This represent relationship and role of speech in prosthodontics

1. GOOD MORNING!

2. SPEECH AND PROSTHODONTICS
2
 Prepared By :- Dr. Pankti Panchal
( Part 1 PG )
Dept.of Prosthodontics

3. CONTENTS:
1. Introduction
2. Organs involved in speech
3. Components of speech
4. Some useful terms
5. Classification of phonetics
6. Consonants
7. Consonants and their prosthodontic
consideration
8. Vowels
9. Prosthodontic implication in denture
design affecting speech
10. Articulatory errors
11. Speech sound deviation according to
structural deviation
12. Speech aid prosthesis
13. References
3

4. INTRODUCTION
 SPEECH is the expression of ideas and thoughts by means of articulate vocal sounds, or
the faculty of thus expressing ideas and thoughts.
 The two primary linguistic disciplines concerned with speech sounds - those sounds that
are used by humans to communicate - are phonetics and phonology. Both are mutually
dependent.
 PHONETICS describes the concrete, physical form of sounds (how they are produced,
heard and how they can be described),
 PHONOLOGY is concerned with the function of sounds, that is with their status and
inventory in any given language.
 Schlosser and Gehl’ said that “correction of speech defects due to the partial or complete
loss of natural teeth in compliance with phonetic requirements” is one of the major
objective for the fabrication of a denture prosthesis.[1]
4
[1] Bloomer, H. H.: Speech Defects Associated With Dental Malocclusions, in Travis, L. E., editor: Handbook of Speech Pathology and Audiology, New York, 1971,
Appleton-Century- Crofts, Inc., chap. 28, p. 731.

5. ORGANS
INVOLVED IN
SPEECH
5
[2] Palmer JM. Analysis of speech in prosthodontic practice. J Prosthet Dent. 1974 Jun;31(6):605-14.

6. 6
BASED ON
FUNCTION
INITIATOR:
used to set the
air into motion
for the
production of
speech sounds
(the main
initiator is the
lungs)
PHONATOR:
used to produce
speech sound
called ‘voice’
(refers to the
vocal cords in
the larynx)
ARTICULATOR:
used to obstruct the
out-going air in the
production of
speech sounds
Movable
(active): the
lips, the tongue,
the uvula, and
the vocal cords
Unmovable
(passive): the
teeth, the teeth-
ridge, the hard
palate

7. 7
Components
of
speech
Respiration
Phonation
Resonance
Articulation
Neurologic
al
integration
Ability to
hear sound
[2] Palmer JM. Analysis of speech in prosthodontic practice. J Prosthet Dent. 1974 Jun;31(6):605-14.

8. • Movement of air during inspiration and
expiration is important for production of
speech.
8
Respiration

9. 9
Phonation
Air course through the
trachea
Sound is produced in
larynx
Vibration of vocal cord
takes place

10. 10
Resonance
Sound that is produced by
vocal cord is modified by
various chambers
Oral cavity Nasal cavity
Paranasal
sinuses
Pharynx

11.  Sound is produced is formed into
meaningful words.
 Tongue, lip, palate and teeth play
very important role
11
Articulation

12.  Factors for speech production are highly coordinated, some sequentially and some
simultaneously by central nervous system. (CNS)
 Speech is learned function and acquire adequate hearing, vision and normal
nervous system for its full development.
12
Neurological
integration

13. SOME USEFUL TERMS:
 Articulation: the act of moving two articulators toward each other for the
obstruction of the out going air.
 Point of articulation or place of obstruction: the point where two articulators are
touching or almost touching each other for the obstruction of the out-going air.
13
[1] Bloomer, H. H.: Speech Defects Associated With Dental Malocclusions, in Travis, L. E., editor: Handbook of Speech Pathology and Audiology, New York, 1971,
Appleton-Century- Crofts, Inc., chap. 28, p. 731.

