar uma grande parte da popula??o com efeitos estéticos rápidos. Por isso, os branqueamentos dentários est?o a tornar-se mais relevantes e populares.Um dos princípios básicos dos prestadores de saúde é executar os tratamentos mais adequados e prevenir danos causados pelos próprios atos médicos. Assim é importante informar os pacientes sobre técnicas mais eficazes e seguras e desmascarar alguns conceitos e métodos criados por estratégias de venda e publicidade e muitas vezes sem serem provados pela ciência.Os branqueamentos dentários s?o eficazes e seguros?Existem diversos materiais e técnicas de branqueamento que permitem resultados eficazes e seguros se forem selecionados e usados de maneira correta.Os produtos de venda livre (disponíveis em supermercados, farmácias, TV-shops, etc.) publicitados como branqueadores n?o devem ser utilizados por serem pouco seguros: a sua eficácia é menor e n?o têm certifica??o nem controlo de qualidade.Há também técnicas utilizadas somente por profissionais que, apesar da sua eficácia potencial, n?o est?o devidamente estudadas no que se refere à sua seguran?a a médio e longo prazo.Que materiais e técnicas de branqueamento podem ser utilizados?Pelas raz?es apresentadas acima já excluímos a utiliza??o de produtos de venda livre;As técnicas utilizadas por profissionais podem ser distinguidas, de modo geral, com base nas concentra??es dos produtos químicos usados e na sua forma de aplica??o;Esta concentra??o pode variar num intervalo muito amplo (cerca de 10 vezes);A sua aplica??o pode ser:Em casa, diretamente pelo paciente;Em casa, pelo paciente usando um “aparelho” adaptado aos seus dentes feito por um profissional;Direta, em consultório, feita por profissionais e mais intensa;Os produtos usados em casa têm menor concentra??o e podem ser aplicados por períodos entre 1 a 6 horas por dia durante vários dias ou semanas;Os produtos usados em consultório têm maior concentra??o e devem ser aplicados por profissionais em ambiente controlado.Quais devem ser usados?A escolha depende principalmente do paciente: do seu estado clínico, das suas expectativas e da rapidez pretendida;O profissional deve aconselhar a técnica mais correta sempre com base na rela??o eficácia/seguran?a;De um modo geral o “tratamento em casa” com produtos de baixa concentra??o, receitados e com instru??es e controlo dos profissionais é eficaz e seguro a médio e longo prazo;A utiliza??o de produtos com maior concentra??o por profissionais em consultório, apesar de eficaz, ainda n?o tem suporte científico que garanta a sua seguran?a, pelo menos em certas condi??es clínicas.S?o necessárias luzes de LASER ou de outro tipo para branquear os dentes?As luzes n?o tornam os dentes mais brancos;As luzes apenas aceleram o efeito branqueador dos produtos químicos utilizados;Esta vantagem potencial pode n?o ser percetível;As luzes que provocam calor, apesar de acelerarem muito a rea??o química, podem ser lesivas para a polpa (“nervo”) dos dentes saudáveis.A quem pode ser feito a um branqueamento dentário?Em princípio, qualquer pessoa com bom estado de saúde oral;Pacientes com problemas dentários (cáries, desgastes, sensibilidade aumentada, etc.) podem precisar de tratamentos antes de fazer o branqueamento;Os jovens e adolescentes podem fazer branqueamentos mas com cuidados especiais;Pessoas com restaura??es e próteses na boca podem ter de as substituir depois do branqueamento para equilibrar a cor dos dentes; os produtos de branqueamento n?o atuam na cor dos materiais destas próteses e restaura??es.Que efeitos secundários podem surgir?Os efeitos secundários, nos dentes e nas gengivas, est?o relacionados com a concentra??o dos produtos, a sua forma de aplica??o e as condi??es de cada paciente;Os mais frequentes s?o a sensibilidade dentária e algum desconforto gengival que desaparece normalmente ao interromper o tratamento;A aplica??o incorreta dos produtos de maior concentra??o pode provocar les?es mais graves e duradouras.PeriodontologiaO que s?o doen?as periodontais?S?o doen?as que afetam os tecidos que envolvem e d?o suporte aos dentes;Incluem a gengiva, osso e outras estruturas que mantêm os dentes bem seguros nos maxilares;Há dois grandes grupos:Gengivites – há inflama??o da gengiva (camada mais à superfície) mas s?o fáceis de tratar e os tecidos (gengiva, etc) recuperam completamente;Periodontites – as estruturas mais profundas s?o destruídas e há perda de osso, sem dor e pode levar à perda de dentes se n?o for tratada.Qual a causa destas doen?as?A causa mais frequente s?o as bactérias; As bactérias que vivem na boca formam uma placa na superfície dos dentes e junto à gengiva (sulco gengival);Quando o número de bactérias é muito grande, causa doen?as periodontais.As doen?as periodontais passam de pais para filhos? (S?o hereditárias?)Para haver doen?a é preciso haver bactérias;A doen?a pode ser mais ou menos grave e pode depender de características genéticas/hereditá que idade come?am estas doen?as?S?o mais frequentes em adultos, por volta dos 30 anos;Geralmente, se o paciente for mais jovem, é mais provável ter uma forma mais grave da doen?a e precisa de mais cuidados;Raramente afetam crian?as mas quando isso acontece, s?o um perigo grave para os dentes e para a saúde geral;S?o das doen?as mais frequentes na ra?a humana;A gengivite afeta quase toda a popula??o;A periodontite afeta quase metade dos adultos com mais de 35 o sei que a minha gengiva está doente?Os sintomas s?o:Sangrar das gengivas durante a escovagem ou sem raz?o aparente (espont?neo);Aparecer pus nas gengivas;Aparecer mau hálito ou mau sabor na boca;Gengiva muito vermelha;A gengiva come?ar a “baixar”;Os dentes ficarem com posi??es diferentes;Os dentes come?am a abanar;Se tiver algum destes sinais deve consultar o seu médico dentista que pode avaliar e fazer o diagnóstico.? normal que a gengiva sangre?N?o;Sangrar das gengivas é o primeiro sinal que algo n?o está bem;Uma gengiva que sangra pode ter gengivite (menos grave) ou uma periodontite (mais grave);Algumas doen?as e alguns medicamentos fazem com que seja mais fácil sangrar das gengivas.Quando os dentes come?am a abanar e há doen?a periodontal, podem ficar bons outra vez?Quando abanam pouco, podem melhorar depois do tratamento;Contudo, nunca param de abanar completamente porque o osso que se perdeu por causa da periodontite n?o volta a crescer;Por estas raz?es o diagnóstico deve ser feito o mais cedo possível.A doen?a periodontal tem cura?O tratamento consegue parar o avan?o da doen?a mas n?o consegue recuperar os tecidos que se perderam;A periodontite é uma doen?a para a vida (crónica);A periodontite precisa de cuidados frequentes (para manuten??o) sen?o pode avan?ar