Speech consideration IN COMPLETE DENTURES

BY EKRAMUL HAQUE

UNDER THE GUIDANCE OF

DR SHAISTA AFROZ

CONTENTS

1. Definition

2. History

3. Mechanism of sound production

4. Types/Classification of speech sounds

5. S sounds and their prosthodontic considerations

6. Prosthodontic implication in denture design affecting speech

7. Speech tests

DEFINITION

• Speech:- Vocalised form of human communication describing thoughts, feelings, or perceptions by the articulation of words.

• Phonetics:- The branch of linguistics that deals with the sounds of speech and their production, combination, description, and representation by written symbols.

HISTORY

• In 1951 ‘Pound’ was successful in improving phonetics by contouring the entire palatal aspect of the maxillary denture to simulate the normal palate

Also explain the key role the ‘s’ sound play in establishing the vertical dimension of occlusion

• ‘Landa’ suggested the use of ‘s’ sound to determine the adequacy of ‘free way space’ & ‘M’ sound to establish a desirable ‘rest position’.

• 1953 & 1956, ‘Silverman’ used ‘speaking method’ to measurepatient’s vertical dimension in natural teeth with dentures & without dentures.

• ‘Morrison’ suggested the use of the word, ‘sixty six’ & ‘Mississippi’ to determine closest speaking space

• 1967, ‘Kaire’ reported & determined the palatal pressure of the tongue in the pronunciation of selected linguopalatal speech sounds, by electronic means under predetermined vertical dimensions of occlusion.

1. The motor( lungs, associated muscle that supply the air).

MECHANISM OF SPEECH PRODUCTION

Normal speech depends on proper functioning of 5 essential mechanism

2. The vibrator ( vocal cord that give pitch to the tone).

3. The resonator ( consist of the oral,nasal, pharyngeal cavity and paranasal sinuses).

4. The enunciators or articulators( lip, tongue, palate and teeth)

5. The initiator( motor area of the brain)

COMPONENTS

OF SPEECH

RESPIRATION

PHONATION

RESONATIONS

ARTICULATIONS

NEUROLOGIC INTEGRATIONS

AUDITION

COMPONENTS OF SPEECH

RESPIRATION

• The movement of air in the inspiratory and expiratory phase is important in production of speech.

PHONATION

• Air from the lungs courses through the trachea.

• Sound is produced in the larynx

• Vibration of vocal cord takes place

RESONANCE

Sound that is produced by the vocal cord is modified by various chamber.

•Resonators are

• pharynx

• oral cavity

• nasal cavity

•Paranasal sinuses

SPEECH ARTICULATION

• Sound that is produced is formed into meaningful words

• Tongue,lips,palate, teeth and mandible play are very important role.

NEUROLOGIC INTEGRATION

Factors for speech production are highly coordinated, some sequentially and some simultaneously by the central nervous system.

• Speech is a learned function and requires adequate hearing, vision, and normal nervous system for its full development.

TYPES OF SPEECH

• 1.VOWELS: a,e,i,o,u. they are voiced sounds,

• 2.CONSONANTS: may be either voiced or produced without vocal cord vibration, in which case they are called breathed sounds. eg: p, b, m, s, t, r, z etc…

• 3.COMBINATION: Is blend of a consonant and vowel, articulated in quick succession that they are identified as single phonemes.

EX:- WORD

CLASSIFICATION OF SPEECH

• According to Boucher

• Vowels.

• Consonants.

•Plosives/stops

•Fricatives

•Affricatives

•Nasal

•Liquid

•Glides

CLASSIFICATION OF CONSONANTS:

Divided into groups depending on theircharacteristic production and use of different articulators and valves. They are as follows.

• Plosive consonants: These sounds are produced when overpressure of the air has been built up by consonants between the soft palate and pharyngeal wall and released in an explosive way. Ex: P (pay), B (bay), T (to), D (dot)

•Fricatives: are also called sibilants and are characterized by their sharp and whistling sound quality created when air is squeezed through the nearly obstructed articulators.

Ex: S (so), Z (zoo)

•Affricative consonants: are a mix between plosive and fricative ones.

Ex: Ch (chin), J (jar)

•Nasal consonants :are produced without oral exit of air. Production involves the coupling of nasal cavity as resonators.

Ex: M (man), N (name), NG (bang)

•Liquid consonants(semi vowels) : are , as the name implies , produced with out friction.

