Speech consideration in complete denture

Definition
History
Mechanism of sound production
Types/Classification of speech sounds
S sounds and their prosthodontic considerations
Prosthodontic implication in denture design affecting speech
Speech tests

1. Speech consideration IN COMPLETE
DENTURES
BY EKRAMUL HAQUE
UNDER THE GUIDANCE OF
DR SHAISTA AFROZ

2. CONTENTS
1.Definition
2.History
3.Mechanism of sound production
4.Types/Classification of speech sounds
5.S sounds and their prosthodonticconsiderations
6.Prosthodontic implication in denture design affecting speech
7.Speech tests

3. DEFINITION
•Speech:-Vocalised form of human communication describing
thoughts, feelings, or perceptions by the articulationof words.
•Phonetics:-The branch of linguistics that deals with the sounds of
speech and their production, combination, description, and
representation by written symbols.

4. 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’.

5. •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 linguopalatalspeech sounds, by electronic
means under predetermined vertical dimensions of occlusion.

6. 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)

7. COMPONENTS
OF SPEECH
RESPIRATION
PHONATION
RESONATIONS
ARTICULATIONS
NEUROLOGIC
INTEGRATIONS
AUDITION
COMPONENTS OF SPEECH

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

9. PHONATION
•Air from the lungs courses
through the trachea.
•Sound is produced in the larynx
•Vibration of vocal cord takes
place

10. RESONANCE
Sound that is produced by
the vocal cord is
modified by various
chamber.
•Resonators are
•pharynx
•oral cavity
•nasal cavity
•Paranasal sinuses

11. SPEECH ARTICULATION
•Sound that is produced is
formed into meaningful words
•Tongue,lips,palate, teeth and
mandible play are very
important role.

12. 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.

13. 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 blendof a consonantand
vowel, articulated in quick succession that they are
identified as single phonemes.
EX:-WORD

14. CLASSIFICATION OF SPEECH
•According to Boucher
•Vowels.
•Consonants.
•Plosives/stops
•Fricatives
•Affricatives
•Nasal
•Liquid
•Glides

15. 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)

16. •Fricatives: are also called sibilantsand 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)

17. •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)

18. CLASSIFICATION OF CONSONANTS BASED
ON THE PLACE OF THEIR PRODUCTION
•Consonant sounds are most important from the dental
point of view. Theymay be classified according to the
anatomic parts involved in their formation:
(1)Bilabial sounds,formedby lips,
(2) Labiodental sounds,formedby lips and teeth,
(3) Linguodentalsounds,formedby tongue and teeth,
(4) Linguoalveolarsounds,formedby the tip of the and
anterior most part of palate
(5) Linguopalataland Linguovelarsounds,trulypalatal
sounds

19. BILABIAL SOUNDS
•B,pand 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.

20. 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

21. LABIODENTAL SOUNDS
•F andV 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.

22. 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), Fwill sound
more like a V.

23. 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.

24. LINGUODENTAL SOUNDS
Consonant This 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.

25. 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
.

26. 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& Lare
representative of the
linguoalveolar group of sounds

27. 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

28. CLINICAL SIGNIFICANCE
•If teeth too lingual –Twill sound like D
•If teeth too forward -Dwill sound like T

29. 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.

30. LINGUOPALATAL SOUNDS FORMED BY
TONGUE AND HARD PALATE
Word like S, T D N andL 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 sis softened towardssh
(Lisping)
If groove is narrow a whistlingwill be heard
when s is pronounced

31. 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

32. 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

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

34. PALATOLINGUAL SOUNDS FORMED
BY TONGUE AND SOFT PALATE
Consonant k, ng andgare
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

35. CLINICAL SIGNIFICANCE
•If the posterior borders are over extended or if there is
no tissue contact kbecomes chsound.

36. PHONETICS IN RECORDING JAW
RELATION
•Also called as the speaking
method
•Sibiliantsounds 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
occlusalrims

37. 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

38. 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

39. DENTURE THICKNESS AND PERIPHERAL
OUTLINE
•If the denture bases are
too thick.
•Lisping will occur with
the word like S C andZ
•Palatolingual sounds
most affected. (T,D).

40. VERTICAL DIMENSION
•Bilabials are mostly
affected P Band M
•If both rims touch
prematurely it indicated
excessive vertical
dimension.
•In try in stage teeth
clickingwill be heard.

41. OCCLUSAL PLANE
•Labiodental sounds F
and V are affected.
•If occlusalplane is too
high the correct positing
of the lower lip is
difficult
•If the occlusalplane is
too low there is overlap
of the lower lip on the
labial surface of upper
teeth

42. ANTEROPOSTERIOR POSITIONING OF
TEETH
•F andV sounds are
hampered.
•labiopalatal positions of
the teeth is very
important
•Teeth if placed to
palatallythe lower lip
will not meet the insical
edge of the upper teeth.

43. 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

44. 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 Sare affected

45. RELATIONSHIP OF THE UPPER AND
LOWER INCISORS
•The chief concern is the S CH, J
and Zsound.
•These sounds need a near
contact of the upper and lower
teeth so that the air stream is
allowed to pass.

46. 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.

47. 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.

48. 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

49. S,Sh Six, sixty, ships, sailed
Mississippi, sure ,sign, sun,
shine
Sixty six ships sailed
Mississippi. Sure sign of sun
shine
T,D,N,LLocator, 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

50. TEST 3: TEST OF READING A PARAGRAPH
Make the patient read a paragraph containing
abundance ofS, Sh, Ch sounds.

51. SPEECH ANALYSIS
•2 categories
•1) Perceptual / acoustic
•Based on broad band spectrogram, recording by
Sonograph

52. 2) Kinematic movement analysis :
•Ultrasonics
•X-ray mapping
•Cineradiography
•Optoelectronic articulatory movement tracking
•Electropalatography

53. MCQ
Q. 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

54. 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

55. 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