2. PHONETICS IN COMPLETEDENTURESDr Zarir Ruttonji 3. CONTENTS1.
Introduction2. Definition3. History4. Mechanism of sound
production5. Types/Classification of speech sounds6. S sounds and
their prosthodontic considerations7. Different parts of oral cavity
and their influence on speech8. Prosthodontic implication in
denture design affecting speech9. Speech tests10. Speech
analysis11. Speech defects12. Conclusion13. List of references 4.
INTRODUCTION 5. DEFINITION Speech:- The faculty or act of
expressing ordescribing thoughts, feelings, or perceptionsby the
articulation of words. Phonetics:- The branch of linguistics that
dealswith the sounds of speech and their production,combination,
description, and representationby written
symbols.http://www.thefreedictionary.com 6. HISTORY In 1949 Sears
recommended grooving the palatejust above the median sulcus of the
patient. In 1951 Pound was successful in improvingphonetics by
contouring the entire palatal aspectof the maxillary denture to
simulate the normalpalate Landa suggested the use of s sound
todetermine the adequacy of free way space &M sound to
establish a desirable rest position. 7. 1953 & 1956, Silverman
used speaking method tomeasure patients vertical dimension in
natural teethwith dentures & without dentures. Morrison
suggested the use of the word, sixty six &Mississippi to
determine closest speaking space 1967, Kaire reported &
determined the palatalpressure of the tongue in the pronunciation
of selectedpalatolingual speech sounds, by electronic means
underpredetermined vertical dimensions of occlusion. 8. 1. The
motor( lungs, associated musclethat supply the air).MECHANISM OF
SPEECH PRODUCTIONNormal speech depends on proper functioning of 5
essentialmechanism2. The vibrator ( vocal cord that givepitch to
the tone).3. The resonator ( consist of the oral,nasal,pharyngeal
cavity and paranasalsinuses).4. The enunciators or articulators(
lip,tongue, palate and teeth)5. The initiator( motor area of the
brain) 9. COMPONENTSOF
SPEECHRESPIRATIONPHONATIONRESONATIONSARTICULATIONSNEUROLOGICINTEGRATIONSAUDITIONCOMPONENTS
OF SPEECHRef:- Chierici, Lawson; Clinical speech consideration in
prosthodontics. J Prosthet dent;1973;29;1:29-39 10. RESPIRATION The
movement of air inthe inspiratory andexpiratory phase isimportant
in productionof speech.Ref:- Chierici, Lawson; Clinical speech
consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39
11. PHONATION Air from the lungscourses through thetrachea. Sound
is produced inthe larynx Vibration of vocal cordtakes placeRef:-
Chierici, Lawson; Clinical speech consideration in prosthodontics.
J Prosthet dent;1973;29;1:29-39 12. RESONANCESound that is produced
bythe vocal cord ismodified by variouschamber. Resonators are
pharynx oral cavity nasal cavity Paranasal sinusesRef:- Chierici,
Lawson; Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39 13. SPEECH ARTICULATION Sound that is
producedis formed intomeaningful words Tongue,lips,palate,teeth and
mandibleplay are very importantrole.Ref:- Chierici, Lawson;
Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39 14. NEUROLOGIC INTEGRATIONFactors for
speechproduction are highlycoordinated, somesequentially and
somesimultaneously by thecentral nervous system. Speech is a
learnedfunction and requiresadequate hearing, vision,and normal
nervoussystem for its fulldevelopment.Ref:- Chierici, Lawson;
Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39 15. TYPES OF SPEECH 1.VOWELS: a,e,i,o,u. they
are voiced sounds, 2.CONSONANTS: may be either voiced or
producedwithout vocal cord vibration, in which case they arecalled
breathed sounds. eg: p, b, m, s, t, r, z etc 3.COMBINATION: Is
blend of a consonant andvowel, articulated in quick succession that
they areidentified as single phonemes.EX:- WORDZarb-
Bolender:Speech consideration with complete dentures ;Prosthodontic
treatment For Edentulous Patients 16. CLASSIFICATION OF SPEECH
According to Boucher Vowels. Consonants. Plosives/stops Fricatives
Afficatives Nasal Liquid GlidesZarb- Bolender:Speech consideration
with complete dentures ;Prosthodontic treatment For Edentulous
Patients 17. STRUDS:-1. Voiceless sounds2. Produced by the
separation ofvocal cordsEg:- s,h,sh,zhACCORDING TO
SONORITYSONANTS1. Voiced sound2. Produced by vibration of a portion
of thevocal cords3. Oral resonators modify the airstream4. All
vowels and vowel like sounds arerepresentatives.CONSONANTS:-1.
