Phonetic in complete denture

PHONETICS IN
COMPLETE DENTURE
Dr. SHANNON FERNANDES
II MDS
Dept. PROSTHODONTICS

CONTENTS
1. Introduction
2. Definition
3. History
4. Types of speech
5. Classification of speech
6. S sound and their prosthodontic considerations
7. Phonetics in recording jaw relation
8. Phonetics during trial insertion
9. Prosthodontic implications in denture designs affecting
speech
10. Speech tests
11. Speech analysis
12. Conclusion

DEFINITION
SPEECH:- the act of expressing or
describing thoughts, feelings, perceptions
by articulation of words.
PHONETICS:- the branch of linguistics that
deals with the sounds and their
production, combination , description and
representation by written symbols.

HISTORY
• 1949 SEARS recommended grooving the palate
just above the median sulcus of the patient.
• LANDA suggested the use of S sound to
determine the free way space and M sound to
establish desirable rest position.
• Landa uses labiodentals ( f and V) as an adjunct to
the arrangement of maxillary anterior teeth. He
believes that teeth should be arranged so that
fricatives can be pronounced properly and
naturally.
• He also maintains that proper vertical dimension
is the key to proper pronunciation of s and sh
Allen: improved phonetics in denture construction. J Pros dent. 8 753-763.1958

Allen: improved phonetics in denture construction. J Pros dent. 8 753-763.1958
• 1951 POUND was successful in improving
phonetics by contouring the entire palatal
aspect of maxillary denture to simulate
normal palate.
• 1953 & 1956 SILVERMAN used speaking
methods to measure patients vertical
dimension with and without denture.
• MORRISON suggested the use of sixty six and
mississippi to determine closest speaking
space.

Normal speech depends upon the proper
functioning of five essential mechanisms:
(1) The Motor, consisting of the lungs and
associated musculature of larynx and muscles
which supply the air,
(2) The vibrator, consisting of the vocal cords
which gives pitch to the tone,
(3) The Resonator, consisting of oral, nasal, and
pharyngeal cavities and paranasal sinuses which
create overtones peculiar to each individual,
.

(4) The enunciators or aticuIators, consisting of
the lips, tongue, soft palate, hard palate and
teeth, which form musculoskeletal valves to
obstruct the passage of air, breaking up the tones
and producing the individual speech sounds, and
(5) The initiator, consisting of the motor speech
area of the brain and the nerve pathways which
convey the motor speech impulses to the speech
organs.

• The primary concern in
phonetics is with the changes
in the stream of air as it passes
through the oral cavity.
• Therefore, the enunciators or
articulators are of greatest
interest to us.
• Of these, the tongue plays a
major role.
• The tongue is the principal
articulator of the consonants
and it changes position and
shape for the pronunciation of
each of the vowels.

NEUROLOGIC INTEGRATION
• Factors for speech
production are highly
coordinated, some
sequentially and some
simultaneously by the CNS.
• Speech is a learned
function and requires
adequate hearing, vision,
and normal nervous system
for its full development.

RESPIRATION
• The movement of air in
the respiratory and
expiratory phase is
important in the
production of our
speech

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

RESONANCE
• Sound that is produced by
the vocal cord is modified
by various chambers.
• Resonators are
1. Pharynx
2. Oral cavity
3. Nasal cavity
4. Paranasal sinuses

SPEECH ARTICULATION
• Sound that is produced
is formed into very
meaningful words
• Tongue, lips, palate,
teeth and mandible
play a very important
role in speech
articulation.

TYPES OF SPEECH
• VOWELS : a e i o u they are called voiced sounds.
• 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
• COMBINATION : is blend of consonant and
vowels , articulated in quick succession and
identified as one. Eg. WORD

CLASSIFICATION OF SPEECH
According to Boucher
• Vowels
• Consonants
 Plosives/stops : these sound are produced when
overpressure of 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)
 Fricatives: also called sibilant sounds characterized by
their sharp and whistling sounds when air is squeezed
through the nearly obstructed articulators. Eg. S (so) Z
(zoo)

Afficatives : mix of plosives and fricatives
Eg. Ch (Chin) J (jar)
 Nasal consonants: produced without oral exit
of air. Eg. M (man) N (name) NG (bang)
 Liquid consonants: also called semi vowels.
As the name suggests they are produced
without friction. Eg. R (rose) L (lily)
 Glides: they are sounds characterized by a
gradually changing articulator types.
Eg. W (witch) Y (you)

Classification of CONSONANTS based
on place of their production
1. Palatolingual sounds
2. Linguodental sounds
3. Labiodental sounds
4. Bilabial sounds

PALATAL SOUNDS PRODUCED BY
TONGUE AND HARD PALATE
• S T D L N
• S – the sound ‘s’ as in sixty six is formed by a hiss
of air escaping through the median groove of the
tongue when the tongue is behind the upper
incisor.
• Groove will not always coincide with the median
palatal raphe.
• If groove is deep a whistling sounds when be
heard when pronouncing s
• If groove is shallow s is softened towards sh
(lisping)

Clinical significance
• Thus we can say that sound
‘ s ’ can be used to check the
proper placement of
anterior teeth.
• Also thickness of denture
base can be adjusted in case
the sound S is not produced
correctly
• Denture should be
thickened in proper area
when the depth of the
groove is deep.