mais;Nos casos mais graves pode n?o ser possível parar a doen?a mas apenas ter um avan?o mais lento;Os casos mais graves s?o:Casos que aparecem em crian?as ou adultos jovens;Pessoas que fumam mais de 20 cigarros por dia;Algumas doen?as (como a diabetes n?o controlada, por exemplo).Como se tratam estas doen?as?O objetivo do tratamento é eliminar as bactérias e controlar os fatores que diminuem a resistência a estas doen?as (tabaco, diabetes, medicamentos, etc.);Nas gengivites basta melhorar a higiene e fazer um tratamento que possa evitar a doen?a (profilaxia), rápido e fácil;Nas periodontites há várias fases:Estudo inicial para fazer diagnóstico e criar um plano;Fase básica – remover a placa bacteriana;Em alguns casos pode ser preciso fazer uma pequena cirurgia;Depois de ter a doen?a controlada faz-se a fase de tratamento de manuten??o (manter a doen?a controlada).Basta escovar os dentes para prevenir a doen?a periodontal?N?o;A escova n?o chega aos espa?os entre os dentes;Para remover a placa bacteriana destes espa?os deve usar fio dentário ou escovilh?es interdentários;Pode ser difícil aprender a utilizar estes instrumentos (fio e escovilh?o);Se sentir mau cheiro ao utilizar estes instrumentos significa que há bactérias que causam altera??es na gengiva;Quanto mais tempo passar entre cada limpeza entre os dentes, pior se torna o cheiro.Mau hálitoO que é a halitose?Halitose (mau hálito) é o termo que descreve um hálito desagradável ;Pode ter origem em várias altera??es na cavidade oral (boca) ou outras localiza??es.Qual a sua frequência na popula??o?N?o se conhece a frequência (quantas vezes acontece);Trata-se de uma situa??o que afeta provavelmente toda a gente, pelo menos de vez em quando e de forma transitória (aparece e desaparece) e apresenta consequências sociais, afetivas e psicológicas.Qual a principal origem da halitose?Na maioria dos casos tem origem na boca;Pode ser o primeiro sinal de uma doen?a sistémica.Quais as causas principais que originam a halitose?Podemos dividir as várias causas em três grupos:Causas orais;Causas externas;Causas relacionadas com outras áreas.Causas oraisMá higiene oral;Presen?a de cáries;Doen?as das gengivas;Ulcera??es (feridas) orais;Infe??es orais (devido a bactérias, vírus ou fungos;Prótese dentárias com má higiene oral;Diminui??o da quantidade de saliva;Cancro oral;Alguns estudos associam presen?a de bactérias que degradam produtos que contenham enxofre e como resultado libertam produtos sulfurosos que d?o a no??o do mau cheiro.Onde se encontram estas bactérias?As bactérias encontram-se em toda a cavidade oral;Devido à sua grande área e estrutura a língua parece formar um ambiente ideal para as bactérias;As bactérias utilizam os produtos presentes na língua (restos de comida, células, saliva, etc.) para produzir compostos sulfurosos.Quais as causas externas?As principais causas externas est?o ligadas à ingest?o de certos alimentos durante o nosso dia a dia (por exemplo o alho e a cebola) que têm efeito direto e sistémico no nosso hálito;Qualquer fator que diminua o fluxo salivar (quantidade de saliva presente na nossa boca e velocidade com que é produzida) como o álcool, tabaco e certos medicamentos, agrava o mau hálito.O que é o hálito matinal? Durante a noite, ao dormir, produzimos menos saliva e passamos várias horas sem ingerir líquidos e alimentos, por isso é normal que às vezes se sinta um hálito mais intenso.Quais as causas relacionadas com outras áreas?A otorrinolaringologia (área da medicina relacionada com ouvidos, nariz, laringe, faringe, etc.) pode ser considerada a segunda área de maior import?ncia associada à halitose o que se deve, por exemplo, à ocorrência de sinusite ou de corpos estranhos no nariz em crian?as;Há causas pouco frequentes que têm origem nos pulm?es, est?mago, fígado e rins;Pode existir uma rela??o entre mau-hálito e doen?as no est?mago e do sistema digestivo;O mau hálito pode também surgir por causa de doen?as e altera??es gerais como por exemplo a diabetes, falta de vitaminas, falta de água (desidrata??o) e até o ciclo menstrual.Temos sempre uma no??o correta do nosso hálito?Muitas vezes n?o;?s vezes podemos estar menos sensíveis por causa da habitua??o;Noutras vezes podemos ter uma ideia mais exagerada e isso pode dever-se a:Publicidade acerca do mau-hálito que torne as pessoas mais sensíveis a esse problema;No??o de mau sabor na boca;Crian?as com pais com mau hálito podem crescer a pensar que também têm esse problema;Se no passado já houve uma chamada de aten??o por causa do mau hálito a pessoa pode continuar o é que um médico dentista pode diagnosticar o meu mau hálito?Num diagnóstico adequado há recolha de história clínica e um exame intra e extra oral (dentro e fora da boca);O seu médico dentista pode ainda usar exames complementares tais como testes à saliva, testes de pesquisa de micróbios e usar aparelhos especiais para o o se pode prevenir o mau hálito?Geralmente o mau hálito pode ser prevenido com uma boa higiene oral;A higiene oral tem de incluir:Escovar os dentes;Fazer limpeza entre os dentes (com fio dentário por exemplo);Fazer a limpeza da língua (com raspadores linguais, por exemplo);Deve ingerir água suficiente para manter uma hidrata??o correta durante o dia;Pode usar ainda elixires que o seu médico dentista lhe recomende e que ajudam na preven??o e tratamento da o posso avaliar o meu hálito?Avalia??o global: coloque as m?os em frente à boca em forma de tigela, inspire (respirar) pelo nariz e cheire o ar depois de expirar (soltar o ar) pela boca;Teste de lamber o pulso: pode fazer este teste sozinho ou pedir ajuda a outros; deve lamber o seu pulso e depois de 5 segundos e a 3 centímetros de dist?ncia, quem vai examinar pode avaliar o cheiro.Teste da colher: raspe a parte de cima (dorso) da sua língua com uma colher plástica, removendo a placa bacteriana e resíduos presentes e analise o cheiro que fica na colher;Avalia??o olfativa (do cheiro) por uma pessoa amiga ou c?njuge: é o melhor método apesar de muitas pessoas n?o se sentirem à vontade para o usar; essa pessoa pode ainda ajudar a avaliar os fatores que causam o mau hálito e deve participar no diagnóstico e de avalia??o do tratamento.EndodontiaO que é a endodontia?A palavra endodontia tem origem na língua grega e significa: dentro (endo) do dente (dontia);Dedica-se às doen?as da polpa dentária (órg?o conhecido como o “nervo” do dente) e tecidos que rodeiam as raízes e o seu tratamento;A polpa dentária ocupa canais na parte de dentro do dente – canais radiculares;Antigamente, os dentes com problemas na polpa dentária eram extraídos;Hoje em dia os tratamentos disponíveis permitem quase sempre salvar estes dentes.Que acontece