speech and it's importance in complete denture patients

SPEECH AND IT’S IMPORTANCE IN
COMPLETE DENTURE
PROSTHESIS
PRESENTED BY,
DR. PRAGATI AGRAWAL

CONTENTS
INTRODUCTION
SPEECH PRODUCTION
SPEECH CLASSIFICATION
VARIOUS SOUNDS
SPEECH ANALYSIS
PROSTHODONTIC
CONSIDERATIONS
ERRORS IN SPEECH
REMEDIAL PROCEDURES
LITERATURE REVIEW
CONCLUSION
BIBLIOGRAPHY
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INTRODUCTION
• Speech is a very sophisticated, autonomous, and unconscious
activity. Its production involves neural, muscular, mechanical,
aerodynamic, acoustic, and auditory factors. As oro-dental
morphological features influence speech, the dentist should
therefore recognize the role of prosthetic treatment on speech
activity.
• Phonetics, the production of speech sounds, can be used as a
guide to the positions of teeth.
• Schlosser and Gehl’said that “correction of speech defects
due to the partial or complete loss of natural teeth in
compliance with phonetic requirements” was the third major
objective for the fabrication of a denture prosthesis.
3
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SPEECH PRODUCTION
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• Rothman lists the following essential mechanisms of
speech production:
1. Initiator -- the motor speech area of the brain.
2. Motor -- the lungs and associated musculature.
3. Vibrator -- expired air from the lungs cause vibrations in
the vocal cords yielding pitch and tone.
4. Resonators -- oral, nasal, and pharyngeal cavities
intensify and enrich the sound.
5. Enunciators -- the lips, tongue, soft palate, hard palate,
and teeth add distinctness and articulation to the speech
sounds.
5
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Rothman R. Phonetic considerations in denture prosthesis. The Journal of Prosthetic Dentistry. 1961 Mar
1;11(2):214-23.

SPEECH
AIRSTREAM
FROM
LUNGS
VOCAL
CORDS,
LARYNX
ARTICULATORS
OR VALVES IN
PHARYNX, ORAL
AND NASAL
CAVITY
TONGUE,
TEETH,
DENTURE
BASE, LIPS
George A. Zarb, Charles L. Bolender et al.; Prosthodontic Treatment for Edentulous Patients:
Complete Dentures and Implant-Supported Prostheses; 13th edition.
STATIC
COMPONENTS: Teeth,
Palate, Alveolus
DYNAMIC
COMPONENTS:
Tongue, Lips, Velum
6
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Yoshida MT. Understanding and Teaching the Pronunciation of English. Yoshida.–
2013.–214 p. 2019.
7
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ACOUSTIC COMPONENTS OF SPEECH SOUND
Palmer JM. Analysis of speech in prosthodontic practice. The Journal of prosthetic dentistry. 1974 Jun 1;31(6):605-14.
8
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Farley DW, Jones JD, Cronin RJ. Palatogram assessment of maxillary complete dentures.
Journal of Prosthodontics. 1998 Jun;7(2):84-90.
9
70 6/3/2020

VARIOUS SOUNDS
1) VOWELS:
• Vowels are voiced sounds; that is, the vocal cords are
activated by vibration in their production.
• They are the free emission of a speech sound through
the mouth and require subglottic pressure for the
production.
• The vowels in English are a, e, i, 0, and u, which
require minimum articulation and are classified
according to the tongue position in the oral cavity and
the position of the lips.
10
a, e, i, o, u
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2) CONSONANTS:
• Produced as a result of the airstream being impeded, diverted, or
interrupted before it is released, such as p, g, m, b, s, t, Y, and z.
11
CONSONANTS
•VOICED
•BREATHED
PLOSIVES
FRICATIVES (SIBILANTS)
AFFRICATIVES
NASALS
LIQUIDS
GLIDES
Complete Dentures and Implant-Supported Prostheses; 13th edition. 6/3/2020
70

12
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PLOSIVES/ STOPS
13
• Produced by stopping
the airflow in the
vocal tract and
releasing the air in an
explosive way.
• Bilabial, linguo-
alveolar, linguo-velar.