Articulated speech2. Airstream has to be modified at theproper
place and time for producingthese sound3. Most important for
dentistJohn. Sharry. Complete denture Prosthodontics 3rd edition;
Phonetics pg 132 18. CLASSIFICATION OFCONSONANTS:Divided into
groups depending on theircharacteristic production and use of
differentarticulators and valves. They are as follows. Plosive
consonants: These sounds areproduced when overpressure of the air
has beenbuilt up by consonants between the soft palate
andpharyngeal wall and released in an explosive way.Ex: P (pay), B
(bay), T (to), D (dot)Zarb- Bolender:Speech consideration with
complete dentures ;Prosthodontic treatment For Edentulous Patients
19. Fricatives: are also called sibilants and arecharacterized by
their sharp and whistling soundquality created when air is squeezed
through the nearlyobstructed articulators.Ex: S (so), Z (zoo)
Affricative consonants: are a mix between plosiveand fricative
ones.Ex: Ch (chin), J (jar)Zarb- Bolender:Speech consideration with
complete dentures ;Prosthodontic treatment For Edentulous Patients
20. Nasal consonants :are produced without oral exit ofair.
Production involves the coupling of nasal cavity asresonators.Ex: M
(man), N (name), NG (bang)Zarb- Bolender:Speech consideration with
complete dentures ;Prosthodontic treatment For Edentulous Patients
21. Liquid consonants(semi vowels) : are , as the nameimplies ,
produced with out friction.Ex: R (rose), L(lily) Glides: that is
sounds characterized by a graduallychanging articulator shapeEx: W
(witch), Y (you)Zarb- Bolender:Speech consideration with complete
dentures ;Prosthodontic treatment For Edentulous Patients 22.
CLASSIFICATION OF CONSONANTS BASEDON THE PLACE OF THEIR PRODUCTION
Consonant sounds are most important from the dentalpoint of view.
They may be classified according to theanatomic parts involved in
their formation:(1) Palatolingual sounds, formed by tongue and hard
or softpalate,(2) Linguodental sounds, formed by the tongue and
teeth,(3) Labiodental sounds, formed by the lips and teeth, and(4)
Bilabial sounds, formed by the lips.Robert Rothman; Phonetic
consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223) 23. PALATOLINGUAL SOUNDS FORMED BY TONGUE
ANDHARD PALATEWord like S, T D N and L belongto this catogoryS- the
sound s as in sixty six- isformed by a hiss of air as it
escapesform the median groove of thetongue when the tongue is
behindthe upper incisorIf groove is decreased s is softened towards
sh(Lisping)If groove is deep a whistling will be heardwhen s is
pronouncedRobert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223) 24. CLINICAL
SIGNIFICANCE1. Thus we can say that the sound Scan be used to check
theproper placement of theanterior teeth2. Also the thickness of
thedenture base can be adjusted incase the sound S is notproduced
correctlyRobert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223) 25. CLINICAL
SIGNIFICANCE3. Silverman also usedthis word to establishand check a
propervertical dimension ofocclusionRef:- Robert Rothman; Phonetic
consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223) 26. T, D, N and L wordRugae area is very
importantfor the production of thesesoundsTongue must be placed
firmlyagainst the anterior part of thehard palate for the
productionof these wordsRobert Rothman; Phonetic consideration in
denture prosthesis, J Prosthet Dent;1961;11:214-223) 27. Therefore.