quando surge uma dor com origem num dente?A maior responsável pela origem da dor de dentes é a cárie dentária;Quando a cavidade causada pela cárie chega a zonas mais profundas do dente, a polpa dentária fica inflamada e normalmente surgem dores causadas pelo frio;Se esta agress?o continuar a polpa perde a capacidade de defesa e recupera??o;Neste estado (irreversível), há normalmente dores intensas e que duram muito tempo provocadas pelo frio, quente ou até que surgem de repente durante a noite;Nesse caso é preciso remover a polpa dentária, ou seja, fazer um tratamento endod?ntico.Que acontece quando surge um abcesso?Quando aparece dor espont?nea (de repente), na maior parte das vezes significa que a polpa dentária encontra-se a “morrer” e as bactérias come?am a invadir essa parte do dente;Essa invas?o das bactérias provoca uma infe??o que se alastra para o osso em volta do dente, podendo causar um abcesso.Em que consiste um tratamento endod?ntico n?o cirúrgico?O objetivo de um tratamento endod?ntico n?o cirúrgico (“desvitaliza??o”) é garantir que os tecidos à volta do dente mantenham ou recuperem o estado saudável;O tratamento come?a com uma anestesia e abertura de uma pequena cavidade no dente para aceder ao seu interior;De seguida desinfetam-se os canais e altera-se a sua forma utilizando instrumentos que podem ser manuais ou mec?nicos;Termina-se o tratamento ao preencher os canais com um material próprio;Depois do tratamento endod?ntico o acesso (cavidade) é selado.Após a endodontia (“desvitaliza??o”), quanto tempo devo esperar até restaurar o dente?Depois do tratamento endod?ntico os canais ficam preenchidos e selados;A cavidade feita para o acesso do tratamento na parte visível do dente deve ser restaurada definitivamente no prazo máximo de um mês para garantir a prote??o e resistência total do dente. O que acontece se n?o fizer a restaura??o em tempo útil?Se n?o restaurar o dente no prazo de um mês, a restaura??o provisória (temporária) poderá estragar-se e/ou sair, o que pode expor o tratamento e causar uma nova infe??o;Como na maior parte dos casos o dente que teve o tratamento já possui pouca estrutura saudável na coroa (parte visível do dente) pode haver fratura, tornando a restaura??o impossível e obrigando a extrair (tirar) o dente.Quanto tempo dura um dente tratado por endodontia?Um dente é tratado com o objetivo de durar toda a vida; no entanto, após o tratamento n?o fica imune (resistente) a novas cáries;Além disso, ao perder a polpa dentária (“nervo”), o dente deixa de doer e de ser capaz de sinalizar as agress?es dentárias;Assim, é essencial fazer consultas periódicas de controlo no médico dentista.N?o será preferível extrair o dente e substituí-lo com prótese?N?o tome a decis?o de extrair um dente sem antes discutir com o seu médico dentista todos os benefícios e desvantagens das op??es de tratamento disponíveis.O custo e simplicidade de uma extra??o dentária podem ser atrativos mas substituir um dente extraído por um dente artificial será quase certamente mais complexo e dispendioso do que fazer um tratamento endod?ntico e reabilitar o dente afetado.O que é um retratamento endod?ntico?? uma op??o de tratamento quando um tratamento endod?ntico prévio falhou;Geralmente tem um grau elevado de dificuldade;Alguns problemas do tratamento prévio podem n?o ser corrigíveis; nesse caso a microcirurgia endod?ntica pode ser uma alternativa de recurso.Cirurgia OralO que é a Cirurgia Oral?Especialidade da medicina dentária;Diagnostica e trata doen?as, les?es e anomalias dos dentes, boca, maxilares e estruturas anexas através de cirurgia. O que é que faz?O seu campo de a??o clínico é grande:Extrair (arrancar) dentes – presentes na boca ou inclusos;Cirurgia endod?ntica (ver folheto de endodontia);Cirurgia de quistos ou tumores;Cirurgia periodontal (dos tecidos que suportam os dentes);Implantologia (cirurgia de implantes);Cirurgia pré-protética (preparar a boca para que seja colocada uma prótese);Cirurgia de les?es infeciosas;Traumatologia oral (quando se partem ossos da face, por exemplo).O que é um dente incluso?? um dente que n?o nasce e fica no interior dos tecidos da boca (osso ou mucosa) mesmo depois da altura normal.Os mais comuns s?o os dentes do siso (3os molares), principalmente os o posso saber se tenho um dente incluso?Geralmente o diagnóstico só pode ser feito com exames de raios-X;Há vários métodos, sendo que o seu médico dentista selecionará o(s) mais indicado(s).Tenho um dente incluso. Devo extraí-lo?N?o existe uma regra geral para esta decis?o; Diferentes critérios s?o ponderados dependendo de cada situa??o clínica;Fale com o seu médico dentista.As cirurgias na boca (atos de cirurgia oral) causam dor?Gra?as à evolu??o da medicina dentária o desconforto causado por qualquer acto cirúrgico é agora muito pequeno;Existe trauma em todos eles mas podem ser minimizados;Deve haver uma boa prepara??o com recolha da história clínica, diagnóstico e planifica??o da cirurgia.Uma boa anestesia, uma técnica que cause o menor trauma possível e medica??o posterior eficaz permitem um grande nível de conforto durante a após a cirurgia.O que devo fazer antes de uma cirurgia oral?Se estiver planeada uma anestesia local durante a cirurgia, deve evitar um período longo de jejum na hora da cirurgia;Apenas se estiver planeada uma anestesia geral deve estar em jejum várias horas antes;O seu médico dentista deve dar-lhe as indica??es necessárias.O que devo fazer depois de uma cirurgia oral?Após a cirurgia é muito importante ter alguns cuidados para minimizar algumas marcas (sequelas) e melhorar a cicatriza??o.Geralmente deve:Aplicar gelo no rosto sobre a regi?o operada, durante 5 a 10 minutos de cada vez durante as primeiras 24h; o gelo deve ser colocado num saco plástico e envolvido por um pano para evitar queimaduras;Evitar apanhar muito sol, alimentos muito quentes e duros e esfor?os físicos até remover a sutura (os pontos);Optar por uma dieta mole ou líquida nas primeiras 24 a 48h (gelados, iogurtes, sumos, batidos, gelatina, etc.);Descansar e dormir com a cabe?a mais elevada do que o resto do corpo e deitar-se sobre o lado n?o afetado;Escovar normalmente os dentes e a língua mas ter cuidado com a regi?o da ferida causada pela cirurgia – pode usar uma escova muito macia (cirúrgica) após as primeiras 24h nesta regi?o;Após as primeiras 24h, fazer bochechos leves (com cuidado) com um elixir oral (anti-séptico) 2 a 3 vezes por dia durante um minuto;Evitar fumar, principalmente nas primeiras 24h;Cumprir a medica??o prescrita (recomendada).O que fazer se tiver uma hemorragia (se sangrar)? normal sentir um sangramento ligeiro nas primeiras 24h;Se sangrar intensamente (hemorragia), deve