FRICATIVES
14
• When air is squeezed through the
nearly obstructed articulators.
Labio-dental
Linguo-dental
Linguo-alveolar
Linguo-velar 6/3/2020
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AFFRICATIVES
15
• A mix between plosive and
fricative.
• Linguo-palatal.
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NASALS
16
• Produced without
oral exit of air.
• Bilabial, linguo-
alveolar, linguo-velar.
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LIQUIDS
17
• Produced without
friction.
• Linguo-alveolar.

GLIDES
18
• Produced by gradually changing
articulator shape.
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BILABIAL SOUNDS
• Contact of the lips.
• B, p, m
• In b and p, air pressure is built up behind the lips and released
with or without a voice sound.
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• Insufficient support of the lips by the teeth or the
denture base.
• Anteroposterior position of the anterior teeth and
thickness of the labial flange.
• An incorrect vertical dimension of occlusion
(VDO) or teeth positioning hindering proper lip
closure.
70
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LABIODENTAL SOUNDS
• F, v
• Between the upper incisors and the labiolingual center
to the posterior third of the lower lip.
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A. Too long (set too far down) -- f sound like a v.
Upper anterior teeth too short (set too high up) -- v sound like an f.
B1. Properly arranged teeth with incisal edge touching the posterior third
of lower lip.
B2. Teeth too far posteriorly.
B3. Upper teeth touch the labial side of the lower lip -- upper teeth too
forward, or the lower anterior teeth too far back in the mouth.
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23
UPPER ANTERIORS
TOO FORWARD
LOWER ANTERIORS
TOO FORWARD
• Upper teeth touch
labial of lower lip.
• Imprints of the labial surfaces of
the lower anterior teeth made in the
mucous membrane of the lower
lip.
• Lower lip tends to raise the lower
denture.
• Upper teeth contact the lingual side
of the lower lip when f and v
sounds are made.
LOWER ANTERIOR
TOO FAR BACK
• Lower lip drops away
from the lower teeth
during speech.
UPPER ANTERIORS
TOO FAR BACK
• Upper teeth contact the
lingual side of the lower
lip when f and v sounds
are made.
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LINGUO-DENTAL
• Tip of the tongue extending slightly between the
upper and lower anterior teeth.
• Closer to the alveolus (the ridge) than to the tip of the
teeth.
• th
24

