THE SOCIAL IMPACT OF HEARING LOSS ASSOCIATED WITH CLINICAL PRACTICE AMONG UNIVERSITY STUDENTS AND DENTAL PROFESSIONALS: SYSTEMATIC REVIEW

Objective: The objective of this study was to estimate the social impact of hearing loss associated with clinical practice on university students and dental professionals. Theoretical Framework: Hearing loss is a significant concern in various industries, but its association with clinical practice in dentistry has received less attention; even so, the use of high-speed equipment and tools would generate noise levels that could exceed the limits recommended and permitted by the WHO (World Health Organization). Method: The methodology adopted for this systematic review used the criteria of the PRISMA-SCR report, by means of which an extensive search was carried out without language limits and published from March 2019 to March 2024. Results and Discussion: Hearing pollution in university and non-university dental clinics is high due to the permanent contact with various acoustic sources of pollution; therefore, its prolonged use could cause damage in the short and long term. Research Implications: Hearing loss would not only impair the clinician's physical/clinical capabilities but would also have a great social impact on dental professionals and people around them; thus, hearing loss could lead to social anxiety and stigmatization, especially in settings where hearing is perceived as a crucial part of communication. Originality/Value: In this article, several basic recommendations for reducing hearing pollution in dental clinics worldwide are presented.


INTRODUCTION
In the field of dentistry, occupational health is a crucial aspect that addresses a number of potential risks to practitioners and is a topic of growing interest due to the various risks to which practitioners are exposed in their daily practice (Dierickx et al., 2021a).Among these risks, hearing loss associated with noise exposure in clinical settings has emerged as an increasingly important concern with university and corporate scope; although, traditionally less attention has been paid to this issue compared to other occupational risks, recent studies have highlighted the relevance and magnitude of this problem in dental practice and its impact on the hearing health of dentists and ancillary staff (Khaimook et al., 2014).
Several studies conducted to date have found that noise levels in dental clinics may exceed the safe limits recommended by occupational health agencies, this is largely due to the use of high-speed pneumatic equipment and other electrical devices that generate noise during dental procedures; thus, prolonged exposure to this noise can result in irreversible hearing damage, affecting the quality of life and work performance of professionals (Al-Omoush et al., 2020a;Dierickx et al., 2021b).Being that, exposure to excessive noise levels during dental procedures is a reality faced by dentists and ancillary staff in their daily routine, some countries have identified it as a major risk factor for hearing loss in dental professionals (Al-Omoush et al., 2020a).
The importance of addressing hearing loss in dentistry lies not only in protecting the hearing health of professionals, but also in preserving their ability to provide quality care to patients; therefore, several authors have mentioned that effective communication during dental procedures would be essential to ensure decreased hearing contamination in clinical-dental settings, however, hearing loss can hinder this communication, which could negatively affect the patient experience and treatment efficacy (Al-Omoush et al., 2020b).
Although the effects of noise exposure may be gradual and not immediately apparent, hearing loss can have significant consequences on the quality of life and job performance of dental professionals.Therefore, it should be imperative to implement preventive and hearing protection measures in the dental clinical environment that are tailored to the realities of each environment and allow for a reduction in the optimization of workspace design (Hoek-Snieders van der et al., 2023).To address this challenge, it is essential to implement preventive and hearing protection measures in dental clinics, research has highlighted the effectiveness of custom hearing protectors in reducing noise exposure and preventing hearing loss in noisy clinical environments.In addition, optimization of workspace design and education on the 4 importance of hearing health could complement these protective measures (Al-Omoush et al., 2020b).
Therefore, the objective of the present research was to know the current picture of the social impact of hearing loss associated with clinical practice in university students and professionals in dentistry, because hearing impairment would limit the professional environment of students and professionals in the dental field.