dobrar uma ou mais compressas de gaze esterilizada, colocar sobre a regi?o que está a sangrar e segurá-las fechando a boca até controlar a hemorragia;Se precisar de aplicar mais compressas n?o remova a primeira, aplicando outra sobre esta; aplique gelo e evite deitar-se;Se a hemorragia continuar contacte o seu médico dentista.Cancro OralO que é o cancro oral?O cancro oral engloba o conjunto de tumores malignos que afetam qualquer localiza??o da boca, dos lábios à garganta (o que inclui as amígdalas e a faringe);S?o mais frequentes no pavimento da boca (mucosa abaixo da língua), parte lateral da língua e palato mole;Mais de 90% afetam o epitélio (revestimento) da mucosa oral e chamam-se carcinomas;Os restantes correspondem a formas raras de tumores (incluem linfomas, sarcomas, melanomas, etc.);O cancro oral tem índices de mortalidade elevados, muito por causa do seu diagnóstico que se faz tarde.O cancro oral é frequente?O carcinoma (cancro) da cabe?a e do pesco?o representa cerca de 2.8% de todos os cancros e é o 6? cancro mais comum em todo o mundo;? mais frequente nos homens, acima dos 45 anos de idade e o risco aumenta muito até aos 65 anos.Quais os fatores de risco do cancro oral?Os principais s?o o tabaco e o álcool;O fumo do tabaco relaciona-se com várias altera??es na mucosa oral e tem um efeito carcinogénico (criador de cancro) direto nas células epiteliais (as que revestem a mucosa);Calcula-se que 80% dos doentes diagnosticados com cancro oral sejam fumadores ou ex-fumadores; estes doentes têm um risco 5 a7 vezes maior de desenvolverem cancro oral quando comparados com n?o-fumadores;O risco diminui depois de deixar de fumar: após 15 anos de ter parado de fumar o risco é parecido com o de um n?o-fumador;O cancro oral está associado com consumo de álcool e tabaco e pouca ingest?o de vegetais e o se manifesta o cancro oral? Quais os seus principais sinais e sintomas?Os carcinomas podem manifestar-se como uma mancha, de cor variável, branca ou avermelhada, uma massa mais ou menos dura ou uma úlcera (ferida) que n?o cicatriza;Come?a por ser indolor (sem dor) e vai ficando cada vez mais doloroso;Sinais e sintomas:?lceras persistentes e les?es que n?o cicatrizam;?reas mais duras que o normal;?reas de crescimento anormal dos tecidos;Dentes que se come?am a mexer;Dor;Perdas de sensibilidade;Dificuldade em engolir, Les?es brancas e vermelhas;G?nglios linfáticos o se trata o cancro oral?Geralmente com cirurgia e radioterapia (com radia??o) e podem ser isoladas ou combinadas;O fator que melhora muito a taxa de sobrevivência à doen?a é fazer um diagnóstico precoce.O cancro oral mata!Apesar dos avan?os da ciência no diagnóstico e tratamento o cancro oral continua a ter uma taxa de mortalidade bastante elevada;Cerca de 6 em cada 10 doentes de cancro oral morrem no espa?o de 5 anos depois do diagnóstico;O insucesso parece estar ligado ao diagnóstico o posso prevenir o cancro oral?A preven??o passa por:Adotar um estilo de vida saudável;N?o consumir tabaco;Diminuir o consumo de álcool;Consumir regularmente vegetais frescos e frutas;Visitar o médico dentista regularmente para permitir o diagnóstico inicial das les?es.Em que consiste uma consulta de rastreio (dete??o) de cancro oral?Nesta consulta o médico dentista examina as estruturas orais (lábios, língua, gengivas, palato, bochechas, pavimento da boca, etc.) e também as estruturas anexas (gl?ndulas salivares, pesco?o, etc.)Faz-se um exame visual e também palpa??o (toque) destas regi?es para detetar aumento do volume e se est?o mais duras que o normal;Podem fazer-se exames de raio-X;Quando se encontra uma les?o suspeita pode ser feita uma biópsia para confirmar o diagnóstico inicial. Próteses dentárias O que s?o próteses dentárias?S?o pe?as que permitem substituir dentes e outras estruturas da boca (gengiva e osso) e restabelecer a fun??o estética, fonética e mastigatória;Há dois tipos: Removíveis – o paciente consegue tirar e voltar a colocar a prótese;Fixas – o paciente n?o consegue tirar e voltar a colocar a prótese.Consultas periódicas de controlo s?o muito importantes – o seu médico dentista examina a sua boca para garantir que as próteses continuam adaptadas e procurar sinais de doen?as, incluindo o cancro oral (da boca).Próteses removíveisO que s?o próteses totais removíveis?Próteses para substituir os seus dentes e o seu sorriso se perdeu todos os seus dentes naturais;Tradicionalmente a prótese total é colocada na boca depois de os últimos dentes na boca serem extraídos e os tecidos estiverem cicatrizados, o que pode levar alguns meses;Uma prótese total imediata é inserida na boca logo depois de remover os últimos dentes; com este tipo de próteses o paciente n?o passa nenhum período sem dentes mas precisa de a ajustar passado poucos meses.O que s?o próteses parciais removíveis?S?o próteses dentárias removíveis usadas quando alguns dentes est?o ausentes e os dentes presentes s?o saudáveis;Têm estrutura em metal ou acrílico para suporte de dentes artificiais;Restabelecem as fun??es orais:Mastiga??o;Estética;Fonética;Estabilidade e preven??o de outros problemas nos dentes naturais. Qual a diferen?a entre uma prótese parcial esquelética e uma acrílica?Prótese parcial esquelética – tem uma base metálica feita sobre um molde e a estrutura fica apoiada sobre a gengiva e os dentes;Prótese parcial acrílica – construída em resina acrílica e apoia apenas nas gengivas; pode ter partes metálicas como ganchos ou redes e barras para refor?o.Quais as vantagens/desvantagens de uma prótese esquelética/acrílica?Quando comparada com uma prótese acrílica, a prótese esquelética tem as seguintes vantagens:? mais resistente e higiénica;Pode ter uma base mais fina, o que aumenta o conforto;Tem melhor suporte do que uma prótese acrílica e n?o se afunda tanto na gengiva;Quando comparada com uma prótese acrílica, a prótese esquelética tem a desvantagem de ser normalmente mais cara devido ao material usado e custos de laboratório que s?o maiores.Qual a sensa??o do uso de próteses dentárias removíveis?As próteses novas podem ser desconfortáveis inicialmente;As próteses novas podem parecer soltas inicialmente;? normal precisar de algum tempo para que os músculos e a língua se habituem e aprendam a manter a prótese no seu lugar;? normal aparecerem pequenas irrita??es ou úlceras nos primeiros dias;? normal que a saliva aumente nos primeiros dias;Estes problemas come?am a diminuir quando se habitua à prótese;? normal ser necessária uma ou mais consultas de controlo com o seu médico dentista depois de ter uma prótese nova.Serei eu capaz de comer com as minhas próteses?A mastiga??o exige prática:deve come?ar com comida mole e cortada em peda?os mais