• About 3mm of tongue not visible – anterior
teeth too far forward or excess vertical
overlap.
• > 6mm of tongue visible – anterior teeth too
far lingual.
Boucher’s Prosthodontic Treatment for Edentulous Patients; 9th edition.
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LINGUO-ALVEOLAR
26
Alveolar sounds:
• t, d, s, z, n, and l
• Produced by the valve formed by
contact of the tip of the tongue
with the most anterior part of the
palate (the alveolus) or the lingual
side of the anterior teeth.
Sibilants and affricatives:
• s, z, sh, ch, and j
• The tongue and alveolus form the
controlling valve.
• The upper and lower incisors
should approach end to end but not
touch. George A. Zarb, Charles L. Bolender et al.; Prosthodontic Treatment for Edentulous Patients:
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• Teeth too far lingually – ‘t’ (as in tend) will
sound like ‘d’.
• Teeth too far labially – ‘d’ sound like ‘t’.
• Also, thick palate of denture base in rugae
area.
27
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A
B
C
A. End to end relationship of lower and upper anterior teeth (proper
horizontal overlap)
B. Lower anterior teeth forward to upper anterior teeth (insufficient
horizontal overlap); vertical lines on vermilion border of upper lip
indicates no lip support
C. Proper lip support with proper horizontal overlap
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PHONETIC PROPERTIES OF ‘S’ SOUND
ARTICULATORY
• The tip of the tongue is placed far forward, coming close to but
never touching the upper front incisors.
• A sagittal groove is made in the upper front part of the tongue,
with a small cross-sectional area.
• The tongue dorsum is flat.
• Normally, the mandible will move forward and upward, with the
teeth almost in contact.
ACOUSTIC
• The comparatively strong sound energy is concentrated to a high-
frequency range, with a steep energy cutoff at about 3 to 4 kHz.
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AUDITORY
• The sound is fairly loud, with a light, sibilant (sharp) quality.
• Both dental and alveolar type of sounds because they are
produced equally well with two different tongue positions, but
there can be some variation even behind the alveolus.
• Most people make the s sound with the tip of the tongue against
the alveolus in the area of the rugae, with but a small space for
air to escape between the tongue and alveolus. The tongue's
anterior dorsum forms a narrow groove near the midline, with a
cross section of about 10 mm2. The size and shape of this small
space will determine the quality of the sound. If the opening is
too small, a whistle will result. If the space is too broad and
thin, the s sound will be developed as a sh sound, somewhat
like a lisp. The frequent cause of undesired whistles with
dentures is a posterior dental arch form that is too narrow.
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LINGUO-PALATAL & LINGUO-VELAR
• The truly palatal sounds (e.g., those in year, she, vision, and onion)
present less of a problem for dentures.
• The velar sounds (k, g, and ng) have no effect on dentures, except
when the posterior palatal seal extension encroaches on the soft
palate.
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METHODS FOR SPEECH ANALYSIS
• Speech pathologist.
• Before prosthodontic rehabilitation.
33
PERCEPTUAL/ ACOUSTIC
ANALYSIS
KINEMATIC METHOD FOR
MOVEMENT ANALYSIS
• Based on a broadband
spectrogram recorded
by a sonograph during
the uttering of different
phrases containing key
phrases.
• Includes such methods as
ultrasonics, x-ray mapping,
cineradiography,
optoelectronic articulatory
movement tracking, and
electropalatography (EPG).
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• EPG is used for registrations of
tongue contact patterns during
speech production and a mapping of
the contacts could be achieved.
34
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35
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36
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37
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Farley DW, Jones JD, Cronin RJ. Palatogram assessment of maxillary complete dentures. Journal of
Prosthodontics. 1998 Jun;7(2):84-90.
38
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PROSTHODONTIC
CONSIDERATIONS
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POSITIONING UPPER ANTERIOR TEETH
• As briefed by Robinson, while pronouncing
‘5’, ‘55’, ‘f’, ‘v’ sounds, incisal edges of
maxillary central incisors should touch the
vermilion border of lower lip (wet and dry
line). This is called as ‘f’position.
• Also, ‘f’, ‘v’ sounds determine the occlusal
plane.
• While pronouncing ‘3’, ‘33’, there should be
enough space for the tip of tongue to protrude
through the incisors.
• While pronouncing ‘emma’, ‘Mississippi’,
upper and lower teeth should not contact.
40
Al Kheraif AA, Ramakrishnaiah R. Phonetics related to prosthodontics. Middle-East J. Sci.
Res. 2012;12(1):31-5.
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POSITIONING LOWER ANTERIOR TEETH
• Incisal edges of lower 4 incisors should be slightly lingual
to the labial incisal edges of upper incisors with a space of
1-1.5mm while pronouncing ‘s’, ‘z’. This is called as ‘s’
position.
41
POSITIONING POSTERIOR TEETH
• Enough space should be provided for dorsum of the
tongue to make contact with the palatal surfaces of
upper posterior teeth while pronouncing ‘t’, ‘d’, ‘s’, ‘n’,
‘k’, ‘c’ sounds.
• Narrow arch – cramped tongue
Kalra¹ A, Fahim MK. Speech considerations with complete denture.
Al Kheraif AA, Ramakrishnaiah R. Phonetics related to prosthodontics. Middle-East J. Sci. Res.
2012;12(1):31-5.
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DETERMINING CLASS OF OCCLUSION
42
Pound E. Utilizing speech to simplify a personalized denture service. Journal of
Prosthetic Dentistry. 1970 Dec 1;24(6):586-600. 6/3/2020
70

Pound E. Utilizing speech to simplify a personalized denture service. Journal of Prosthetic
Dentistry. 1970 Dec 1;24(6):586-600.
43
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CLASS III OCCLUSION
• If there is no distal movement from ‘s’
position.
• In these patients, the vertical dimension
of occlusion would be 1.5 mm. less than
the “S” dimension and directly vertical
from the lower incisal edge.
CLASS II OCCLUSION
• If there is distal movement of anterior
teeth more than 3mm from ‘s’ position.
CLASS I OCCLUSION
• If there is only 2-3mm of retrusion.
44
Pound E. Utilizing speech to simplify a personalized denture service. Journal of
Prosthetic Dentistry. 1970 Dec 1;24(6):586-600. 6/3/2020
70