THE WORLD HEALTH ORGANIZATION AND POLICIES ON OCCUPATIONAL SAFETY AND HEARING PROTECTION IN WORKPLACE ENVIRONMENTS
The theoretical framework in a study comprises a critical and organized analysis of the literature relevant to the topic, providing a theoretical contextualization and defining the key concepts.It must comprehensively contain theories, models and previous research, identifying gaps, contradictions and consensuses in the literature that are important for the focus of the work being developed.
According to the WHO (World Health Organization), it is estimated that approximately 600 million workers worldwide are exposed to hazardous levels of noise in the workplace, which can lead to hearing loss and other hearing disorders (Kushalnagar, 2019).In response to this challenge, WHO has established international standards and guidelines for occupational noise exposure, which provide safe limits for noise exposure in the workplace; according to these standards, the daily noise exposure level should not exceed 85 decibels (dB) over an 8hour period (WHO, 2019).In addition, it is recommended that workers who are exposed to noise levels above 85 dB use appropriate hearing protectors to protect their hearing.
Awareness of the importance of hearing health in the workplace is also promoted, highlighting the risks associated with occupational noise exposure and the importance of hearing loss prevention.According to WHO data, occupational hearing loss is estimated to be the second most common cause of work-related disability worldwide (WHO, 2019) and the Pan American Health Organization (PAHO), to promote occupational safety and hearing protection policies at the global level and also allows the exchange of information, resources and best practices in the field of occupational hearing health (Pan American Health Organization, 2017; WHO, 2019).

RISKS OF NOISE EXPOSURE
Noise-induced hearing loss (NIHL) is a growing concern in the dental community, as undergraduate students and practicing professionals are exposed to elevated noise levels during clinical practice, which can have serious consequences for their long-term hearing health.In such a context, it is possible to mention that dental clinical environments are inherently noisy due to the use of high-speed equipment, such as drills and ultrasound devices, as well as suction systems and compressors.These equipment would generate noise levels that may exceed the safe limits recommended by occupational health agencies (Alberti et al., 2023).
Prolonged exposure to noise in dental clinical settings may increase the risk of developing hearing loss and other hearing disorders.In addition, research has shown that continued exposure to noise can have negative effects on physical and mental health, including stress, fatigue, and sleep disorders (Gilels et al., 2017).Statistics reveal a high prevalence of hearing loss among university students and dental professionals, as up to 40% of dentists have reported experiencing some degree of hearing loss related to their clinical practice (Al-Omoush et al., 2020a).
The statistics on the prevalence of hearing loss associated with clinical practice in dentistry are of concern worldwide; several studies conducted in various countries have revealed a high incidence of this problem among university students and practicing professionals.In North America, for example, it is estimated that up to 40% of dentists may experience some degree of hearing loss related to their clinical practice, similar and alarming values were observed in European studies, with a significant proportion of dental professionals presenting symptoms of hearing loss attributed to noise exposure in clinical settings (Al-Omoush et al., 2020a;Gilels et al., 2017;Khaimook et al., 2014).
In Asia, where dental practice is constantly expanding, the situation is no different, Research in countries such as Japan and South Korea has revealed a high incidence of hearing loss among dental students and practicing professionals, highlighting the need to address this problem effectively.Similarly, in Africa, the lack of specific data on this topic is a challenge, but similar concerns have been identified regarding noise exposure in dental clinics and its impact on the hearing health of dental professionals (Alberti et al., 2023;Sheffield & Smith, 2019).
These statistics demonstrate that hearing loss associated with clinical practice in dentistry is a global problem that affects professionals in all regions of the world.It is critical to address this problem with appropriate preventive and hearing protection measures to ensure the hearing health and well-being of dental students and practitioners worldwide.

IMPACT ON THE QUALITY OF DENTAL CARE IN ROUGH ENVIRONMENTS
The impact of hearing loss associated with the clinical practice of dentistry in noisy environments is significant and can adversely affect the quality of dental care provided.
Effective communication between the practitioner and patient during dental procedures is critical to ensuring optimal and satisfactory outcomes.7 ability to hear and understand the patient's needs and concerns during the consultation.
This can affect the dentist's ability to provide personalized care tailored to the patient's individual needs; • Errors in symptom interpretation: Lack of clarity in communication due to hearing loss can lead to misunderstandings and errors in the interpretation of the patient's symptoms.This could result in inaccurate diagnoses or the omission of important information, which would negatively affect the treatment plan and the quality of care provided; • Risk of complications during procedures: During dental procedures, it is crucial that the dentist be able to communicate effectively with the patient to ensure comfort and safety.Hearing loss can make it difficult to detect early on any discomfort or complications during the procedure, which could increase the risk of unintentional incidents or injuries; • Impact on Patient Experience: Lack of effective communication due to hearing loss can negatively impact the patient experience in the dental clinic.Patients may perceive a lack of attention or understanding on the part of the dentist, which could diminish their trust in the professional and affect their overall satisfaction with the treatment received.