pequenos;deve mastigar devagar e usando os dois lados da boca ao mesmo tempo;à medida que se habitua à prótese, comece com outros alimentos até voltar à dieta normal.As próteses fazem-me parecer diferente?As próteses podem ser feitas de modo a ficarem parecidas com os seus dentes naturais;As altera??es s?o muito pequenas e quase n?o se notam.As próteses podem melhorar a aparência da sua face e do seu sorriso.As próteses v?o alterar a forma como eu falo?Pode precisar de algum tempo e prática para voltar a pronunciar corretamente algumas palavras;Pode tentar ler em voz alta e dizer palavras difíceis;Se os problemas continuarem deve consultar o seu médico dentista.Quanto tempo devo usar as minhas próteses?Durante os primeiros dias deve usar as próteses o máximo de tempo possível, mesmo enquanto dorme;Depois de se habituar às próteses deve dormir sem elas para que as gengivas descansem e aumente a saúde oral.Devo usar fixador (adesivo/“cola”) de prótese?Estes adesivos funcionam bem em próteses bem adaptadas; N?o s?o a solu??o para próteses antigas e desajustadas;N?o devem ser usados sempre;Estas próteses desajustadas podem precisar de ser adaptadas de novo (rebasadas) ou mesmo substituídas por outras novas;Caso n?o o fizer podem causar feridas de alguma gravidade.Posso fazer ajustes pequenos ou reparar a minha prótese?Pode causar dano às suas próteses e fazer mal à sua saúde se a tentar ajustar sozinho;Se a sua prótese partiu, rachou, estalou ou se perdeu um dos dentes visite o seu médico dentista;O seu médico dentista pode fazer os ajustes em tempo úo devo cuidar das minhas próteses?Mantenha as próteses afastadas de animais ou crian?as quando n?o as está a usar;As próteses s?o muito frágeis e podem partir se caírem, mesmo de poucos centímetros;Tal como os dentes, deve escovar as suas próteses diariamente para remover comida e placa bacteriana, prevenir o aspeto sujo e manter um hálito fresco e saudável;Deve usar escovas próprias para próteses ou escovas macias;Deve ter uma toalha ou o lavatório com água para as proteger da queda enquanto limpa as suas próteses;O seu médico dentista pode recomendar-lhe produtos para limpar a sua prótese, que pode comprar na farmácia.As minhas próteses v?o precisar de ser substituídas?Com o passar do tempo é preciso reajustar as suas próteses ou até fazer próteses novas;Com o uso normal as próteses podem ficar soltas na boca e/ou apresentar um grande desgaste;As próteses ficam desadaptadas porque a sua boca também se altera com idade e perde osso e gengiva;Próteses que causam irrita??es constantes podem causar feridas ao fim de algum tempo pelo que deve evitar usar uma prótese desajustada durante muito tempo. Próteses fixasO que é a prótese fixa?? restaurar a coroa de um dente de maneira parcial ou total através de uma prótese que n?o pode ser removida pelo paciente e que é colocada:Num dente natural preparado para isso;Sobre um implante dentário.Pode ser utilizada para substituir um só dente (coroa) ou vários dentes perdidos (ponte);As próteses fixas têm o objetivo de imitar ao máximo os dentes naturais do paciente;? a op??o ideal quando faltam poucos dentes devido ao conforto e à estética.Qual é o objetivo das coroas?As coroas s?o aconselhadas quando é preciso:Dar mais resistência a dentes danificados para que durem mais tempo;Melhorar a estética;Melhorar o formato ou alinhamento dos dentes;Conseguir a forma e a estrutura de um dente perdido quando colocada sobre um implante.Qual é o objetivo das pontes?As pontes s?o usadas para substituir um ou mais dentes ausentes e s?o várias coroas, todas unidas;Podem ser feitas sobre dentes naturais mas nestes casos é necessário haver dentes nas pontas (extremos) das zonas sem dentes;Nas pontes maiores podem existir dentes ou implantes entre os extremos para ser possível suportar toda a estrutura.Em que situa??es est?o indicadas as próteses fixas?As próteses fixas s?o indicadas quando queremos:substituir uma grande restaura??o quando n?o resta muita estrutura do dente natural;proteger um dente enfraquecido que se partiu;aumentar a reten??o e suporte de uma prótese removível esquelética (metálica);substituir um dente ausente colocando-a sobre um implante dentário;“cobrir” um dente com altera??o de cor ou forma;proteger dentes desvitalizados que se tornaram frágeis;substituir dentes ausentes.Qual é o objetivo do uso dos implantes dentários?As coroas sobre implantes dentários permitem-nos substituir um ou mais dentes; os implantes funcionam como as raízes dos dentes naturais e suportam as próteses fixas;Os implantes s?o muito úteis quando os pacientes n?o têm dentes naturais e as condi??es da boca (osso e gengiva) n?o permitem usar uma prótese total com conforto e de maneira estável;Neste caso os implantes aumentam o suporte e a reten??o da prótese que será removível mas bem estável.Há necessidade de realiza??o de tratamento endod?ntico (“desvitaliza??o”) dos dentes que suportam a prótese fixa?Idealmente n?o;O melhor suporte é um dente com boa estrutura e gengivas saudáveis;O tratamento endod?ntico está indicado se houver dúvidas quanto à saúde da polpa dentária (“nervo” do dente);Algumas situa??es clínicas podem levar à decis?o de desvitalizar estes dentes.Quanto tempo demora a fazer uma prótese fixa? Depende se o caso é complexo ou extenso mas s?o necessárias várias sess?es clínicas;Também deve ter em conta o tempo que se demora a fazer as próteses em laboratório;Pode demorar vários meses.O resultado estético é bom? (Fica bonito?)Sim, na maior parte dos casos é bom;Há situa??es que tornam difícil conseguir uma estética excelente;Nesses casos a prioridade é:Voltar a conseguir uma boa mastiga??o;Conseguir um tratamento que dure bastante;Conseguir um tratamento que fique bonito.Eu fico sem os dentes durante o tratamento?N?o;? feita uma prótese fixa provisória (temporária) enquanto o tratamento n?o está completo;Esta prótese vai permitir mastigar, falar e sorrir de maneira normal durante o tratamento; n?o tem tanta estética nem resistência mas permite proteger o dente preparado;A prótese fixa provisória n?o tem qualidade suficiente para ser considerada uma restaura??o fixa permanente.Este tratamento é simples?Sim mas requer grande experiência e conhecimento técnico/científico por parte do médico dentista;Utilizam-se materiais e equipamento de grande qualidade;O trabalho laboratorial é feito por um técnico de prótese com conhecimentos para este o realizar uma boa higiene para evitar mau hálito e garantir que as próteses fixas duram muito tempo? Quando bem desenhadas e adaptadas as próteses fixas s?o como dentes naturais e precisam dos mesmos cuidados de higiene oral;Pacientes com pontes precisam de ferramentas