Speech Therapy
with
Obturator
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www....
INTRODUCTION:INTRODUCTION:
 Speech and communication
 VP defects and speech
 Prosthodontist and speech therapist
 Spee...
PHONATION AND SITE OF DEFECT:PHONATION AND SITE OF DEFECT:
 InterrelatedInterrelated
 speech problems vary with location...
www.indiandentalacademy.comwww.indiandentalacademy.com
SPEECH EVALUATION:SPEECH EVALUATION:
1.1. Oral mechanicalOral mechanical
examination:examination:
 ClassificationClassifi...
2. Articulation Test:2. Articulation Test:
 Velopharyngeal insufficiency and nasal air emission areVelopharyngeal insuffi...
b.b. Clarity Of Speech:Clarity Of Speech:
• phrases/sentencesphrases/sentences
• spontaneous speech, story telling, narrat...
3. Nasal Oral Resonance:3. Nasal Oral Resonance:
 Nares occluded/unoccludedNares occluded/unoccluded
 Hyper nasal/ hypon...
4.Overall Speech Intelligibility4.Overall Speech Intelligibility::
 Using familiar and unfamiliar listenersUsing familiar...
TheThe BOREL- MAISONNYBOREL- MAISONNY classificationclassification
to score the quality of phonation on a scale of typeto ...
 TYPE 2MTYPE 2M - PHONATION WITH CONTINUOUS- PHONATION WITH CONTINUOUS
NASAL EMISSION,NASAL EMISSION,
POOR INTELLIGIBILIT...
THE ROLE OF PROSTHODONTISTTHE ROLE OF PROSTHODONTIST
 In conjunction withIn conjunction with speech therapistspeech thera...
 Korrecta wax can be used for building the tail whichKorrecta wax can be used for building the tail which
can be supporte...
FINAL ASSESSMENT :FINAL ASSESSMENT :
 Visual examination in mouthVisual examination in mouth
 Auditory – perceptual judg...
WEEKLY RE-CALL APPOINTMENT:WEEKLY RE-CALL APPOINTMENT:
(session duration of 25-45min)(session duration of 25-45min)
 For ...
SYSTEMATIC REDUCTION PROGRAMMESYSTEMATIC REDUCTION PROGRAMME
WITH PALATAL PLATE / BULB:WITH PALATAL PLATE / BULB:
 Assess...
COMPENSATORY ARTICULATION:COMPENSATORY ARTICULATION:
 For structural deficits uncorrected by prosthesisFor structural def...
Optimal Speech
Prosthodontist Speech Therapist
PatientParents
CONCLUSION:
www.indiandentalacademy.comwww.indiandentalacade...
REFERENCES:REFERENCES:
 Ann .S. Kummer – Craniofacial AnomaliesAnn .S. Kummer – Craniofacial Anomalies
 Bzoach – Cleft l...
www.indiandentalacademy.comwww.indiandentalacademy.com
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Speech therapy with obturator/ dentistry dental implants

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Speech therapy with obturator/ dentistry dental implants

  1. 1. Speech Therapy with Obturator INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. INTRODUCTION:INTRODUCTION:  Speech and communication  VP defects and speech  Prosthodontist and speech therapist  Speech therapy protocol www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. PHONATION AND SITE OF DEFECT:PHONATION AND SITE OF DEFECT:  InterrelatedInterrelated  speech problems vary with location of defect .speech problems vary with location of defect . www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. SPEECH EVALUATION:SPEECH EVALUATION: 1.1. Oral mechanicalOral mechanical examination:examination:  ClassificationClassification system(Okriens,1987) likesystem(Okriens,1987) like LAHSHAL anatomicalLAHSHAL anatomical representation of cleft liprepresentation of cleft lip (L)(L), alveolus, alveolus (A)(A), and hard, and hard (H)(H) and soft palateand soft palate (S)(S).. www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. 2. Articulation Test:2. Articulation Test:  Velopharyngeal insufficiency and nasal air emission areVelopharyngeal insufficiency and nasal air emission are the major causes for speech defects.the major causes for speech defects. a.a. Nasal emission test:Nasal emission test: Using oral sounds like pa, ba, ca,and daUsing oral sounds like pa, ba, ca,and da followed by words which has (K) –followed by words which has (K) – syllable.syllable. ex:ex: ccat poat pockcket walet walkk www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. b.b. Clarity Of Speech:Clarity Of Speech: • phrases/sentencesphrases/sentences • spontaneous speech, story telling, narration etc.spontaneous speech, story telling, narration etc. • counting from 60-69.counting from 60-69.  