Ex: R (rose), L(lily)

•Glides: that is sounds characterized by a gradually changing articulator shape

Ex: W (witch), Y (you)

CLASSIFICATION OF CONSONANTS BASED ON THE PLACE OF THEIR PRODUCTION

• Consonant sounds are most important from the dental point of view. They may be classified according to the anatomic parts involved in their formation:

(1) Bilabial sounds,formed by lips,

(2) Labiodental sounds,formed by lips and teeth,

(3) Linguodental sounds,formed by tongue and teeth,

(4) Linguoalveolar sounds,formed by the tip of the and anterior most part of palate

(5) Linguopalatal and Linguovelar sounds,truly palatal sounds

BILABIAL SOUNDS

•B,p and m are representatives of the bilabial group of sounds.

•Formed by the stream of air coming from the lungs which meets with no resistance along its entire path until it reaches the lip.

CLINICAL SIGNIFICANCE

1. Used to asses the correct

interarch space

2. Correct labiolingual

positioning of the anterior

teeth

3. Labial fullness of the rims

can also be checked

LABIODENTAL SOUNDS

• F and V are representatives of the labiodental group of sounds.

• Formed by raising the lower lip into contact with the incisal edge of the maxilliary anterior teeth.

CLINICAL SIGNIFICANCE

Upper anterior teeth are too

short (set too high up), V

sound will be more like an F.

• If they are too long (set too

far down), F will sound

more like a V.

LINGUODENTAL SOUNDS

•Sound is actually made closer to the alveolus (the ridge) than to the tip of the teeth.

• Careful observation of the amount of tongue that can be seen with the words - this, that, these and thosewill provide information as to the labio-lingual position of the anterior teeth.

LINGUODENTAL SOUNDS

Consonant Th is representative of the

linguodental group of sounds

Dental sounds are made with the tip of

the tongue extending slightly between

the upper and lower anterior teeth.

CLINICAL SIGNIFICANCE

• If about 3mm of the tip of the tongue is not visible, the anterior teeth are probably too far forward,

• If more than 6mm of the tongue extends out between the teeth when such sounds are made, the teeth are probably too lingual

.

LINGUOALVEOLAR SOUNDS

Formed with the valve

formed by contact of the tip

of the tongue with the most

anterior part of the palate (the

alveolus) or the lingual sides

of the anterior teeth.

T, D, S, Z, V & L are

representative of the

linguoalveolar group of sounds

T, D, N and L word

Rugae area is very important

for the production of these

sounds

Tongue must be placed firmly

against the anterior part of the

hard palate for the production

of these words

CLINICAL SIGNIFICANCE

• If teeth too lingual – T will sound like D

• If teeth too forward - D will sound like T

LINGUOPALATAL SOUNDS

• Sibilants (sharp sounds) s, z, sh, ch & j

(with ch & j being affricatives) are alveolar sounds, because the tongue and alveolus forms the controlling valve.

•Important observations when these sounds are produced are the relationship of the anterior teeth to each other.

LINGUOPALATAL SOUNDS FORMED BY TONGUE AND HARD PALATE

Word like S, T D N and L belong

to this catogory

S- the sound ‘s’ as in sixty six- is

formed by a hiss of air as it escapes

form the median groove of the

tongue when the tongue is behind

the upper incisor

If groove is broad s is softened towards sh

(Lisping)

If groove is narrow a whistling will be heard

when s is pronounced

CLINICAL SIGNIFICANCE

Upper and lower incisors should approach end to

end but not touch.

The minimal amount of space between upper and lower

teeth in this position is called silverman’s closest

speaking space

CLINICAL SIGNIFICANCE

1. Thus we can say that the sound S

can be used to check the

proper placement of the

anterior teeth

2. Also the thickness of the

denture base can be adjusted in

case the sound S is not

produced correctly

CLINICAL SIGNIFICANCE

3. Silverman also used this word to establish and check a proper vertical dimension of occlusion

PALATOLINGUAL SOUNDS FORMED BY TONGUE AND SOFT PALATE

Consonant k, ng and g are

representative of the palatolingual

group of sounds.

Sound is formed by raising the

back of the tongue to occlude with

the soft palate and then suddenly

depressing the middle portion of the

back of the tongue realising the air

in a puff

CLINICAL SIGNIFICANCE

• If the posterior borders are over extended or if there is no tissue contact k becomes ch sound.

PHONETICS IN RECORDING JAW RELATION

• Also called as the speaking method

• Sibiliant sounds like S and M is used.

