speech consideration in complete denture
TRANSCRIPT
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