especiais para limpar os espa?os entre as coroas (p?nticos) tais como:passadores de fio dentário;fios com ponta mais dura;escovilh?es.A má higiene ou má adapta??o de uma prótese fixa pode levar a que restos de comida e bactérias causem inflama??o da gengiva e mau hálito, estragando a estrutura que suporta a prótese fixa;Por vezes as coroas e as pontes podem soltar-se; isto é normal acontecer se os dentes ou o osso que as suportam forem danificados por doen?as;Para prevenir danos na prótese fixa deve evitar trincar alimentos ou objetos duros;O mais importante para que as próteses fixas durem muito tempo é fazer visitas regulares ao médico dentista para controlo e higiene. Implantes dentáriosO que s?o os implantes dentários?S?o “raízes artificiais”, utilizadas para substituir os dentes em falta com o objetivo de suportar uma coroa e/ou próo se liga um implante ao osso?Quando s?o colocados em contacto com o osso, os implantes estabelecem uma uni?o biológica saudável e estável com este.S?o sempre a melhor solu??o quando falta um dente?Os implantes s?o mais uma alternativa de tratamento para substituir dentes perdidos, tal como as próteses removíveis e próteses fixas;Os implantes s?o geralmente a op??o mais próxima da denti??o natural em termos de fun??o e conforto.E quando faltam vários ou todos os dentes?Como referido atrás, existem outras op??es de tratamento;Cada uma tem diferentes indica??es e o posso saber a melhor solu??o para o meu caso?Deve informar-se com o seu médico dentista que poderá fazer o seu diagnóstico e explicar-lhe as alternativas de tratamento que melhor se adaptam ao seu caso clínico.Os tratamentos com implantes provocam dor?Há regras bem estipuladas nas cirurgias com implantes e a maioria das situa??es n?o implica nenhum incómodo e/ou dor;Realiza-se este procedimento com anestesia local;Depois da cirurgia pode haver uma ligeira inflama??o e edema da área (pode “inchar”);Em raras ocasi?es estes sintomas podem ser mais acentuados;O seu médico dentista pode receitar-lhe medicamentos para aliviar os incómodos nas situa??es que julgue necessárias.Em que consiste o tratamento com implantes?Em termos gerais tem quatro fases: planifica??o, cirurgia, reabilita??o e manuten??o:Fase de planifica??o – a complexidade depende da situa??o inicial. Implica geralmente o estudo clínico e radiográfico (com raios-X) do seu caso e outros tratamentos dentários para atingir uma boa saúde oral antes do tratamento com implantes;Fase cirúrgica – realiza-se uma cirurgia para colocar o implante (raiz artificial) em contacto com o osso; pode haver necessidade de mais cirurgias dependendo do seu caso, geralmente quando há pouco osso disponível;Fase restauradora ou de reabilita??o – pode ser feita no mesmo dia ou até 6 meses após a coloca??o do implante; envolve procedimentos necessários para fabricar a prótese que vai ser colocada sobre o implante e pode envolver várias consultas;Fase de manuten??o – pode ser considerada a mais importante pois é a que permite manter em saúde o que foi realizado antes; a dura??o e a qualidade do tratamento dependem muito dos cuidados de higiene oral feitos pelo paciente e pelo médico dentista.Podem os implantes perder-se?Em pacientes com boa saúde oral e geral, vários estudos indicam uma eficácia de tratamento na ordem dos 90% a 98%;Tal como outros tratamentos dependem de vários fatores como características dos pacientes e os seus hábitos de higiene oral, tabágicos e outros;O seu médico dentista poderá informá-lo sobre as possibilidades de êxito no seu caso;Se perder um implante pode sempre colocar outro sem que isso signifique um risco aumentado de fracasso no futuro.E porque falham os implantes?Os implantes podem perder-se por múltiplas raz?es em diferentes fases:Numa fase inicial por n?o se conseguir a uni?o osso-implante (devido a infe??es, falta de sangue na regi?o, altera??o da cicatriza??o – frequente nos fumadores – e for?as muito grandes sobre as próteses colocadas nos implantes;Numa fase posterior pode haver falha devido a perda do ajuste ou fratura das próteses ou das pe?as que as unem ao implante; podem também acontecer infe??es que resultam da falta de higiene oral – falta de tratamento de manuten??o.O tabaco aumenta realmente o risco de fracasso?O tabaco diminui a quantidade de sangue que chega ao osso e à gengiva e atrasa a cicatriza??o o que aumenta o risco de infe??o;Está provado que os implantes em pacientes que fumam têm maior taxa de insucesso.Que problemas podem acontecer durante o tratamento?Durante a fase cirúrgica s?o as mesmas de qualquer tratamento de cirurgia oral;Apesar de pouco frequentes podem acontecer les?es em nervos ou em dentes vizinhos mas s?o facilmente evitáveis se houver uma boa fase de prepara??o.E agora, depois de ter o implante, que altera??es posso apresentar?Em termos de fun??o, os implantes s?o como os dentes naturais, ou seja, as pessoas n?o os sentem como sendo algo estranho;Dependendo do tipo de prótese que se coloca os pacientes podem sentir algum movimento da prótese, o que é normal; este movimento é sempre mais pequeno do que uma prótese removível normal;A estética e a mastiga??o melhoram;Deve ter em aten??o que o tabaco e a higiene oral influenciam a dura??o a longo prazo destes tratamentos.Quanto tempo duram os tratamentos com implantes? S?o para toda a vida?Nenhum tratamento reabilitador em Medicina Dentária é eterno;Com os avan?os recentes da tecnologia pode esperar uma durabilidade dos implantes sempre superior a 15 anos e no caso das próteses que s?o apoiadas nos implantes 10 anos é o tempo mínimo aceitável de dura??o;Se houver alguma infe??o ou problema mec?nico no conjunto implante-prótese este período de dura??o esperada reduz bastante; estes problemas costumam surgir quando a manuten??o destes tratamentos é má;Deve fazer consultas de controlo no mínimo de 6 em 6 meses.A prótese definitiva é colocada no mesmo dia em que os implantes s?o colocados?Normalmente n?o; apesar de ser possível, a desvantagem é que está a colocar uma prótese que pode n?o ficar bem adaptada à gengiva que rodeia os implantes;? possível colocar uma prótese fixa provisória (temporária) no mesmo momento em que s?o colocados os implantes e a sua vantagem principal é o conforto que obtém enquanto espera em média 8-12 semanas até que o implante se adapte ao osso;A prótese definitiva é muito parecida com a provisória mas é feita num material mais resistente e duradouro e está mais adaptada à gengiva.Os implantes e outras patologias de saúde geral…O tratamento com implantes pode fazer-se:em pacientes diabéticos, desde que tenham os níveis metabólicos controlados;em mulheres com osteoporose, mas pode ser necessária uma