RECORDING MAXILLO-MANDIBULAR
RELATIONSHIP
• Silverman’s closest speaking space measures the
vertical dimension as the patient says ‘s’.
• Vertical dimension at rest measured by pronouncing ‘m’
(unstrained appearance of lips).
• Clicking teeth in increased vertical dimension during
‘ch’, ‘j’, ‘s’, ‘z’ sounds.
45
Kalra¹ A, Fahim MK. Speech considerations with complete denture.
Res. 2012;12(1):31-5. 6/3/202070

DURING TRY-IN
• ‘33’– enough space between anterior teeth for thrust of
tongue.
• ‘emma’– no contact of teeth.
• ‘55’-- incisal edge of the maxillary central incisor should
contact the vermillion border of the lower lip at the
junction of the rough and smooth mucosa without tooth
interference posteriorly.
• ‘Mississippi’– no contact of teeth.
46
Res. 2012;12(1):31-5. 6/3/202070

RELATED TO DENTURE THICKNESS
• Palatal rugae and incisive papilla area.
• Tongue space at posterior region of palatal surface.
• According to Slaughter, smoothness of the denture gets
disturbed and without producing rugae at anterior part
of hard palate, the tongue loses its capacity for
orientation. This is because while pronouncing palato-
lingual sounds, tongue must be placed firmly against
anterior part of the palate.
• Thick border at PPS area or posterior edge finished as a
square instead of chamfer can also affect speech
(‘I’,‘e’,‘k’,‘g’).
47
Res. 2012;12(1):31-5. 6/3/202070

SPEECH PROBLEMS AT THE TIME OF DENTURE
DELIVERY
• 2 REASONS:
i. The tongue and lips interact in a different manner
with wax (used during the trial stage) compared
with the finished dentures.
ii. Copious salivary flow often associated with
insertion of new dentures.
48
Res. 2012;12(1):31-5. 6/3/202070

49
1. Whisteling ‘s’:
• The anterior part of the
tongue is obstructed by
the upper premolars
making a groove too
large for the escape of
air.
2. Lisping ‘s’:
• The air space is too small
thus the palatal part of the
denture must be made
thinner.
3. Indistinctive ‘th’ and ‘t’:
• Inadequate inter-occlusal
space or the anterior
teeth are too far lingual.
4. Indistinctive ‘f’or ‘v’:
• Vertical or horizontal
placement of upper
incisors.
Res. 2012;12(1):31-5. 6/3/2020
70

OTHER PROSTHODONTIC CONSIDERATIONS
• Listen to and analyze patients' speech sounds before the
rehabilitation starts and inform patients that temporary
speech sound deterioration may result from the treatment.
• Speech adaptation to new complete dentures: within 2 to 4
weeks after insertion
• Long experience of denture wearing – difficulty in learning
new motor acts. So, duplication of denture considered.
• Study the profile form and lip line of patient’s face, as a
guide in anterior teeth inclination.
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ADAPTATION TO COMPLETE DENTURES...???
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51
Auditory and oro-sensory feedbacks during
function.
Only the patient will be aware of remaining articulatory difficulties,
which often are related to certain specific sound.
Sensory stimulation from orofacial afferents to central areas.
Finally, if the process of adaptation proceeds, the patient will not be
aware of any articulatory difficulties or distortional sounds caused by
the prosthesis.
George A. Zarb, Charles L. Bolender et al.; Prosthodontic Treatment for Edentulous Patients: Complete Dentures
and Implant-Supported Prostheses; 13th edition.