14. 14
CLASSIFICATION OF
PHONETICS
CONSONANTS
Produced due to direct
contact between active
articulators and passive
articulators
1.
Plosives
2.
Fricatives
3.
Affricates
4.
Nasals
5.
Liquids
6.
Post
alveolar
VOWELS
Produced without
such obstruction
Front Back Central
[3] Meagan Ayer, Allen and Greenough’s New Latin Grammar for Schools and Colleges. Carlisle, Pennsylvania:
Dickinson College Commentaries, 2014. ISBN: 978-1-947822-04-7

15. 15
CONSONANTS

16. Bilabial (P, B)
Alveolar (T, D)
Velar (K, G)
1. PLOSIVES:
Consonant that are made up by
completely blocking the air
flow.
16
[4] Alwan A, Jiang J, Chen W. Perception of Place of Articulation for Plosives and Fricatives in Noise. Speech
Commun. 2011 Feb 1;53(2):195-209.

17. • BILABIALS(P, B)
o [p] and [b] are produced with
both lips pressed together.
o The active articulator is the
lower lip;
o The passive articulator is the
upper lip.
17

18. • ALVEOLAR (T, D)
o [t] and [d] are produced with the tip of
the tongue firmly pressed against the
(middle part of the) alveolar ridge.
o The active articulator is the tip of the
tongue.
o The passive articulator is the alveolar
ridge.
18

19. • VELAR (K, G)
o [k] and [g] are articulated with the
back of the tongue against the soft
palate.
o The active articulator is the back of the
tongue.
o The passive articulator is the soft
palate.
19

20. Labiodental (F,V)
Interdental (Th)
Alveolar (S,Z)
2.FRICATIVES:
Fricatives are consonants
that are produced by impeding,
but not completely blocking the
airflow, i.e., there is a narrow
gap between the active and the
passive articulator along which
the airflow can leave the oral
cavity.
20
Palate-alveolar (Ʒ)
Glottal (H)
[3] Alwan A, Jiang J, Chen W. Perception of Place of Articulation for Plosives and Fricatives in Noise.
Speech Commun. 2011 Feb 1;53(2):195-209.

21. • LABIODENTAL (F, V)
o The lower lip is very close to the edge
of the upper front teeth, thus forming
an incomplete obstruction.
21

22. • INTERDENTAL ( Th)
o The tip of the tongue is either close to
the edge of the upper teeth or slightly
projected between the teeth.
22

23. • ALVEOLAR (S, Z)
o The tip of the tongue is close to the
alveolar ridge.
o The teeth are very close together.
o The airstream mechanism is pulmonic,
which means it is articulated by
pushing air solely with
the lungs and diaphragm, as in most
sounds.
o Its phonation is voiceless, which means
it is produced without vibrations of the
vocal cords.
o It is a central consonant, which means
it is produced by directing the
airstream along the center of the
tongue.
23
[11] Puppel, Stanisław; Nawrocka-Fisiak, Jadwiga; Krassowska,
Halina (1977), A handbook of Polish pronunciation for English
learners, Warszawa: Państwowe Wydawnictwo
Naukowe, ISBN 9788301012885

24. • PALATE-ALVEOLAR ( Ʒ )
o The tip of the tongue is close to the
back part of the alveolar ridge forming
a flat narrowing.
o The front part of the tongue is raised
towards the hard palate forming the
front secondary focus.
24

25. • GLOTTAL ( H )
o It is produced with the voiceless
expulsion of air from the lungs with
the mouth and tongue already in
position for the following vowel.
25

26. 3. AFFRICATIVES ( ch, j )
o Affricates are sounds that are similar
to both plosives and fricatives.
o The tip of the tongue touches the back
part of the teeth ridge, the front part of
the tongue is raised towards the hard
palate.
26
[4] Jain CD, Bhaskar DJ, Agali CR, Singh H, Gandhi R. Phonetics in Dentistry. Int J Dent Med
Res2014;1(1):31-37.

27. 4. NASAL
NASALS ARE LIKE
PLOSIVES BUT
AIRFLOW ESCAPES
THROUGH THE
NASAL CAVITY.
27
[4] Jain CD, Bhaskar DJ, Agali CR, Singh H, Gandhi R. Phonetics in Dentistry. Int J Dent Med Res2014;1(1):31-37.