planifica??o específica;em pacientes que tomem medicamentos que alterem a velocidade com que estanca normalmente o sangramento (coagula??o e agrega??o plaquetária) – neste caso deve informar o seu médico dentista uma vez que pode ser necessário alterar a medica??o antes de colocar os implantes.Que mitos existem?Os implantes dentários s?o detetados ao passar nos detetores de metais – falso;O tratamento com implantes dentários é doloroso – falso;Pode p?r-se e tirar-se um implante depois de colocado – falso.OrtodontiaO que é a ortodontia?? a especialidade da medicina dentária que previne e corrige as más posi??es dos dentes e dos maxilares.Em que idade se deve efetuar a primeira consulta de ortodontia?Todas as crian?as devem ter a sua primeira consulta de ortodontia com o seu médico dentista por volta dos 6-7 anos de idade.Quais s?o os benefícios do tratamento ortod?ntico?Melhoria estética da face e do sorriso, aumentando a autoestima e inser??o social;Correto alinhamento dos dentes, facilitando a higiene oral;Boa fun??o ao mastigar, promovendo a saúde dos músculos e da articula??o que usamos ao mastigar, beneficiando a saúde e o bem-estar geral.Quais s?o as principais causas dos problemas ortod?nticos?Os problemas ortod?nticos podem ser:Hereditários (familiares – queixo ou dentes salientes do pai ou m?e);Ambientais (hábitos – chupar no dedo, respirar pela boca, perda precoce de dentes de leite);Combina??o hereditário/ambiental.Os adultos também podem corrigir os dentes?Sim. Qualquer pessoa com problemas ortod?nticos pode beneficiar de um tratamento ortod?ntico na idade adulta.Quanto tempo demora o tratamento?Em média 24 meses;Pode variar dependendo do tipo de deforma??o e da dificuldade do tratamento a efetuar.Os aparelhos fixos requerem cuidados especiais de higiene oral?Os aparelhos fixos tornam mais fácil a reten??o de placa bacteriana;Os dentes devem por isso ser escovados depois de todas as refei??es (incluindo lanches), utilizando uma pasta fluoretada e uma escova ortod?ntica.Os aparelhos de ortodontia provocam dor?Os aparelhos podem provocar algum desconforto, principalmente nas primeiras horas depois de serem colocados ou ajustados. Esse incómodo desaparece rapidamente.Que tipos de aparelhos ortod?nticos existem?Atualmente existe uma grande variedade de aparelhos fixos e removíveis criados para movimentar os dentes e os próprios maxilares para as posi??es o é que se movem os dentes?Através de for?as leves que os aparelhos fazem sobre os dentes, que promovem a transforma??o do osso que os rodeia.Podem-se praticar desportos com aparelhos fixos?Sim. No entanto deve usar-se uma prote??o individualizada no caso de desportos com contacto físico (rugby, andebol, judo, etc.) para evitar les?es nos tecidos moles.O que é um especialista em ortodontia?Do mesmo modo que existem especialidades em medicina, em medicina dentária existem especialistas em ortodontia, que possuem conhecimentos acrescidos para efetuar este tipo de tratamentos;No entanto, a Ortodontia faz parte das competências profissionais de qualquer médico dentista.Saúde oral na grávida e no bebéA gravidez enfraquece os dentes e aumenta o risco de cárie?N?o;A má saúde oral pode ficar mais grave durante a gravidez mas n?o aumenta o risco de cárie sozinha.Durante a gravidez os dentes enfraquecem por causa do bebé?N?o, o cálcio dos dentes da m?e é estável e n?o vai para o sangue;A gravidez por si só n?o aumenta o número de cáries.A gengiva sangra mais na gravidez?Sim, por causa de altera??es que acontecem no corpo da mulher a gengiva pode doer e sangrar;A situa??o fica mais grave se n?o houver uma boa higiene oral.Em caso de dor de dentes que medicamentos pode tomar a grávida?Nunca tome medicamentos sem consultar um médico!A grávida pode consultar um médico dentista para recomendar medicamentos ou tratamentos para resolver a dor de dentes.A grávida pode fazer qualquer tipo de tratamento dentário?Sim, mesmo que precise de anestesia;Uma infe??o oral faz pior ao bebé do que o tratamento dentário;O ideal é fazer uma consulta de medicina dentária antes da gravidez para evitar infe??es da boca ou dos dentes enquanto está grávida;As consultas devem ser curtas, durante a manh? e entre o 4? e o 7? mês de o é que a higiene oral pode afetar a saúde do bebé?A higiene oral é a melhor maneira de evitar infe??es na boca;A grávida pode fazer mal ao bebé por causa de bactérias com origem em doen?as como a cárie ou doen?as periodontais (das gengivas).Quando se deve come?ar os cuidados de saúde oral?Devem come?ar antes do nascimento com conselhos aos pais;A educa??o funciona como preven??o e permite à crian?a crescer, desenvolver e funcionar sem problemas;Mesmo antes de nascerem os dentes, as gengivas do bebé devem ser limpas todos os dias, de preferência à noite, com uma gaze e água.Qual a idade ideal para levar o bebé ao dentista pela primeira vez?A primeira visita deve ser feita até ao primeiro ano de vida ou quando nasce o primeiro dente temporário (de leite).Os primeiros dentes s?o importantes?Os dentes temporários (de leite) permitem que a crian?a desenvolva bem:Estética;Mastiga??o;Espa?o para os dentes definitivos;Fala;Crescimento dos maxilares (ossos da boca e cara);Respira??o;Engolir (degluti??o);Alguns dentes de leite podem estar na boca até aos 11-12 anos e devem estar em condi??es até essa idade.Os “dentes de leite” devem ser tratados?Sim;Estes dentes s?o mais frágeis que os definitivos e também podem ter cáries;Deve evitar-se a infe??o destes dentes por causa da dor e de n?o afetar os dentes que vêm depois e a saúde em geral.O que fazer se houve trauma (pancada) nos “dentes de leite”?Deve visitar logo o médico dentista;Uma pancada nestes dentes pode afetar a forma??o dos dentes permanentes (definitivos) e alterar a sua cor, forma, posi??o…Se um dente de leite cair por acidente n?o o volte a p?r no sítio pois pode estragar o dente permanente que vem a seguir.Quando erupcionam (“nascem”) os primeiros dentes?Normalmente entre os 6-8 meses e v?o nascendo até aos 2,5-3 anos;Alguns bebés já nascem com dentes na boca (dentes natais) ou podem ter dentes durante o primeiro mês de vida (dentes neonatais). Consulte o seu médico dentista.Saúde oral na crian?aA partir de que idade é que a crian?a deve ir ao dentista? E de quanto em quanto tempo?A primeira consulta deve acontecer quando os primeiros dentes temporários (“de leite”) nascem ou no máximo até ao primeiro ano de vida;Quando há boa saúde oral, a crian?a deve ser vista a cada 6 meses;Se houver maior risco de cárie a crian?a deve ser vista a cada 3 meses.Em que idade aparecem os primeiros dentes?Em média os primeiros dentes aparecem entre os 6 e os 8 meses;Entre os 2 anos e meio