1.phonetics in cd

GOOD MORNING

PHONETICS IN COMPLETE DENTURES

Dr Zarir Ruttonji

CONTENTS

1. Introduction2. Definition 3. History 4. Mechanism of sound production5. Types/Classification of speech sounds6. S sounds and their prosthodontic considerations 7. Different parts of oral cavity and their influence on speech 8. Prosthodontic implication in denture design affecting speech 9. Speech tests10. Speech analysis11. Speech defects12. Conclusion13. List of references

INTRODUCTION

DEFINITION

• Speech:- The faculty or act of expressing or 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.

http://www.thefreedictionary.com

HISTORY

• In 1949 ‘Sears’ recommended grooving the palate just above the median sulcus of the patient.

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

• ‘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 measure patient’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 palatolingual 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

Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39

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

Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

CLASSIFICATION OF SPEECH

• According to Boucher

• Vowels.• Consonants.

– Plosives/stops– Fricatives– Afficatives– Nasal– Liquid– Glides


STRUDS:- 1. Voiceless sounds2. Produced by the separation of vocal cords Eg:- s,h,sh,zh

ACCORDING TO SONORITY

SONANTS1. Voiced sound2. Produced by vibration of a portion of the

vocal cords 3. Oral resonators modify the airstream4. All vowels and vowel like sounds are

representatives.

CONSONANTS:-1. Articulated speech2. Airstream has to be modified at the

proper place and time for producing these sound

3. Most important for dentist

John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132

CLASSIFICATION OF CONSONANTS:

Divided into groups depending on their characteristic 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) Palatolingual sounds, formed by tongue and hard or soft

palate,

(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)

PALATOLINGUAL 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 decreased s is softened towards sh (Lisping)

If groove is deep a whistling will be heardwhen s is pronounced


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



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

Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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


• Therefore…. Should rugae be duplicated in the denture or no is the question that arises….

Slaughter say.. The smoothness of the denture is disturbing and the tongue looses its capacity for local orientation

Landa says that rugae is useless or even detrimental because it adds more bulk to the denture…

Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)


• If teeth too lingual – T will sound like D

• If teeth too forward - D will sound like T

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


• If the posterior borders are over extended or if there is

no tissue contact k becomes ch sound.


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.

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 those will provide information as to the labio-lingual position of the anterior teeth.



• 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 & 1 are representative of the linguoalveolar group of sounds


LINGUOALVEOLAR 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.

Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223 )


Upper and lower incisors should approach end to end but not touch.

Failure indicates a possible error in the horizontal overlap of the anterior teeth

Ref :- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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.



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.


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.



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

Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

VOWELS

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

Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet dent 1953;3:193-199

S-SOUND AND THEIR PROSTHODONTIC COSIDERATIONS

• Say now shibboleth; and he said sibboleth, for he could not frame to

pronounce it right…..”

(THE BIBLE )


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

DIFFERENT PARTS OF ORAL CAVITY AND THEIR INFLUENCE ON SPEECH

TONGUE: LIPS

PALATE TEETH

PROSTHODONTIC IMPLICATION IN DENTURE DESIGN AFFECTING

SPEECH

1. Denture thickness and peripheral outline

2. Vertical dimension

3. Occlusal plane

6. Anteriorposterior positioning of teeth

5. Post dam area

7. Width of dental arch

4. Relationship of the upper and lower teeth

Fenn, clinical dental prosthetics, 3rd edition pg 138

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).

Ref:-Fenn, Clinical dental prosthetics, 3rd edition pg 138

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.

Ref:-Fenn, clinical dental prosthetics, 3rd edition pg 139

OCCLUSAL PLANE

• Labioldental 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

Ref:-Fenn, clinical dental prosthetics, 3rd edition pg 138

ANTERIORPOSTERIOR 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 insical edge of the upper teeth.

Ref:-Fenn, Clinical Dental Prosthetics, 3rd edition pg 138

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

• Objective opinion of performance

(Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

2) Kinematic movement analysis :

– Ultrasonics – X-ray mapping– Cineradiography– Optoelectronic articulatory movement tracking– Electropalatography

Ref:- Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

PALATOGRAPHY

• What is palatography?

• a group of techniques to record contact between the tongue and the roof the mouth to get articulatory

records for the production of speech sounds.

PREREQUISITE FOR MAKING PALATOGRAM

1. The artificial palate made must be uniformly adapted, no adhesive must be used.

2. Patient who have severe gagging must not be used for

making palatograms.3. The patient has to be trained to open his mouth

after uttering the desired word.

4. The tracing material must not be distasteful and its consistency should permit easy application

5. The palate has to be thoroughly dried before the medium is applied and the medium must have a contrasting colour so that it can be easily identified

6. Talc is considered the best material that can be used for palatogram, although activated charcoal, chocolate powder where also used

PALATOGRAM OF VOWELS.

PALATOGRAM OF CONSONANTS.

TERMINLOGIES RELATED TO SOME SPEECH DISTURBANCES

1. APHASIA (DYSPHASIA): Means defective speech due to damage of cortical area required for speech making. (Broca’s area, Wernicke’s area).

2. DYSARTHRIA: Motor speech problems caused, not due to sensory loss or mental retardation.

3. SPEECH AND LANGUAGE RETARDATION: Delay in acquistion of communicating skills

DISORDERS OF SPEECH

Hypernasality Hyponasality

Denasality

NASAL BALANCE

Eg: m, n & ng

b d g

Morning bordig

ARTICULATOR DEFETCS

Distortion

Eg: Vowel pop for pipe

Consonants cah for car

Substitution

Eg: teef for teeth

Omission

Eg: bow for boat


RELATION TO MAXILLOFACIAL DEFECTS

Acquired

Accidental or surgical

Nervous system – cerebral palsy, lateral sclerosis, poliomyelitis, myasthenia gravis, myotonic dystrophy

Congenital

Cleft palate,

Short palate,

Large velopharyngeal space,

Limited velar mobility,

Submucous cleft palate

CORRECTING SPEECH DEFECTS RELATED TO IMPLANT PROSTHESIS

• A fully bone anchored prosthesis in maxilla can cause phonetic problems,

• Normal pronunciation is possible after approximately 3 months,

• removable appliances like artificial gingival extensions made of silicones or resin materials should be given.

CONCLUSION

REFERENCES

1. John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics.

2. Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients.

3. Fenn, Clinical Dental Prosthetics, 3rd edition pg 138.

4. Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39.

5. Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223).

6. Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet dent 1953;3:193-199.

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1.phonetics in cd