28. 28

29. 29
BILABIAL ( M ):
The lips are firmly kept
together forming the
complete obstruction.
The active articulator is
the lower lip;
the passive articulator is
the upper lip.
01
ALVEOLAR ( N ):
The tip of the tongue is
pressed against the alveolar
ridge forming the complete
obstruction.
The active articulator is the
tip of the tongue,
and the passive articulator is
the alveolar ridge.
02
VELAR ( IN ):
The back of the tongue is
pressed to the soft palate
forming the complete
obstruction.
The active articulator is
the back of the tongue,
the passive articulator is
the soft palate.
03

30. 5. LIQUIDS ( L)
o The tip of the tongue is in firm contact
with the alveolar ridge forming the
complete obstruction.
o The active articulator is the tip of the
tongue,
o The passive articulator is the alveolar
ridge.
30
[4] Jain CD, Bhaskar DJ, Agali CR, Singh H, Gandhi R. Phonetics in Dentistry. Int J Dent Med Res2014;1(1):31-37.

31. 6. POST-ALVEOLAR (R)
o The tip of the tongue is held in a
position near to but not touching the
back part of the alveolar ridge.
o The soft palate is raised and the air
flows quietly between the tip of the
tongue and the hard palate.
31
[4] Jain CD, Bhaskar DJ, Agali CR, Singh H, Gandhi R. Phonetics in Dentistry. Int J Dent Med
Res2014;1(1):31-37.

32. • CONSONANTS AND THEIR
PROSTHODONTIC
CONSIDERATION
32
[5] Bhat JT, Kumar N, Singh K, Tanvir H. Phonetics in prosthodontics: its clinical implications in designing of prosthesis.
International Journal of Applied Dental Sciences 2021; 7(2): 84-93

33. Linguopalatal- tongue and
palate
Linguodental- tongue and teeth
Labiodental- Lips and teeth
CONSONANTS:
CLASSIFICATION
ACCORDING TO ANATOMIC
PARTS INVOLVED IN THEIR
PRODUCTION.
33
Bilabial - lips
Linguoalveolar- tongue and
alveolus

34. LINGUOPALATAL “S” SOUND AND THEIR
PROSTHODONTIC CONSIDERATION
34
 During the production of the syllable ‘s’, the tongue
comes in contact with the anterior most part of the
palate just behind the maxillary incisors and the
anterior teeth must come in close approximation to
each other without contact.
 The airstream passes through a MEDIAN
GROOVE formed between the tongue and the
hard palate.
 This median groove may or may not coincide with
the median raphe of the palate.

35. 35
EFFECT OF
THICKNESS
OF
DENTURE
Excessive
thickness of
denture
Lisping sound
will be heard,
because median
groove is too
shallow
Trim the denture
base to make the
groove deeper
Insufficient
thickness of
denture
Whistling sound
will be heard,
because median
groove is too deep
Thickening of
denture base to
make the groove
shallow
[5] Bhat JT, Kumar N, Singh K, Tanvir H. Phonetics in prosthodontics: its clinical implications in designing
of prosthesis. International Journal of Applied Dental Sciences 2021; 7(2): 84-93

36. 36
Palatograms of s, sh, and th. Note that an increase in the width of the channel corresponds to an increase in
shallowness of the groove in the tongue, causing softening of s to sh and to th. A palatogram is a representation of
the palate. The dark portions indicate parts of vertical vault of palate, palatal occlusion and palatal surface.
[5] Bhat JT, Kumar N, Singh K, Tanvir H. Phonetics in prosthodontics: its clinical implications in
designing of prosthesis. International Journal of Applied Dental Sciences 2021; 7(2): 84-93

37. 37
EFFECT
OF
ANTERIOR
POSITIONING
OF
TEETH
Mandibular incisor set too
far posteriorly
Lisping sound will
be heard, because
median groove is
too shallow as
tongue is crowded
posteriorly
Mandibular incisor set
too far anteriorly
Whistling sound
will be heard,
because median
groove is too deep
as tongue is
overextended

38. 38
EFFECT
OF
VERTICAL
DIMENSION OF
OCCLUSION
Increased vertical
dimension of occlusion
Clicking sound
will be heard
Decreased vertical
dimension of occlusion
Space can be seen
while
pronounciation

39. 39
Vertical length of the anterior teeth during sibilant production from left to right is shown
as correct, excessive, and with inadequate vertical overlap.

40. LINGUODENTAL “K” “G” SOUND
AND THEIR PROSTHODONTIC
CONSIDERATION
40
 If the posterior border of the upper denture is
overextended or does not make firm contact with the
tissue at the posterior palatal seal, the k becomes
altered toward the ch sound

41. LINGUODENTAL “TH” SOUND
AND THEIR PROSTHODONTIC
CONSIDERATION
41
 3 mm of tongue should be visible.
 Interarch space and labiolingual position of teeth affect this
sound.