Should rugae be duplicated in thedenture or no is the question that
arises.Slaughter say.. The smoothness of the denture isdisturbing
and the tongue looses its capacity for localorientationLanda says
that rugae is useless or even detrimentalbecause it adds more bulk
to the dentureRef:-Robert Rothman; Phonetic consideration in
denture prosthesis, J Prosthet Dent;1961;11:214-223) 28. CLINICAL
SIGNIFICANCE If teeth too lingual T will sound like D If teeth too
forward - D will sound like T 29. PALATOLINGUAL SOUNDS FORMED
BYTONGUE AND SOFT PALATEConsonant k, ng and g arerepresentative of
the palatolingualgroup of sounds.Sound is formed by raising theback
of the tongue to occlude withthe soft palate and then
suddenlydepressing the middle portion of theback of the tongue
realising the airin a puff 30. CLINICAL SIGNIFICANCE If the
posterior borders are over extended or if there isno tissue contact
k becomes ch sound.Ref:- Robert Rothman; Phonetic consideration in
denture prosthesis, J Prosthet Dent;1961;11:214-223) 31.
LINGUODENTAL SOUNDSConsonant Th is representative of
thelinguodental group of soundsDental sounds are made with the tip
ofthe tongue extending slightly betweenthe upper and lower anterior
teeth. 32. 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 tonguethat can be seen with the words
- this, that,these and those will provide information as tothe
labio-lingual position of the anteriorteeth.Robert Rothman;
Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223) 33. CLINICAL SIGNIFICANCE If about 3mm of the
tip of the tongue is not visible, theanterior teeth are probably
too far forward, If more than 6mm of the tongue extends out
betweenthe teeth when such sounds are made, the teeth areprobably
too lingual.Robert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223) 34. LINGUOALVEOLAR
SOUNDSFormed with the valveformed by contact of the tipof the
tongue with the mostanterior part of the palate (thealveolus) or
the lingual sidesof the anterior teeth.T, D, S, Z, V & 1
arerepresentative of thelinguoalveolar group of soundsRobert
Rothman; Phonetic consideration in dentureprosthesis, J Prosthet
Dent;1961;11:214-223) 35. LINGUOALVEOLAR SOUNDS Sibilants (sharp
sounds) s, z, sh, ch & j(with ch & j being affricatives)
are alveolarsounds, because the tongue and alveolus formsthe
controlling valve. Important observations when these sounds
areproduced are the relationship of the anteriorteeth to each
other.Robert Rothman; Phonetic consideration in denture prosthesis,
J Prosthet Dent;1961;11:214-223) 36. CLINICAL SIGNIFICANCEUpper and
lower incisors should approach end toend but not touch.Failure
indicates a possible error in the horizontaloverlap of the anterior
teethRef :- Robert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223) 37. LABIODENTAL SOUNDS
F and V arerepresentatives of thelabiodental group ofsounds. Formed
by raising thelower lip into contactwith the incisal edgeof the
maxilliaryanterior teeth.Ref:- Robert Rothman; Phonetic
consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223) 38. CLINICAL SIGNIFICANCEUpper anterior teeth
are tooshort (set too high up), Vsound will be more like an F. If
they are too long (set toofar down), F will soundmore like a
V.Ref:- Robert Rothman; Phonetic consideration in denture
prosthesis, JProsthet Dent;1961;11:214-223) 39. BILABIAL SOUNDS B,p
and m arerepresentatives of thebilabial group ofsounds. Formed by
the streamof air coming from thelungs which meetswith no
resistancealong its entire pathuntil it reaches the lip.Robert
Rothman; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223) 40. CLINICAL SIGNIFICANCE1. Used to asses the
correctinterarch space2. Correct labiolingualpositioning of the
anteriorteeth3. Labial fullness of the rimscan also be
checkedRef:-Robert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223) 41. VOWELS 42.
PHONETICS IN RECORDING JAWRELATION Also called as the
speakingmethod Sibiliant sounds like S and M isused. S sound gives
the approximateclosest speaking space M sound gives us the
freewayspace Approximately 2mm of spacemust be there between the
twoocclusal rimsMeyer M Silverman :The speaking method in measuring
vertical dimension; J prosthet dent 1953;3:193-199 43. S-SOUND AND
THEIR PROSTHODONTICCOSIDERATIONS Say now shibboleth; and he
saidsibboleth, for he could not frame topronounce it right..(THE
BIBLE ) 44. CLINICAL SIGNIFICANCE1. Thickness of denture2.