PREVENTIVE AND HEARING PROTECTION MEASURES
It is essential to implement preventive and hearing protection measures to mitigate the risks associated with noise exposure in the clinical practice of dentistry.This includes education about hearing hazards and the proper use of custom hearing protectors, as well as optimizing workspace design to reduce ambient noise.
University students and dental professionals. -Concept.
Social impact of hearing loss.

RESULTS AND DISCUSSIONS
Hearing pollution in dental clinics is a major problem worldwide, thus, these places are often busy and noisy environments with various sources of noise pollution that can affect the hearing health of dental professionals and patients, these sources of noise in dental clinics may include high-speed dental handpieces, ultrasonic scalers, suction devices and other equipment, and in addition, the continuous and repetitive use of these devices can cause damage to the hearing acuity of dental professionals over time, patients also, the continuous and repetitive use of these devices can cause damage to the hearing acuity of dental professionals over time, patients also, and patients, ultrasonic scalers, suction devices and other equipment, and in addition, the continuous and repetitive use of these devices can cause damage to the hearing acuity of dental professionals over time, patients may also be exposed to high levels of acoustics, which can cause discomfort and anxiety, and affect their overall experience in the clinic (Ai et al. , 2017).
Air turbines are high-speed dental handpieces that are used to cut and shape teeth, and generate a significant amount of noise during use, are commonly used in all areas of dentistry, and therefore could pose a significant risk of hearing damage to dental professionals.This noise generated by air turbines can exceed 90 decibels (dB), which could be maintained during the more than eight hours a day of the average working day worldwide (Elmehdi, 2011).Moreover, the World Health Organization (WHO) recommends that people should not be exposed to noise levels above 85 dB (Pan American Health Organization, 2017); unfortunately, noise levels in dental clinics can often exceed these limits, leading to hearing damage and other health problems.Several studies have shown that dental professionals are at high risk of temporary or permanent noise-induced hearing loss, which can negatively affect their quality of life, perspectives of dental professionals, students, and patients in general (Pan American Health Organization, 2017; Sheffield & Smith, 2019).
The risk of damage to hearing levels from air turbines can be particularly high for dental professionals who work long hours or have limited access to hearing protection (Elmehdi, 2011).Studies have shown that dental professionals who use air turbines frequently have an increased risk of developing hearing loss and tinnitus, which is ringing in the ears (Cobos-Torres et al., 2020).In addition, hearing loss can lead to social anxiety and stigmatization, especially in settings where hearing ability is perceived as a crucial part of communication.Also, it can also affect learner interactions with patients (Cobos-Torres et al., 2020) who may feel uncomfortable or unsure of how to communicate with a learner with hearing loss, which could affect the trust and rapport that is essential for successful patient care.Learners with hearing wasting may also feel difficulty with social interactions and trust in clinical practice; for example, they may have difficulty listening and responding to patients' questions, concerns, and comments, which may hinder their ability to provide high-quality care.In addition, they may have difficulty understanding instructions and feedback from clinical supervisors, which could negatively affect their learning and performance; these challenges can lead to decreased confidence, frustration, and social anxiety, which ultimately affects their clinical practice (Tahir et al., 2022).
So too, the social impact of hearing loss can extend beyond the academic setting, for example, students may feel self-conscious about their hearing aids, which can affect their social interactions with peers outside of class, they may also have difficulty communicating in noisy environments, such as social gatherings or clinical settings with high levels of background noise; so, because effective communication is essential in dental practice and hearing loss could significantly hinder a student's or practitioner's ability to communicate with patients, colleagues, and faculty, this can lead to a number of social and emotional challenges that can negatively affect the student's overall well-being; thus, hearing impairment in dentistry can have significant short-term and long-term social impacts (Cobos-Torres et al. , 2020;Tahir et al., 2022).decreased sense of self-esteem, confidence, and motivation, which ultimately affects their academic performance; in addition, students with hearing damage may feel stigmatized or marginalized, which can lead to a number of negative social impacts.Thus, they may feel excluded from social activities or peer groups, which can further affect their sense of social support and connection to the academic community; similarly, hearing impairment in undergraduate and graduate dental students can negatively affect their ability to interact with patients (Emmett & Francis, 2015).
Patients may have difficulty communicating with a student with hearing loss, which can potentially affect the trust and rapport that are necessary for effective patient care.This can lead to increased social isolation and anxiety for the student and affect their overall clinical practice, and ultimately, all of the above could affect the quality of patient care as well as the student's confidence and performance in the academic training program (Jahan et al., 2022).