42.  Inadequate interocclusal distance may
cause a sensation of tongue biting
when th is articulated.
 The patient may tend to place the tip of
the tongue behind the anterior teeth
instead of between them and th will be
pronounced t.
• EFFECT OF INTERARCH
SPACE
42

43.  If about 3mm of the tip of the tongue is not
visible, the anterior teeth are probably too
far forward (except for class 2
malocclusions), or there is excessive
overbite which doesn’t allow the tongue to
protrude through.
 If more than 6mm of the tongue extends out
between the teeth when such sounds are
made, the teeth are probably too lingual.
 th is pronounced t when the anterior teeth
are set too far lingually. The tongue becomes
pressed against the lingual surfaces of the
upper and lower teeth and against the
linguogingival margin of the upper anterior
teeth. The sound t will result from this
relation of the tongue and teeth
• EFFECT OF
LABIOLINGUAL
POSITION OF TEETH
43

44. 44
[6] Celdrán, Eugenio. (2008). Some Chimeras of Traditional Spanish Phonetics.

45. LABIODENTAL “F” “V” SOUND
AND THEIR PROSTHODONTIC
CONSIDERATION
45
 This sound will help us to determine position of
lower lip and incisal edge of maxillary anterior
teeth.

46. • Effect of tooth
positioning on f and
v.
46
A, Upper antetior teeth too long, During the pronounciation
off, they will contact the lower lip in a position similar to v, and
the sounds may sound alike.
B, effect of antero-posterior positioning of the teeth from
left to right are, correct, too far posterior and too far anterior.

47. BILABIAL “P” “M” SOUND AND
THEIR PROSTHODONTIC
CONSIDERATION
47
 If there is insufficient support of the lips by the
teeth or the denture base can cause these sounds
to be defective.

48.  If the interarch distance is increased,
then the patient will not be able to
close the lips comfortably to form a
seal or
 if insufficient interarch distance exists,
the lips will contact prematurely.
• EFFECT OF INTERARCH
SPACE
48

49.  When the teeth are placed too far
labially, the lips do not meet
comfortably;
 with a lingual displacement of the
anterior teeth, the lips meet
prematurely
• EFFECT OF CORRECT
LABIOLINGUAL
POSITIONING OF THE
ANTERIOR
TEETH ON BILABIALS
49
[7] Murell GA. Phonetics, function and anterior occlusion. J Prosthet Dent 1974, 23-31.

50. 50
VOWEL

51. 51
CLASSIFICATION
OF VOWEL
DEPENDING ON
HEIGHT OF
TONGUE
HIGH
MID
LOW
DEPENDING ON
PART OF TONGUE
THAT IS RAISED
FRONT
BACK
CENTRAL
[4] Jain CD, Bhaskar DJ, Agali CR, Singh H, Gandhi R. Phonetics in Dentistry. Int J Dent Med Res2014;1(1):31-37.

52. • SOFT
PALATE AND
SPEECH
52
 The soft palate must rise and form a
competent velopharyngeal sphincter
closing the nasopharyngeal space in all
speech sounds except n, m, and ng.
 When the soft palate is inactive, the
space remains open, causing a nasal
tone.
 An overextended maxillary denture may
cause irritation of the velum, with
subsequent stiffening of its muscles.
[5] Bhat JT, Kumar N, Singh K, Tanvir H. Phonetics in prosthodontics: its clinical implications in
designing of prosthesis. International Journal of Applied Dental Sciences 2021; 7(2): 84-93

53. • PALATAL
RUGAE AND
SPEECH
53
 Palatal rugae may aid in lingual placement
during speech production by providing
landmarks for the tongue.
 Palatal rugae plays a very important role in
phonetics. The absence of rugae impedes
proper articulation due to the lack of tactile
sense.
 Conventional complete dentures do not
provide palatal rugae duplication and therefore
leads to altered speech, especially the
linguopalatal sounds.
 So, the patient’s own rugae can be transferred
to the palatal surface of the denture in a
number of ways. using plastic palate forms,
corrugated metal palate, free hand wax carving
of anatomic palate and interdental floss.
[15] Kar S, Tripathi A, Madhok R. Replication of Palatal Rugae and Incorporation in Complete Denture. J Clin Diagn
Res. 2016 Aug;10(8):ZJ01-2.