• Silverman also use words with S to establish
and check a proper vertical dimension of
occlusion.

• The sound ‘s’ may be distorted to a slushy ‘sh’.
• This results from leakage of air at the lateral
borders of the tongue when the tongue is not
sufficiently confined in the bicuspid region.
This phenomenon, known as stigmatismus
lateralis.

• Rugae area is very Important for production of
these sounds T D N L
• Tongue must be placed firmly against the
anterior part of hard palate for production of
these words.
PALATOLINGUAL SOUNDS PRODUCED
BY TONGUE AND RUGAE

• Therefore…. Should rugae be duplicated in
the denture or no is the question that arises….
• Slaughter says.. The smoothness of the
denture is disturbing and the tongue looses its
capacity for local orientation
• Landa says that rugae is useless or even
detrimental because it adds more bulk to the
denture…

• If teeth too lingual – T will sound like D
• If teeth too forward - D will sound like T

PALATOLINGUAL SOUNDS FORMED BY
TONGUE AND SOFT PALATE
• Consonant k(committee), ng and g (give) are
representative of the palatolingual group of
sounds.
• This 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 and
releasing the air in a puff.

• If the posterior borders are over extended or if
there is no tissue contact k becomes ch
sound.

LINGUODENTAL SOUNDS
• Consonant Th is
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.

• This 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.

• 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.

LINGUOALVEOLAR SOUNDS
• T, D, S, Z, are representative of the
linguoalveolar group of sounds
• 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.

• 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.

• Upper and lower incisors should approach
end to end but not touch.
• Failure indicates a possible error in the
horizontal overlap of the anterior teeth

LABIODENTAL SOUNDS
• F and V 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.

• 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), F will
sound more like a V.

BILABIAL SOUNDS
• B,p and 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.

• 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

PHONETICS IN RECORDING JAW
RELATION
• Also called as the speaking method
• Sibiliant sounds 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 occlusal rims

Clinical significance of ‘S’ sound
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

PHONETICS DURING TRIAL INSERTION
• It is difficult to locate speech problems at the
try-in stage because the tongue and lips do
not react the same with the wax as they do
with the finished and polished denture base.
But to accept the correct vertical dimension,
the patient should be put through a series of
phonetic tests.
Tikrit University College of Dentistry 4th class/reem prosthetic lec-16

1) Evaluation of the "closest speaking space":
Ask the patient to say s,s,s or count from 50 to 60
• a-If the teeth make contact during speech,
indicate that there is not enough interocclusal
distance between the teeth(increase vertical
dimension).
• b-If there is whistling during saying sss, so the
vertical dimension of occlusion may need to be
increased or the position of the anterior teeth
changed.
• c-thickness of palatal area of upper denture may
also affect …

2) Instruct the patient to say "th” as in 33.
The tongue should protrude to occupy the
interocclusal space
• If the interocclusal space is less than 2 – 4 mm
the anterior teeth may be placed too far
anteriorly or the vertical overlap may be so
great that there is insufficient space for the
tongue to protrude between the teeth.

3)Instruct the patient to pronounce "m" rapidly
• The mandible should remain stationary while the
lips contact each other to make sound.
4)Instruct the patient to say "f" or "v” or 55
• To evaluate both the anterior – posterior and
superior – inferior position of the maxillary
teeth.
• a-If the incisal edges of the upper anterior teeth
contact the lingual side of the lower lip, so the
upper anterior teeth are set too far lingually or
the lower anterior teeth are set too far labially.

• b-Difficulty in making contact between the
lower lip and upper teeth usually indicates
that the maxillary anterior teeth must be
moved downward.
• c-The upper teeth are placed too far inferiorly
if the incisal edges depresses the lower lip
when the "f" and "v" sounds are formed.

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. Anteriorposterior positioning of teeth
• 7. Width of dental arch

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

VERTICAL DIMENSION
• Any change in VD, Bilabials are mostly affected
like P B and M
• If both rims touch prematurely it indicates
excessive vertical dimension.
• In try in stage teeth clicking will be heard.

OCCLUSAL PLANE
• Any changed in occlusal plane, Labioldental
sounds like F and V are affected.
• If occlusal plane is too high the correct
positing of the lower lip is difficult
• If the occlusal plane is too low there is overlap
of the lower lip on the labial surface of upper
teeth

ANTERIORPOSTERIOR
POSITIONING OF TEETH
• F and V sounds are
hampered.
• labiopalatal positions of
the teeth is very
Important
• Teeth if placed too
palatally the lower lip
will not meet the
incisal edge of the
upper teeth.