Antero-posterior position of teeth3. Vertical dimension of
occlusion4. Width of dental arch:5. Relationship of upper teeth to
the lower anterior teethby S-POSITION 45. DIFFERENT PARTS OF ORAL
CAVITY ANDTHEIR INFLUENCE ON SPEECHTONGUE: LIPSPALATE TEETH 46.
PROSTHODONTIC IMPLICATION INDENTURE DESIGN AFFECTINGSPEECH1.
Denture thickness and peripheral outline2. Vertical dimension3.
Occlusal plane6. Anteriorposterior positioning of teeth5. Post dam
area7. Width of dental arch4. Relationship of the upper and lower
teethFenn, clinical dental prosthetics, 3rd edition pg 138 47.
DENTURE THICKNESS ANDPERIPHERAL OUTLINE If the denture bases aretoo
thick. Lisping will occur withthe word like S C and Z Palatolingual
soundsmost affected. (T,D).Ref:-Fenn, Clinical dental prosthetics,
3rd edition pg 138 48. VERTICAL DIMENSION Bilabials are
mostlyaffected P B and M If both rims touchprematurely itindicated
excessivevertical dimension. In try in stage teethclicking will be
heard.Ref:-Fenn, clinical dental prosthetics, 3rd edition pg 139
49. OCCLUSAL PLANE Labioldental sounds F andV are affected. If
occlusal plane is toohigh the correct positing ofthe lower lip is
difficult If the occlusal plane is toolow there is overlap of
thelower lip on the labialsurface of upper teethRef:-Fenn, clinical
dental prosthetics, 3rd edition pg 138 50.
ANTERIORPOSTERIORPOSITIONING OF TEETH F and V sounds arehampered.
labiopalatal positions ofthe teeth is veryimportant Teeth if placed
topalatally the lower lipwill not meet the insicaledge of the upper
teeth.Ref:-Fenn, Clinical Dental Prosthetics, 3rd edition pg 138
51. POST DAM AREA Palatolingual consonants are affected (K,NG and
G) Thick post dam areas will irritates thedorsum of the tongue
Patient feels nausea like effect whilespeaking If inadequate the
plosive sound of theword is hampered This area is very important in
singerswho wear complete dentureRef:-Fenn, Clinical Dental
Prosthetics, 3rd edition pg 138 52. WITDH OF DENTAL ARCH If teeth
are set into anarch that is too narrowthe tongue will becramped
Consonants like T, D, NK and S are affectedRef:-Fenn, Clinical
Dental Prosthetics, 3rd edition pg 138 53. RELATIONSHIP OF THE
UPPERAND LOWER INCISORS The chief concern is theS CH, J and Z
sound. These sounds need anear contact of theupper and lower teeth
sothat the air stream isallowed to pass.Ref:-Fenn, Clinical Dental
Prosthetics, 3rd edition pg 138 54. SPEECH TEST The speech test
should be made after satisfactoryesthetics, correct centric
relation, proper verticaldimension and balanced occlusion have been
attainedand after wax up for esthetics has been completed.John.
Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg
132 55. TEST 1:TEST OF RANDOM SPEECH Engage the patient in a
conversation and obtaining asubjective speech analysis by asking
the patient sayhow he feels, how his speech sounds to him and
whatwords seem most difficult to pronounce.John. Sharry. Complete
denture Prosthodontics 3rd edition; Phonetics pg 132 56. TEST 2:
TEST OF SPECIFIC SPEECH SOUNDS This is best accomlpished by having
the patient say 6-8words containing the sound and then combining
thesewords into a sentence.The following is the list ofsounds to be
testedJohn. Sharry. Complete denture Prosthodontics 3rd edition;
Phonetics pg 132 57. S,Sh Six, sixty, ships, sailedMississippi,
sure ,sign, sun,shineSixty six ships sailedMississippi. Sure sign
of sunshineT,D,N,L Locator, located, tornado, near,ToledoLocator
located tornado nearToledoCh,J Joe, Joyce, joined, George,Charles,
churchJoe and Joyce joinedGeorge and Charles atchurchK Committee,
convented, political,convention, ConnecticutThe committee convented
atthe political convention inconnecticut.F,V Vivacious, Vivian,
lived, five,fifty, five, fifth, avenueVivacious Vivian lived at
fivefifty-five fifth avenue 58. TEST 3: TEST OF READING A
PARAGRAPHMake the patient read a paragraph containing abundanceof
S, Sh, Ch sounds.John. Sharry. Complete denture Prosthodontics 3rd
edition; Phonetics pg 132 59. SPEECH ANALYSIS 2 categories 1)
Perceptual / acoustic Based on broad band spectrogram, recording
bySonograph Objective opinion of performance(Zarb- Bolender:Speech
consideration with complete dentures ;Prosthodontic treatment For
Edentulous Patients 60. 2) Kinematic movement analysis :
Ultrasonics X-ray mapping Cineradiography Optoelectronic
articulatory movement tracking ElectropalatographyRef:- Zarb-
Bolender:Speech consideration with complete dentures ;Prosthodontic
treatment For Edentulous Patients 61. PALATOGRAPHY What is
palatography? a group of techniques to record contact between
thetongue and the roof the mouth to get articulatoryrecords for the
production of speech sounds. 62. PREREQUISITE FOR
MAKINGPALATOGRAM1. The artificial palate made must be uniformly
adapted,no adhesive must be used.2. Patient who have severe gagging
must not be used formaking palatograms.3. The patient has to be
trained to open his mouthafter uttering the desired word.4. The
tracing material must not be distasteful andits consistency should
permit easy application 63. 5. The palate has to be thoroughly
dried before themedium is applied and the medium must have
acontrasting colour so that it can be easily identified6. Talc is
considered the best material that canbe used for palatogram,
although activatedcharcoal, chocolate powder where also used 64.
PALATOGRAM OFVOWELS.PALATOGRAM OFCONSONANTS. 65. TERMINLOGIES
RELATED TOSOME SPEECH DISTURBANCES1. APHASIA (DYSPHASIA): Means
defective speech dueto damage of cortical area required for speech
making.(Brocas area, Wernickes area).2. DYSARTHRIA: Motor speech
problems caused, not dueto sensory loss or mental retardation.3.
SPEECH AND LANGUAGE RETARDATION: Delayin acquistion of
communicating skills 66. DISORDERS OF SPEECHHypernasality
HyponasalityDenasalityNASAL BALANCEEg: m, n & ngb d gMorning
bordig 67. ARTICULATOR DEFETCSDistortionEg: Vowel pop for
pipeConsonants cah for carSubstitutionEg: teef for teethOmissionEg:
bow for boatZarb- Bolender:Speech consideration with complete
dentures ;Prosthodontic treatment For Edentulous Patients 68.
RELATION TO MAXILLOFACIAL DEFECTSAcquiredAccidental or
surgicalNervous system cerebralpalsy, lateral
sclerosis,poliomyelitis, myastheniagravis, myotonic
dystrophyCongenitalCleft palate,Short palate,Large
velopharyngealspace,Limited velar mobility,Submucous cleft palate
69. CORRECTING SPEECH DEFECTSRELATED TO IMPLANT PROSTHESIS A fully
bone anchored prosthesis in maxilla can causephonetic problems,
Normal pronunciation is possible after approximately 3months,
removable appliances like artificial gingival extensionsmade of
silicones or resin materials should be given. 70. CONCLUSION 71.
REFERENCES1. John. Sharry. Complete denture Prosthodontics
3rdedition; Phonetics.2. Zarb- Bolender:Speech consideration with
completedentures ;Prosthodontic treatment For EdentulousPatients.3.
Fenn, Clinical Dental Prosthetics, 3rd edition pg 138.4. Chierici,
Lawson; Clinical speech consideration inprosthodontics. J Prosthet
dent;1973;29;1:29-39.5. Robert Rothman; Phonetic consideration in
dentureprosthesis, J Prosthet Dent;1961;11:214-223).6. Meyer M
Silverman :The speaking method inmeasuring vertical dimension; J
prosthet dent1953;3:193-199. 72. THANKYOU