IMPLANT PROSTHODONTICS
• Mandibular implant prosthesis – better comfort, stability,
satisfaction and mastication, but no significant difference in
speech than conventional denture.
• Speech problems with maxillary fixed implant prosthesis within
first several weeks after delivery and may continue over several
months.
• In maxillary edentulous patients who receive an immediate loaded
implant-supported prosthesis after wearing a denture for a long
period, the patient should be informed about the possibility of a 3
to 6 months speech adaptation period.
• In a within-subject crossover study, maxillary implant
overdentures with and without palates enabled patients to produce
more intelligible speech than fixed prostheses, especially for stops
and fricatives, but not for vowels.
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ERRORS IN SPEECH
53
Palmer JM. Analysis of speech in prosthodontic practice. The Journal of prosthetic
dentistry. 1974 Jun 1;31(6):605-14. 6/3/2020
70

Journal of Prosthodontics. 1998 Jun;7(2):84-90.70 6/3/2020
54

GENERAL REMEDIAL PROCEDURES
• Remodelling the rugae or papilla to match the lingual
sulcus.
• Adding bulk to the denture base in resorbed ridge
areas or removing the extra bulk from denture bases.
• Placing a roughened spot in incisive papilla region
for proper positioning of tongue.
• Remodelling of molar area in manbibular dentures.
Palmer JM. Analysis of speech in prosthodontic practice. The Journal of prosthetic
dentistry. 1974 Jun 1;31(6):605-14. 6/3/202070
55

LITERATURE REVIEW
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• By recording and interpreting certain mandibular movements of
speech, the patient reveals seven informative facts that are
directly related to restoring the original mandibular tooth
position, phonetic sharpness, and occlusal harmony:
(1) the vertical overlap
(2) horizontal overlap
(3) former lower anterior tooth display
(4) former class of occlusion
(5) maximum usable vertical dimension
(6) an accurate index for incisal guidance
(7) the maximum serviceable cusp height.
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5757

Which mandibular movements to record?
• The lower teeth must move downward out of their centric
occlusal position. This movement must be sufficient to
prevent any tooth contacts during speech.
• When repeatedly pronouncing the letter “S,” the mandible
assumes its most forward speaking position, and the
anterior teeth are in their most intimate relation with one
another. At this time, the incisal edges of the lower teeth
involuntarily are placed slightly lingually and below the
incisal edges of the upper teeth, with a space of about 1.0
mm. between them.
58
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58

Physiologic/
Impression Wax
Waxed contour of
palate
Plaster key on
contoured palate
Autopolymerizing
reline material
Plaster key over
reline material
Final finished and
polished palatal
contour
S curve in sagittal
plane anteriorly
S curve in frontal
plane posteriorly
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60
To investigate (1) changes in the speech patterns of patients with new
complete dentures before and at various times after insertion of the new
dentures and (2) any relationship between speech production and the
palatal contour of the denture.
• Most of the patients showed speech improvement when the dentures were
first inserted.
• With increased length of time of wearing the new dentures, the speech
intelligibility was improved.
• Acoustic distortions occurred more frequently in the s, sh, ch, zh, and j
sounds than in the z, t, n, d, and 1 sounds.
• The ‘s’ sound is a poor prognostic sound for intelligibility of speech.
• The palatal ridge formation (palatal contour) of complete dentures affects the
acoustic distortion of affricative and fricative sounds.
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The inclination angle of central incisor blocks in duplicate
complete maxillary dentures was changed in a range of –30
degrees to +30 degrees from the original position (0
degrees). Test words and sentences were acoustically
analyzed.
• The change of incisor block angle in both directions usually
caused a poorer execution of the /s/ sound.
• The labial angulation seemed to have a greater effect than the
palatal angulation.
• Immediate phonetic adaptation of prosthetic restorations in the
maxillary incisor region can be achieved only if the original
position of the natural teeth is transferred to the denture.
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Zaki Mahross H, Baroudi K. Spectrogram analysis of complete dentures with different thickness and
palatal rugae materials on speech production. International journal of dentistry. 2015;2015.

SPEECH IN CLEFT PALATE
The deviant speech characteristics associated with impairment to
the velopharyngeal valve includes four chief stigmata:
i. Hypernasality
ii. Nasal air emission
iii. Weak pressure consonants
iv. Compensatory articulation
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• Pharyngeal stop
• Mid-dorsum palatal
stop
• Posterior nasal fricative
Trost JE. Articulatory additions to the classical description of the speech of persons with cleft palate.
The Cleft palate journal. 1981 Jul 1;18(3):193-203.