• S sound gives the approximate closest speaking space

• M sound gives us the freeway space

• Approximately 2mm of space must be there between the two occlusal rims

S-SOUND AND THEIR PROSTHODONTIC CONSIDERATION

1. Thickness of denture

2. Antero-posterior position of teeth

3. Vertical dimension of occlusion

4. Width of dental arch:

5. Relationship of upper teeth to the lower anterior teeth by “S-POSITION

PROSTHODONTIC IMPLICATION IN

DENTURE DESIGN AFFECTING

SPEECH

1. Denture thickness and peripheral outline

2. Vertical dimension

3. Occlusal plane

6. Anteroposterior positioning of teeth

5. Post dam area

7. Width of dental arch

4. Relationship of the upper and lower teeth

DENTURE THICKNESS AND PERIPHERAL OUTLINE

• If the denture bases are too thick.

•Lisping will occur with the word like S C and Z

•Palatolingual sounds most affected. (T,D).

VERTICAL DIMENSION

•Bilabials are mostly affected P B and M

• If both rims touch prematurely it indicated excessive vertical dimension.

• In try in stage teeth clicking will be heard.

OCCLUSAL PLANE

•Labiodental sounds F and V are affected.

• If occlusal plane is too high the correct positing of the lower lip is difficult

• If the occlusal plane is too low there is overlap of the lower lip on the labial surface of upper teeth

ANTEROPOSTERIOR POSITIONING OF TEETH

•F and V sounds are hampered.

• labiopalatal positions of the teeth is very important

•Teeth if placed to palatally the lower lip will not meet the insicaledge of the upper teeth.

POST DAM AREA

• Palatolingual consonants are affected (K, NG and G)

• Thick post dam areas will irritates the dorsum of the tongue

• Patient feels nausea like effect while speaking

• If inadequate the plosive sound of the word is hampered

• This area is very important in singers who wear complete denture

WITDH OF DENTAL ARCH

• If teeth are set into an arch that is too narrow the tongue will be cramped

•Consonants like T, D, N K and S are affected

RELATIONSHIP OF THE UPPER AND LOWER INCISORS

• The chief concern is the S CH, J and Z sound.

• These sounds need a near contact of the upper and lower teeth so that the air stream is allowed to pass.

SPEECH TEST

•The speech test should be made after satisfactory esthetics, correct centric relation, proper vertical dimension and balanced occlusion have been attained

and after wax up for esthetics has been completed.

TEST 1:TEST OF RANDOM SPEECH

•Engage the patient in a conversation and obtaining a subjective speech analysis by asking the patient say how he feels, how his speech sounds to him and what words seem most difficult to pronounce.

TEST 2: TEST OF SPECIFIC SPEECH SOUNDS

•This is best accomlpished by having the patient say 6-8 words containing the sound and then combining these words into a sentence.The following is the list of sounds to be tested

S,Sh Six, sixty, ships, sailed

Mississippi, sure ,sign, sun,

shine

Sixty six ships sailed

Mississippi. Sure sign of sun

shine

T,D,N,L Locator, located, tornado, near,

Toledo

Locator located tornado near

Toledo

Ch,J Joe, Joyce, joined, George,

Charles, church

Joe and Joyce joined

George and Charles at

church

K Committee, convented, political,

convention, Connecticut

The committee convented at

the political convention in

connecticut.

F,V Vivacious, Vivian, lived, five,

fifty, five, fifth, avenue

Vivacious Vivian lived at five

fifty-five fifth avenue

TEST 3: TEST OF READING A PARAGRAPH

Make the patient read a paragraph containing

abundance of S, Sh, Ch sounds.

SPEECH ANALYSIS

• 2 categories

• 1) Perceptual / acoustic

• Based on broad band spectrogram, recording by Sonograph

2) Kinematic movement analysis :

•Ultrasonics

•X-ray mapping

•Cineradiography

•Optoelectronic articulatory movement tracking

•Electropalatography

MCQQ. The maxillary teeth if placed too far anteriorly and superiorly in a complete denture result in faulty pronunciation of

a) F and V sounds

b) S and T sounds

c) B and P sounds

d) K and G sounds

Q. Silverman’s closest speaking space indicates

a) Vertical dimension of the patient

b) Horizontal dimension of the patient

c) Both of the above

d) None of the above

Q. If the gap between upper and lower incisor is very narrow while speaking sibilant sound will result in

a) Whistling

b) Lisping

c) Clicking

d) No effect