54. 54
[8] Watson, A. (2013). Anaesthesia for cleft lip and palate surgery in children. In I. James & I. Walker (Eds.), Core
Topics in Paediatric Anaesthesia (pp. 228-237). Cambridge: Cambridge University Press.

55. • PROSTHODONTIC IMPLICATION IN
DENTURE DESIGN AFFECTING
SPEECH
1. Denture thickness and peripheral outline
2. Vertical dimension
3. Occlusal plane
4. Relationship of the upper and lower teeth
5. Post dam area
6. Anterior-posterior positioning of teeth
7. Width of dental arch
55
[09] Allen LR. Improved phonetics in denture construction. J Prosthet Dent 1958;8:753-763.

56. 1. Denture thickness and peripheral outline 56
Denture
peripheries
• Increase in the thickness
consequently causes a decrease
in the volume of oral cavity and
loss of tongue space.
• The denture should be extended
to as much area as possible
without encroaching upon the
movable tissues.
• Overextended peripheries of the
denture will hinder the
movements of the articulators
while speaking. This will lead to
incomprehensible speech.
Denture
thickness
• The thickness of the denture
base covering the palate
decreases the amount of tongue
room and the oral air volume.
• Excessive thickness of denture
base in palate and horizontal
slopes of alveolar ridge area can
cause defective phonation of T,
D, S, G, Z, R, L, GH, J.

57. 2. Vertical dimension
 The bilabials such as P, B and M
require that the lips contact to form a
seal.
 With P and B, the lips part quite
forcibly, but in case of the M sound,
the lip contact is passive.
 The syllable ‘M’ is used to obtaining
the correct vertical height.
 If there is a strained appearance
during lip contact, or the lips fail to
make contact, it would mean that the
occlusal rims are contacting
prematurely
 The syllables G, S and Z when
produced bring the teeth in close
approximation to each other without
coming into contact.
 If the vertical dimension of occlusion
is too large, the dentures will actually
make contact as these consonants are
formed, and a clicking sound will be
produced.
57

58. • CLOSEST SPEAKING SPACE
 The space between the anterior teeth when the patient is speaking; according to Dr Earl Pound, the
space should not be more or less than 1 to 2 mm of clearance between the incisal edges of the teeth
when the patient is unconsciously repeating the letter “S.” Dr Meyer M. Silverman termed this
speaking centric, which was defined as the closest relationship of the occlusal surfaces and incisal
edges of the mandibular teeth to the maxillary teeth during function and rapid speech;
 This was later called closest speaking level by Dr Silverman and finally the closest speaking space.
[GPT-9]
 The closest speaking space measures vertical dimension when the mandible and muscles involved
are in the active full function of speech.
58

59. 59
[09] Allen LR. Improved phonetics in denture construction. J Prosthet Dent 1958;8:753-763.

60. 3. Occlusal Plane
 Labiodental group of sounds F and V help in determining the correct occlusal
plane.
 In case the maxillary anterior teeth are placed above the occlusal plane, then V
sound will be more like an F.
 If they are placed below the occlusal plane, then F will sound more like a V.
60

61. 4. Relationship of upper anterior to the lower
anterior teeth
 The sibilant S requires near contact of maxillary and mandibular incisors so that
the air stream can escape through the slight space between the teeth.
 The consonants Ch, J and Z require a similar air channel in their formation.
61

62. 5. Post dam area
 Vowels such as I and E and the
palatolinguals such as K, NG, G and
G can be used to determine the extent
of the post dam area.
 A denture which has a thick base in
the post-dam area, or that edge
finished square instead of tapering,
will irritate the dorsum of the tongue,
impeding the speech.
 A denture with poor palatal seal will
unseat when the words requiring
expulsion of burst of airsteam
forcefully are pronounced. Such
syllables include the plosive such as
P, B etc.
62

63. 6. Anteroposterior postioning of teeth
 Labiodental F, V and Ph may be used as a guide in the anteroposterior positioning
of the incisors. If the teeth are placed too far palatally, the contact of the lower lip
with the incisal and labial surfaces will become difficult.
 Palatolinguals S, G (soft), and Z are also affected in this case, since the tongue will
make premature contact with the incisors, this will result in a lisp.
63

