1) Several studies from the 1950s-1970s analyzed how the tongue and speech sounds are impacted by changes in vertical dimension and loss of teeth. Researchers measured palatal pressures and studied how the tongue adapts to different vertical dimensions. 2) Chierici and Lawson identified 7 components essential for normal speech: respiration, phonation, resonance, speech articulation, audition, neurological function, and emotional behavior. They emphasized evaluating each patient's condition thoroughly to provide an optimal prosthesis. 3) Sounds are produced by combinations of the lips, tongue, teeth and palate. Consonant sounds are classified by the involved anatomic structures, such as bilabial or linguoalveolar sounds. Care

1. BY
R.PADMINI RANI
PG TRAINEE
DEPARTMENT OF PROSTHODONTICS
AND CROWN AND BRIDGE

2.  Speech:- Vocalised form of human
communication describing thoughts, feelings,
or perceptions by the articulation of words.
 Phonetics:- The branch of linguistics that
deals with the sounds of speech and their
production, combination, description, and
representation by written symbols.

3.  Meyer M. Silverman (1952) suggested the use of the
speaking method to measure a patients vertical
dimension before the loss of the remaining natural teeth,
and to reproduce this measurement in full dentures at a
later stage.
 Barnett Kessler (1955) analyzed the tongue factor and its
functioning areas in dental prosthesis. He suggested that
comprehension of the tongue function and its operating
area ,in both the buccal cavity and the vestibular space is
a prerequisite in achieving or approaching the ideal dental
prosthesis
 Meyer M.Silverman (1956,) Determination of vertical dimension by phonetics,
J.Prosth. dent., 6:465-47
 An analysis of the tongue factor and its functioning areas in dental prosthesis
Kessler, Barnett Journal of Prosthetic Dentistry , Volume 5 , Issue 5

4.  Anthony K. Kaires (1956) in his article –“ Palatal pressures
of the tongue in phonetics and deglutition” quantitatively
measured the variations in the palatal pressures of the
tongue at definite vertical dimensions.
1. During pronunciation of palatolingual sounds
2.During swallowing.
 It was concluded that the tongue was capable of adapting
itself to the different predetermined vertical dimensions
of occlusion
 Rothman R. “Phonetic considerations in denture prosthesis”. J Prosthet Dent. 1961;
11(2): 214-223
 Palatal pressures of the tongue in phonetics and deglutition Kaires, Anthony K.
Journal of Prosthetic Dentistry , Volume 7 , Issue 3 , 305 - 317

5.  Alexander L. Martone and John W. Black (1962) in his
fifth article in the series of articles titled “An approach to
prosthodontics through speech science” discussed the
speech science research of prosthodontic significance. He
pointed that the loss of teeth alters the articulatory cavity
and affects the speech pattern of the individual.
 Earl Pound (1966) suggested that 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.
 An approach to prosthodontics through speech science Martone, Alexander L. et al.
Journal of Prosthetic Dentistry ,Volume 12 , Issue 3 , 409 – 419
 The mandibular movements of speech and their seven related values Pound, Earl
Journal of Prosthetic Dentistry , Volume 16 , Issue 5 , 835 - 843

6.  George Chierici and Lucie Lawson (1973) studied on the
clinical speech considerations in prosthodontics, from the
perspective of a prosthodontist and speech pathologist.
He considered the various dimensions of speech
production separately. For this seven related functions
and their importance were assessed.
 Respiration Phonation Resonance Speech articulation
Audition Neurological function Emotional behaviour
 He concluded that each patient’s condition should be
thoroughly evaluated so that the prosthesis is able to
provide an optimal environment for its accommodation
and acceptance towards a more natural speech.
Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39

7.  Normal speech depends on proper functioning of
five essential mechanisms
 1. The motor( lungs, associated muscle that
supply the air).
 2. The vibrator ( vocal cord that give pitch to the
tone).
 3. The resonator ( consist of the oral,nasal,
pharyngeal cavity and paranasal sinuses).
 4. The enunciators or articulators( lip, tongue,
palate and teeth)
 5. The initiator( motor area of the brain)

9.  RESPIRATION
 The movement of air in the inspiratory and
expiratory phase is important in production of
speech
 Action is generated from the intercostal muscles
and diaphragm in the complex motor activity
 Ref:- Chierici, Lawson; Clinical speech consideration
in prosthodontics. J Prosthet dent;1973;29;1:29-39

10.  PHONATION
 Air from the lungs courses through the trachea.
 Sound is produced in the larynx
 Vibration of vocal cord takes
place
Ref:- Chierici, Lawson; Clinical speech consideration in
prosthodontics. J Prosthet dent;1973;29;1:29-39

11.  RESONANCE
 Sound that is produced by the vocal cord is
modified by various chamber.
 Resonators are
 pharynx
 oral cavity
 nasal cavity
 Paranasal sinuses
 Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39

12.  SPEECH ARTICULATION
 Sound that is produced is formed into meaningful
words .
 Tongue ,lips ,palate, teeth form musculoskeletal
valves to obstruct the passage of air, breaking up
the tones, and producing individual speech sounds.
 Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39
 Rothman R. “Phonetic considerations in denture prosthesis”. J Prosthet Dent. 1961;
11(2): 214-223