Post dam area
• Palatolingual
consonants are
affected (K,NG and
G)
• Thick post dam areas
will irritate 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

Width of dental arch
• If teeth are set in an arch that is too narrow
the tongue will be cramped
• Consonants like T, D, N ,K and S are affected

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

SPEECH TEST
The speech test should be made after
(1) satisfactory esthetics, (2) correct centric
relation, (3) proper vertical dimension and
balanced occlusion have been attained and
also after wax up for esthetics has been
completed.

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.

TEST 2: TEST OF SPECIFIC SPEECH
SOUNDS
• This is best accomplished 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

S Sh Six, sixty, ships, sailed
Mississippi, sure ,sign, sun,
shine
T D N L Locator, located, tornado, near,
Toledo
Ch J Joe, Joyce, joined, George,
Charles, church
F V Vivacious, Vivian, lived, five,
fifty, five, fifth, avenue

Test 3: TEST OF READING A
PARAGRAPH
• Make the patient read a paragraph containing
abundance of S, Sh, Ch sounds.

PALATOGRAPHY
• Palatography is a group of techniques to
record contact between the tongue and the
roof of mouth to get articulatory records for
the production of speech sounds.
• Palatography is used for speech analysis.

REQUIREMENT FOR MAKING
PALATOGRAM
• Patient with severe gagging must not be used for
making palatograms.
• A uniformly thin artificial palate is constructed of
methyl methacrylate.
• Palate is inserted in mouth and tested for retention and
adaptation.
• The subject has to practice speaking with this palate in
mouth until speech becomes clear.
• The patient should be trained to open his mouth wide
as soon as the desired sounds are pronounced without
contacting the palate and tongue again.

• The tracing material should permit easy
application and must not be distasteful.
• The palate must be thoroughly dried before
applying the material (nonscented talcum
powder) and must have a contrasting colour
for visibility and identification.*
• Activated charcoal and chocolate powder can
also be used.

• A study of the palatograms showed that in
pronouncing the consonants, the primary area of
tongue contact is the alveolar area, and that only a
small portion of the hard palate is involved.
• In a comparative analysis of the ‘s’ and ‘sh ’
palatography ,it was interesting to note that the
rugae area was contacted slightly in some cases and
not at all in others , but that in all cases the entire
posterior alveolar area was always contacted.*
• It was further noted that the rugae area was only
slightly Involved in the pronunciation of the t,
d,n,and l.

SOME PROSTHETIC CONSIDERATIONS
• Older complete denture wearers experience greater
difficulties in adapting their speech to new prostheses and
need longer time to regain their natural speech. A frequent
cause is impaired auditory feedback, and therefore a simple
auditory test might be useful in such patients to make a
proper diagnosis.
• Speech adaptation to new complete dentures normally
takes place within 2 to 4 weeks after insertion. If
maladaptation persists, special measures should be taken
by the dentist or by a speech pathologist.
• When new prostheses have to be made for these patients,
certain difficulties in learning new motor acts may delay
and obstruct the adaptation.

• Consequently, a virtual duplication of the
previous denture’s arch form and polished
surfaces, especially the palate of maxillary
denture, will frequently solve a problem that may
arise due to speech and adaptation difficulties.
• Variation in thickness and or volume of denture
and of the vertical and horizontal dimension of
occlusion may result in unpredictable audible
changes to the voice.
• Patient should be informed about possible effects
of modified or new denture on their new voice.

CONCLUSION
With the increased tendency to arrange
anterior teeth in an irregular mode, dentist
must be aware of the consequences to
phonetic impairment. Therefore, appropriate
measures must be taken to correct phonetic
problems.
Finally, if the speech problem persists in spite
of providing the patient with phonetically
correct dentures, then the dentist must
consider the patient’s level of education.

REFERENCES
• Zarb and bolender: speech consideration with complete denture;
prosthodontic treatment for edentulous patients.
• Robert Rothman; phonetic consideration in denture prosthesis, J Prosthet
dent 1961;11:214-223
• Allen: improved phonetics in denture construction. J Pros dent. 8 753-
763.1958
• Sharry . Complete denture prosthodontics 3rd edi. Phonetics.
• Cheierici, lawson; clinical speech consideration in prosthodontics. J postht
dent; 1973; 29; 1:29-39.
• Meyer M Silverman: the speaking method in measuring vertical
dimention; J Prosthet dent 1953;3: 193-199
• Tikrit University College of Dentistry 4th class/reem prosthetic lec-16
• Middle-East Journal of Scientific Research 12 (1): 31-35, 2012 ISSN 1990-
9233 A Abdullah Al Kheraif and R Ramakrishnaiah
• Indian Journal of Dental Sciences. Speech considerations with complete
denture A Kalra, M Kinra R Fahim review article

Phonetic in complete denture

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