SUMMARY
• Speech difficulty as a sequel of oral rehabilitation with
complete dentures is generally a transient problem.
• As Bloomer said, “. . . surgeons and dentists who have
labored carefully and skillfully to fashion or restore
anatomical form are frequently disappointed to find that
anatomical form is no guarantee of function.”
• Therefore efforts should be made to avoid them by pre-
treament records or assessment of speech and provision of
information to patients about likely initial deviations from
normal speech immediately after the oral rehabilitation.
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SUMMARY
• If difficulties persist for more than 2 to 4 weeks, it is
recommended that the dentist follow this protocol:
1. If the patient has a previous complete denture experience,
compare the new set with the old one to diagnose possible
design differences of significance for speech production.
2. If, on the other hand, a remaining natural dentition is to be
converted into a complete denture, a transfer of the original
position of the natural teeth to the denture should facilitate
adaptation.
3. Listen to the patient and then try to produce the very same
distorted sound yourself. Observe the position of your own
articulatory structures. and transform them to the patient.
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4. Make the necessary modifications; soft wax might be
helpful.
5. Have the patient's hearing checked. An auditory deficit
will prolong the adaptation period and render it more
difficult.
6. If the reported/perceived problem cannot be resolved by
dental methods, the patient should be referred to a speech
pathologist.
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SUMMARY
George A. Zarb, Charles L. Bolender et al.; Prosthodontic Treatment for Edentulous Patients: Complete
Dentures and Implant-Supported Prostheses; 13th edition.

BIBLIOGRAPHY
• George A. Zarb, Charles L. Bolender et al.; Prosthodontic Treatment
for Edentulous Patients: Complete Dentures and Implant-Supported
Prostheses; 13th edition.
• Boucher’s Prosthodontic Treatment for Edentulous Patients; 9th
edition.
• Goyal BK, Greenstein P. Functional contouring of the palatal vault
for improving speech with complete dentures. The Journal of
prosthetic dentistry. 1982 Dec 1;48(6):640-6.
• Goodbole S, Phakan J, Kale S. Prosthodontic Considerations of
Speech in Complete Denture. JDMS. 2016;15(11):41-.
• Kalra¹ A, Fahim MK. Speech considerations with complete denture.
• Palmer JM. Analysis of speech in prosthodontic practice. The
Journal of prosthetic dentistry. 1974 Jun 1;31(6):605-14.
6/3/202070
67

BIBLIOGRAPHY
• Yoshida MT. Understanding and Teaching the Pronunciation of
English. Yoshida.–2013.–214 p. 2019.
• Tanaka H. Speech patterns of edentulous patients and morphology
of the palate in relation to phonetics. Journal of Prosthetic Dentistry.
1973 Jan 1;29(1):16-28.
• Pound E. The mandibular movements of speech and their seven
related values. The Journal of prosthetic dentistry. 1966 Sep
1;16(5):835-43.
• Runte C, Lawerino M, Dirksen D, Bollmann F, Lamprecht-
Dinnesen A, Seifert E. The influence of maxillary central incisor
position in complete dentures on/s/sound production. The journal of
prosthetic dentistry. 2001 May 1;85(5):485-95.
• Farley DW, Jones JD, Cronin RJ. Palatogram assessment of
maxillary complete dentures. Journal of Prosthodontics. 1998
Jun;7(2):84-90.
6/3/202070
68

BIBLIOGRAPHY
• Pound E. Utilizing speech to simplify a personalized denture
service. Journal of Prosthetic Dentistry. 1970 Dec 1;24(6):586-600.
• Al Kheraif AA, Ramakrishnaiah R. Phonetics related to
prosthodontics. Middle-East J. Sci. Res. 2012;12(1):31-5.
• Zaki Mahross H, Baroudi K. Spectrogram analysis of complete
dentures with different thickness and palatal rugae materials on
speech production. International journal of dentistry. 2015;2015.
• Rothman R. Phonetic considerations in denture prosthesis. The
Journal of Prosthetic Dentistry. 1961 Mar 1;11(2):214-23.
• Trost JE. Articulatory additions to the classical description of the
speech of persons with cleft palate. The Cleft palate journal. 1981
Jul 1;18(3):193-203.
6/3/202070
69

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