The clarity varies with the severity of nasal emissionThe clarity varies with the severity of nasal emission www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. 3. Nasal Oral Resonance:3. Nasal Oral Resonance:  Nares occluded/unoccludedNares occluded/unoccluded  Hyper nasal/ hyponasalHyper nasal/ hyponasal  Check for audible nasal emissionCheck for audible nasal emission  Finger under nostrilFinger under nostril  Paper piece held under nostrilPaper piece held under nostril  Straw techniqueStraw technique Evaluation using a straw. Evaluation using a “listening tube.” www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. 4.Overall Speech Intelligibility4.Overall Speech Intelligibility::  Using familiar and unfamiliar listenersUsing familiar and unfamiliar listeners  Instrumentation:Instrumentation:  NasometryNasometry  Naso endoscopyNaso endoscopy - LPW,PPW and Velum- LPW,PPW and Velum activityactivity  Video fluorographicVideo fluorographic assessment- gives aassessment- gives a pictorial idea of the defectpictorial idea of the defect Final diagnosisFinal diagnosis -- analysis of all the above 4analysis of all the above 4 parameters.parameters.www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. TheThe BOREL- MAISONNYBOREL- MAISONNY classificationclassification to score the quality of phonation on a scale of typeto score the quality of phonation on a scale of type 0 – 30 – 3  TYPE 0TYPE 0 - NO PHONATION- NO PHONATION  TYPE 1TYPE 1 - EXCELLENT PHONATION,NO AIR EMISSION- EXCELLENT PHONATION,NO AIR EMISSION  TYPE1/2TYPE1/2 - GOOD PHONATION,INTERMITTENT- GOOD PHONATION,INTERMITTENT NASAL AIR EMISSION,GOODNASAL AIR EMISSION,GOOD INTELLIGIBILITYINTELLIGIBILITY  TYPE 2TYPE 2 –– PHONATION WITH CONTINUOUS NASALPHONATION WITH CONTINUOUS NASAL EMISSIONEMISSION  TYPE 2bTYPE 2b - PHONATION WITH CONTINUOUS NASAL- PHONATION WITH CONTINUOUS NASAL EMISSION BUT GOOD INTELLIGIBILITYEMISSION BUT GOOD INTELLIGIBILITY AND NO SOCIAL DISCOMFORTAND NO SOCIAL DISCOMFORT www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11.  TYPE 2MTYPE 2M - PHONATION WITH CONTINUOUS- PHONATION WITH CONTINUOUS NASAL EMISSION,NASAL EMISSION, POOR INTELLIGIBILITY.POOR INTELLIGIBILITY.  TYPE 2/3TYPE 2/3 – PHONATION WITH CONTINUOUS– PHONATION WITH CONTINUOUS NASAL EMISSION WITHNASAL EMISSION WITH COMPENSATORY ARTICULATION,COMPENSATORY ARTICULATION, POOR INTELLIGIBILITY.POOR INTELLIGIBILITY.  TYPE 3TYPE 3 – CONTINUOUS COMPENSATORY– CONTINUOUS COMPENSATORY ARTICULATION ,NO INTELLIGIBILTY.ARTICULATION ,NO INTELLIGIBILTY. ((De Buys Roessingh et al. Speech Out After cranial –De Buys Roessingh et al. Speech Out After cranial – Based Pharyngeal Flap.J.Oral Maxillofac.surg.2006)Based Pharyngeal Flap.J.Oral Maxillofac.surg.2006)www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. THE ROLE OF PROSTHODONTISTTHE ROLE OF PROSTHODONTIST  In conjunction withIn conjunction with speech therapistspeech therapist  Palatal lift/palatal bulb prosthesisPalatal lift/palatal bulb prosthesis  INTIAL PROSTHESIS:INTIAL PROSTHESIS: An inactive plate with no softAn inactive plate with no soft palate portion.palate portion.  Wear for 1-2 weeks prior addition of palatal lift/bulb toWear for 1-2 weeks prior addition of palatal lift/bulb to the posterior portion.the posterior portion. www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  Korrecta wax can be used for building the tail whichKorrecta wax can be used for building the tail which can be supported by wireloop /acrylic.can be supported by wireloop /acrylic.  Assess speech using the already explained 4Assess speech using the already explained 4 parameters. Additions and subtractions using waxparameters. Additions and subtractions using wax done until speech is improved.done until speech is improved.  