e os 3 anos os 20 dentes temporários já devem estar presentes na boca;Os dentes permanentes (“definitivos”) come?am a aparecer na boca entre os 5 e os 7 anos e podem ser até 32 dentes, caso os terceiros molares consigam erupcionar (“nascer”), o que nem sempre acontece;Se a crian?a n?o tiver nenhum dente e já tiver um ano de idade deve ser observada por um Médico Dentista.Quais as queixas que a crian?a pode ter enquanto os dentes est?o a “nascer”(erupcionar)? Como posso ajudar a crian?a nesta fase?Os sintomas mais comuns s?o:Gengivas mais vermelhas;Maior quantidade de saliva;Perda de apetite;Ansiedade;A crian?a pode n?o conseguir dormir;Se a crian?a tiver febre, vómitos ou diarreia deve ser vista por um médico pois pode haver outras raz?es;Pode ajudar a crian?a limpando a boca 2 a 3 vezes por dia com uma gaze molhada ou usar mordedores (para a crian?a morder) ou gel disponível no mercado.Quando deve parar o uso da chupeta, biber?o ou chuchar nos dedos?Estas situa??es devem ser terminadas até aos 3 anos de idade e o biber?o mais cedo, até a crian?a ter 1 ano;Pode trocar o biber?o por exemplo, por um copo com palhinha ou o evitar que apare?am cáries em bebés ou crian?as pequenas (cáries precoces da inf?ncia)?Promover a amamenta??o materna até aos 4-6 meses;Colocar apenas leite ou água no biber?o;Dar o biber?o à crian?a só durante o dia e nunca quando estiver a dormir;N?o colocar líquidos com a?úcar nem no biber?o nem na chupeta;Limpar os dentes depois das refei??es com uma gaze ou escova macia logo depois de estes nascerem.Quais as causas mais frequentes para altera??es na cor dos dentes das crian?as?Cáries;Trauma (pancadas);Problemas na forma??o do dente;Má higiene oral;Colora??o devida a bactérias ou alimentos.As crian?as devem tomar flúor?N?o há acordo sobre este tema;A Dire??o Geral de Saúde recomenda dar prioridade a aplicar flúor através das pastas usadas durante a escovagem;Os comprimidos e gotas apenas s?o aplicados a crian?as com mais de 3 anos e com alto risco de cárie;Nesta situa??o os comprimidos devem ser dissolvidos lentamente na boca, antes de o deve ser feita a escovagem dentária nas crian?as?Depende mais da idade:0-3 anos – devem ser os pais a escovar com uma gaze, escova macia ou dedeira, duas vezes por dia e uma das vezes antes de deitar a crian?a;3-6 anos – a crian?a come?a a escovar sozinha duas vezes por dia e uma das vezes antes de deitar, mas deve ser acompanhada por um adulto, usando uma escova macia e de tamanho certo e a pasta igual ao tamanho da unha do dedo mais pequeno da crian?a;Mais de 6 anos – a crian?a já deve ser capaz de escovar sozinha duas vezes por dia e uma das vezes antes de deitar, mas os pais podem ver se ela o faz de maneira correta e ajudar se for preciso; podem usar uma escova macia ou média e a pasta pode ter o tamanho de uma ervilha pequena ou até 1cm.As crian?as podem usar fio dentário?Podem e devem come?ar assim que possível; Normalmente por volta dos 8 a 10 anos a crian?a já deve ser capaz de o fazer sozinha.O que é um selante de fissuras e para que serve?? uma espécie de verniz que se aplica nos dentes posteriores (pré-molares e molares definitivos) para prevenir a cárie dentária;? bastante eficaz mas o risco de cárie deve ser analisado antes de ser aplicado.Saúde oral séniorCom a idade, quais os problemas que podem surgir na minha boca?Com a idade é mais frequente: aparecerem cáries, principalmente nas raízes dos dentes;aparecer doen?a periodontal (das gengivas e estruturas que suportam o dente);haver altera??es funcionais (da mastiga??o, por exemplo);haver desgaste dentário;aparecer cancro oral;xerostomia (sentir a boca seca);sofrer dores na cara/cabe?a;a mucosa (revestimento interno da boca) ficar mais sensível e fina;haver altera??o da cor dos dentes;deixar de sentir certos sabores.Posso fazer tratamentos dentários se tiver problemas de saúde geral?Sim; Deve visitar o seu médico dentista e dar informa??o (escrita) quanto a todos os seus problemas de saúde e todos os medicamentos que está a tomar;Assim, o tratamento dentário pode ser feito em seguran?a pois o profissional toma todos os cuidados que s?o precisos.? importante informar o meu médico dentista de todos os medicamentos que tomo?Sim;Alguns medicamentos podem alterar a forma como a sua boca se comporta e podem influenciar os tratamentos;O médico dentista deve ajustar o seu modo de a??o e realizar o tratamento com seguran?a.? importante manter os dentes naturais?Sim;Um único dente pode ser importante para ajudar a segurar uma prótese removível durante alguns anos, por exemplo;Deve ter sempre aten??o e visitar regularmente o seu médico dentista para cuidar dos dentes, mesmo que sejam poucos.As altera??es (dos dentes e gengivas) que surgem com a idade podem ser corrigidas?Sim;Com a idade os dentes podem ficar mais amarelos ou escuros e terem altera??es no tamanho;Os dentes podem parecer mais longos se a gengiva come?ar a baixar e podem parecer mais curtos se houver desgaste;Existem alguns tratamentos simples (restaura??es ou branqueamento) e outros mais complexos (próteses fixas e ortodontia) que podem ajudar a melhorar a estética em algumas destas situa??es, mesmo nestas idades.Há risco em manter os dentes naturais na minha boca?N?o, mas só se:o dente n?o tiver problemas como cárie e doen?a periodontal;o dente n?o cause danos nas gengivas/mucosas; o dente n?o provoque problemas de saúde geral; O seu médico dentista deve avaliar a sua saúde oral e estabelecer um plano de tratamento adequado.Quais os problemas mais graves que podem surgir se perder os meus dentes naturais?Além das altera??es no aspeto da cara e do sorriso, na fala e na fun??o, perder um dente leva a altera??es na rela??o entre os dentes pois os dentes que ficam podem mover-se para os espa?os “vazios” que se criam.Quando os dentes “abanam” ou as gengivas sangram e causam dor, o que devo fazer?Deve ir com urgência ao médico dentista para que este avalie o que é preciso fazer;Pode ser urgente fazer uma “limpeza” (destartariza??o) para remover as bactérias ou o tártaro (“pedras” nos dentes) que causam esta situa??o;O tártaro aparece quando a placa bacteriana n?o é removida e fica dura.Que posso fazer para ajudar a manter a saúde da minha boca?Escove os dentes todos os dias, pelo menos 2 vezes por dia;Uma destas vezes tem de ser antes de se deitar;Use uma escova de dureza média e use escovilh?es ou fio dentário para limpar entre os dentes e um raspador para limpar a língua;Use diariamente dentífrico e suplemento para bochecho com flúor (pasta, gel, etc.). Anexo B – Parecer e Declara??oParecer do OrientadorDeclara??o do Investigador ................
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