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  • Speech is very essential for human activity.....Thus speech must be considered as acardinal feature in fabrication of a successfull denture Phonetics must be considered as cardinal factor for the success of the dental prosthesis along with esthetics and mechanical factors Phonetics (from the Greek (phonê) "sound" or "voice") is the study of the physical sounds of human speech.
  • Insical
  • In brief, it involves putting a marker paint on the tongue, pronouncing a word and seeing where ink rubbed off onto the roof of the mouth. This gives the place of articulation. Also, the roof of the mouth can be painted and it can be investigated where the ink rubbed off onto the tongue. These two types of records are called palatograms and linguograms respectively
  • due to the space between the prosthesis and residual ridge.Normal pronunciation can extend upto one year also
  • A man is not only judged by wt he says but also the way hw says itSo phonetics must also be given atmost importance in fabrication of complete.

1.phonetics in cd 1.phonetics in cd Presentation Transcript

  • GOOD MORNING
  • PHONETICS IN COMPLETEDENTURESDr Zarir Ruttonji
  • 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
  • INTRODUCTION
  • 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 theirproduction, combination, description, andrepresentation by written symbols.http://www.thefreedictionary.com
  • 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’.
  • • 1953 & 1956, ‘Silverman’ used ‘speaking method’ tomeasure patient’s 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.
  • 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)
  • COMPONENTSOF SPEECHRESPIRATIONPHONATIONRESONATIONSARTICULATIONSNEUROLOGICINTEGRATIONSAUDITIONCOMPONENTS OF SPEECHRef:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39
  • 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
  • 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
  • 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
  • SPEECH ARTICULATION• Sound that is producedis formed intomeaningful words• Tongue,lips,palate, teeth and mandible playare very important role.Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39
  • 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
  • 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
  • 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
  • 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
  • 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
  • • 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
  • • 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
  • • 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
  • 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)
  • 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)
  • 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)
  • 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)
  • 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)
  • • 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 denture…Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)
  • CLINICAL SIGNIFICANCE• If teeth too lingual – T will sound like D• If teeth too forward - D will sound like T
  • 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
  • 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)
  • 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.
  • 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)
  • 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)
  • 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)
  • 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)
  • 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)
  • 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)
  • 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)
  • 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)
  • 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)
  • VOWELS
  • 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
  • S-SOUND AND THEIR PROSTHODONTICCOSIDERATIONS• Say now shibboleth; and he saidsibboleth, for he could not frame topronounce it right…..”(THE BIBLE )
  • 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
  • DIFFERENT PARTS OF ORAL CAVITY ANDTHEIR INFLUENCE ON SPEECHTONGUE: LIPSPALATE TEETH
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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.
  • 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
  • 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
  • PALATOGRAM OFVOWELS.PALATOGRAM OFCONSONANTS.
  • TERMINLOGIES RELATED TOSOME SPEECH DISTURBANCES1. APHASIA (DYSPHASIA): Means defective speech dueto damage of cortical area required for speech making.(Broca’s area, Wernicke’s area).2. DYSARTHRIA: Motor speech problems caused, not dueto sensory loss or mental retardation.3. SPEECH AND LANGUAGE RETARDATION: Delayin acquistion of communicating skills
  • DISORDERS OF SPEECHHypernasality HyponasalityDenasalityNASAL BALANCEEg: m, n & ngb d gMorning  bordig
  • 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
  • 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
  • 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.
  • CONCLUSION
  • 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.
  • THANKYOU