Velopharyngeal adequacy confirmed viaVelopharyngeal adequacy confirmed via nasoendoscopy / videofluorography, continuenasoendoscopy / videofluorography, continue shape/define for optimal speech.shape/define for optimal speech. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. FINAL ASSESSMENT :FINAL ASSESSMENT :  Visual examination in mouthVisual examination in mouth  Auditory – perceptual judgment of speech.Auditory – perceptual judgment of speech. (articulation, nasalresonance, intelligibility)(articulation, nasalresonance, intelligibility)  Instrumental – nasoendoscopy / videofluroscopyInstrumental – nasoendoscopy / videofluroscopy  Patient perceptionPatient perception  Parent / listener perception.Parent / listener perception. Convert the wax to acrylic, polish and finish.Convert the wax to acrylic, polish and finish. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. WEEKLY RE-CALL APPOINTMENT:WEEKLY RE-CALL APPOINTMENT: (session duration of 25-45min)(session duration of 25-45min)  For evaluation of speech over timeFor evaluation of speech over time  Addition/subtraction in VP area using wax followingAddition/subtraction in VP area using wax following speech testsspeech tests  Repeat nasoendoscopy / videofluorographyRepeat nasoendoscopy / videofluorography  Speech drill – alternating oral and nasal soundsSpeech drill – alternating oral and nasal sounds ex:ex: ah n ah nah n ah n ah n ah maah n ah ma www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. SYSTEMATIC REDUCTION PROGRAMMESYSTEMATIC REDUCTION PROGRAMME WITH PALATAL PLATE / BULB:WITH PALATAL PLATE / BULB:  Assessment of LPW AND PPW activity and adequateAssessment of LPW AND PPW activity and adequate lateral reductions done in the bulb, 1-2mm each timelateral reductions done in the bulb, 1-2mm each time  Top, sides and back reduction done for palatal liftTop, sides and back reduction done for palatal lift prosthesisprosthesis  Continue reduction till the speech become acceptable.Continue reduction till the speech become acceptable.  Acceptable achieved mostly by 6 monthsAcceptable achieved mostly by 6 months  Repeat speech evaluation at regular intervals; needsRepeat speech evaluation at regular intervals; needs numerous appointments to achievenumerous appointments to achieve optimaloptimal speechspeech  Reinforce speech exercisesReinforce speech exercises www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. COMPENSATORY ARTICULATION:COMPENSATORY ARTICULATION:  For structural deficits uncorrected by prosthesisFor structural deficits uncorrected by prosthesis  Velar pressure compensated by pressure fromVelar pressure compensated by pressure from alternate areas like glottal area ,pharyngeal areaalternate areas like glottal area ,pharyngeal area and/or mid portion of the palateand/or mid portion of the palate  Bilabial sounds compensated by velar sounds.Bilabial sounds compensated by velar sounds. eg:eg: pa - ahpa - ah www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. Optimal Speech Prosthodontist Speech Therapist PatientParents CONCLUSION: www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. REFERENCES:REFERENCES:  Ann .S. Kummer – Craniofacial AnomaliesAnn .S. Kummer – Craniofacial Anomalies  Bzoach – Cleft lip and palate volume IIIBzoach – Cleft lip and palate volume III  Mc William – Cleft palate speechMc William – Cleft palate speech  Speech out come after cranial base pharyngeal flap inSpeech out come after cranial base pharyngeal flap in children born with total cleft, cleft palate or primarychildren born with total cleft, cleft palate or primary Velopharyngeal insufficiency – J. oral Maxillo fac surgVelopharyngeal insufficiency – J. oral Maxillo fac surg 64:1736-1742, 2006 .64:1736-1742, 2006 .  Bailley and Love – Text book of General Surgery 24Bailley and Love – Text book of General Surgery 24thth editionedition www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. www.indiandentalacademy.comwww.indiandentalacademy.com

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