EDUCATION
Effective communication is essential in dental practice, and hearing loss can significantly hinder a student's ability to communicate with patients, colleagues, and faculty.
This can lead to a number of social and emotional challenges that can negatively affect a student's overall well-being, including their professional and personal life beyond college.
Students with hearing impairments may face challenges in finding employment and advancing their careers after graduation (Emmett & Francis, 2015;Sheffield & Smith, 2019).The ability to communicate effectively is a key requirement in dental practice, and hearing impairment may limit the opportunities available to students in the field; thus, students with hearing impairment may also experience discrimination or prejudice from potential employers, which may further hinder their career prospects (D'Eramo et al., 2023;Jahan et al., 2022;Leadbeatter et al., 2023).
In addition, hearing loss can also affect a student's personal life, as it can limit their ability to participate in social activities and communicate with family and friends.This can result in feelings of social isolation, anxiety, and depression, which can negatively affect mental 12 health and general well-being; as well, hearing damage can lead to other physical and cognitive health problems, including cognitive impairment, increased risk of falls, and decreased quality of life.These problems can further affect a student's social and emotional well-being, limiting their ability to participate in activities and engage with their community (Hoek-Snieders van der et al., 2023;Tahir et al., 2022;Xu et al., 2023).

CONCLUSION
Noise pollution is a serious problem in dental and university dental facilities around the world, and addressing it is essential to protect the hearing health of dental professionals and improve the overall quality of patient care.Here are some recommendations for reducing noise levels in dental clinics: SOCIAL IMPACT OF HEARING LOSS IN DENTAL STUDENTSDental students with hearing loss may face a number of challenges in the classroom and clinical settings.For example, they may have difficulty understanding instructions, discussions, or comments from their professors, which could affect their learning and performance.They may also have difficulty understanding instructions and comments from clinical supervisors, which could negatively affect their learning and performance; as well as, listening and responding to patients' questions, concerns, or comments, which could reduce the quality of patient care they provide, these challenges can lead to decreased confidence, frustration, and social anxiety, ultimately affecting their clinical practice(Cobos-Torres et al., 2020).
SHORT-TERM SOCIAL IMPACT OF HEARING LOSS ON DENTAL EDUCATION Students with hearing loss may experience social isolation and anxiety, especially if they have difficulty communicating effectively with peers or instructors.This can result in a

1.
Wear hearing protection: wearing hearing protection, such as earplugs or earmuffs, can significantly reduce the risk of hearing damage for dental professionals.Employers should provide hearing protection to all employees and encourage its use during noisy procedures; 2. Implement engineering controls: Engineering controls, such as sound-absorbing materials and acoustic barriers, can help reduce the amount of noise generated in the dental office.Employers should consider installing these controls in areas where noise levels are high; 3. Control noise sources: Noise sources, such as dental handpieces and air compressors, are major contributors to noise pollution in dental practices.Employers should select equipment with lower noise levels and implement maintenance procedures to keep noise levels to a minimum; 4. Educate staff about hearing health: Dental professionals should be educated about the importance of protecting their hearing and how to prevent hearing damage.Training should be provided on the proper use of hearing protection and the risks of exposure to loud noise; 5. Conduct regular noise monitoring: Employers should conduct regular noise monitoring to identify areas where noise levels exceed safe levels.This can help identify areas where additional engineering controls or hearing protection may be needed; 6. Provide quiet areas: Employers should provide quiet areas where dental professionals can take breaks from noisy procedures.These areas can help reduce the risk of hearing damage and provide a place for employees to recharge; The Social Impact of Hearing Loss Associated with Clinical Practice Among University Students and Dental Professionals: Systematic Review ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.3 | p.1-15 | e07024 | 2024.13 7. Encourage communication: Effective communication is essential in dental practice, and various noise sources can make communication between dental professionals and patients difficult.Employers should encourage open communication and ensure that dental professionals can listen and communicate effectively with patients.
(Hoek- Snieders van der et al., 2023)ng to the noise level to which the worker is exposed and should provide an adequate fit to ensure effective protection(Hoek- Snieders van der et al., 2023). Context.