64. 7. Width of dental arch
 A narrow arch cramps the tongue which cause the size and shape of the air channel
to alter.
 Consequently, Defective phonation of such syllables such as T, D, S, M, N, K, G
and H, where the lateral margins of the tongue make contact with the palatal
surfaces of the upper posterior teeth, occurs.
64

65. • 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.
65
[10] John sharry; complete denture prosthodontics, 3rd edition; phonetics; pg-141

66. 66
TEST 1: Test of
random speech
TEST 2: Test of
specific speech sounds
• Engage the patient 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.
• This is best accomplished by having
the patient say 6-8 words containing
the sound and then combining these
words into sentences.
• This sound mainly include S, SH, T,
D, N, L, CH, J, K, F, V.
[10] John sharry; complete denture prosthodontics, 3rd edition; phonetics; pg-141

67. • ARTICULATORY ERRORS
 Speech problems associated with prosthesis generally known as articulatory
errors.
67
[2] Palmer JM. Analysis of speech in prosthodontic practice. J Prosthet Dent. 1974 Jun;31(6):605-14.

68. 68
Articulatory
errors
Omission
•May be seen kids or
may be heard in a
person trying to learn
a new unfamiliar
language or a person
with auditory
defects. This type of
articulatory error is
not so common in
denture wearers
Substitution
•Those when a sound
is replaced by some
other, for example
‘think for sink’. Here
the person may have
replaced ‘th’ by ‘s’
sound. This is termed
as lisp. We may come
across prosthodontic
patients exhibiting this
type of error.
Distortion
when a sound intended
to produce is so
distorted that it
becomes some other
word completely. The
speech may become
incomprehensible

69.  SPEECH SOUND DEVIATION ACCORDING
TO STRUCTURAL DEVIATION
69
[2] Palmer JM. Analysis of speech in prosthodontic practice. J Prosthet Dent. 1974 Jun;31(6):605-14.

70. • TONGUE TIE
(ANKYLOGLOSSIA)
•There will be difficulty lifting the tongue to the
upper teeth or moving the tongue from side to
side andTrouble sticking out the tongue past the
lower front teeth.
•Which can nterfere with the ability to make
certain sounds — such as "t," "d," "z," "s," "th,"
"r" and "l."
70

71.  A speech aid is that portion of a prosthesis that extends into the palatopharyngeal
area to primarily treat speech difficulties most commonly caused by cancer
surgery and congenital cleft palate.
 The speech aid helps the patient to control nasality and nasal emission of air that
these defects cause.
71
• SPEECH AID PROSTHESIS
[12] John sharry; complete denture prosthodontics, 3rd edition; MAXILLOFACIAL PROSTHESIS; page- 414

72. 72
[14] Dhakshaini, M R & Mariswamy, Pushpavathi & Garhnayak, Mirna & Dhal, Angurbala. (2015). Prosthodontic Management in
Conjunction with Speech Therapy in Cleft Lip and Palate: A Review and Case Report. Journal of international oral health : JIOH. 7. 106-11.

73. • MODIFIED PROSTHETIC PALATE
 W hen a portion of a patient’s tongue has to be resected or if the tongue does not
move efficiently because of a neuromuscular problem the functions of speech,
mastication, and swallowing become disturbed.
 Very commonly, the patient cannot adequately reach the teeth and hard palate in
order to articulate sound appropriately or to manipulate the bolus of food during
the initial stages of chewing and swallowing
 A common way of treating this debilitating situation is simply to prosthetically
lower the hard palate area of the denture so the patient can functionally reach it
with the attenuated tongue
 For example, if the patient has had a hemiglossectomy, the opposite portion of the
opposing hard palate can be lowered to improve function.
73

74. 74
[13] Abdulhadi AL-SAMAWI, Laith. (2012). Different Techniques for Palatal Augmentation in Partially Glossectomized Patients. A Report of Two
Cases. Open access scientific reports.

75. REFERENCES 75
1. Bloomer, H. H.: Speech Defects Associated With Dental Malocclusions, in Travis, L. E., editor:
Handbook of Speech Pathology and Audiology, New York, 1971, Appleton-Century- Crofts, Inc., chap.
28, p. 731.
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