13.  NEUROLOGIC INTEGRATION
 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 initiator is of importance in the neurotic patient or the
patient with a nervous disorder who has apparent difficulty
even though the denture is phonetically correct.
 Such a patient requires careful instruction and practice in
proper enunciation.
 Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet
dent;1973;29;1:29-39

14.  AUDITION
 Chierici and Lawson added a sixth component i.e. audition or
the ability to hear sounds.
 The ability to receive acoustic signals, is vital for normal
speech.
 Hearing permits receptions and interpretation of acoustic
signals and allows the speaker to monitor and control speech
output.
 Compromised hearing can affect speech. Speech development
and subsequent speech therapy is hampered in patients with
hearing impairments.
 Chierici G. and Lawson L. “Clinical speech considerations in prosthodontics: Perspectives of
the prosthodontist and speech

15.  VOWELS: a,e,i,o,u. they are voiced sounds,
 CONSONANTS: may be either voiced
(b,d,g,v,th,z,r,m,n,w) or produced without vocal
cord vibration, in which case they are called
breathed sounds( p,t,k,f,th,sh,s,h)
 COMBINATION: Is blend of a consonant and vowel,
articulated in quick succession that they are
identified as single phonemes.
 Ref- Zarb- Bolender : Speech consideration with complete dentures ;Prosthodontic
treatment For Edentulous Patients

16.  Vowels
 Consonants.
• Plosives/stops (p,b)
• Fricatives (f,v,th,s,z,sh,h)
• Affricatives (ch,j)
• Nasal (m,n,ng)
• Liquid (r)
• Glides (w,u)
Ref-Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment
For Edentulous Patients

17.  Consonant sounds are most important from the dental point
of view. They may be classified according to the anatomic
parts involved in their formation:
(1) Bilabial sounds-formed by lips
(2) Labiodental sounds-formed by lips and teeth
(3) Linguodental sounds-formed by tongue and teeth
(4) Linguoalveolar sounds-formed by the tip of the tongue and
anterior most part of palate
(5) Linguopalatal and Linguovelar sounds-truly palatal sounds
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous
Patients

18.  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.

19. 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

20.  The sounds made when the patient’s lower lip touches
the maxillary incisors are the “f” and “v” sounds.
 A good way to assess this is to have the patient count
from fifty to sixty and watch carefully as the patient
says “fifty-five”.
 If the “v” sound doesn’t come out clearly (usually
sounds like a “b” sound), then the lower lip is not
touching the teeth correctly and a change must be
made to correct this deficiency during the anterior wax
try-in appointment.

21.  If the maxillary anterior teeth is too low, the patient will
struggle to position the lip correctly, it will contact the teeth
prematurely.
 This will create a “f” sound instead of a “v” sound when the
patient says “fifty-five” and it will sound like “fifty-fife” and
the “f” sounds will be somewhat “airy” as the air is forced
unnaturally over the teeth.
 The patient will also generally spew saliva when speaking if
the maxillary anterior teeth are too long.
Maxillary anteriors are
over-long and collide
with the lower lip.

22.  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.
 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.

23.  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 .

24.  T, D, S, Z, V & L are representative of the linguoalveolar
group of sounds
 Formed with the valve 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.
 T, D, N and L word- Rugae area is very important for
the production of these sounds
 Tongue must be placed firmly against the anterior part
of the hard palate for the production of these words
 Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223)

25.  If teeth too lingual – T will sound like D
 If teeth too forward - D will sound like T

26.  Sibilants (sharp sounds) s, z, sh, ch, jh , 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.
 “I went to church to see the judge” this pharse will
determine the relative position of incisal edges but
will not indicate which teeth is incorrect
labiolingually

27.  LINGUOPALATAL SOUNDS FORMED BY TONGUE AND
HARD PALATE
 Word like S, T D N and L belong to this catogory .
 The sound ‘s’ as in sixty six- is formed by a hiss of air
as it escapes form the median groove of the tongue
when the tongue is behind the upper incisor
 If groove is narrow a whistling will be heard when s is
pronounced
 If groove is broad s is softened towards sh (Lisping)
 Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223

28.  Upper and lower incisors should approach end to
end but not touch.
 The minimal amount of space between upper and
lower teeth in this position is called silverman’s
closest speaking space.
 Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet
dent1953;3:

29.  During the production of the Sibilants (“s” or “z”) sounds:
 The anterior and posterior teeth should not collide (no
clicking).There should be no hissing or air loss (not sound
like “th”).
 The closest speaking space should be 1.5 to 3 mm at the
second molar region.
 During ‘s’ sound the interincisal seperation ,VD should
average 1-1.5mm
 If the vertical dimension of occlusion is increased, the teeth
will contact prematurely and give a clicking sound.
 Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment
For Edentulous Patients

30.  Instruct the patient to count from sixty to seventy
to assess the vertical dimension, and carefully
listen to observe the sounds that are made when
the patient says ”sixty-six”.
 The sound may come out a clicking sound , if the
increase is slight
 If the vertical dimension is decreased “th” sound
(sickthy-sikth) will come and the tongue is placed
between the teeth to fill the gap.

31.  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 by “S-POSITION”

32.  Consonant k, ng and g are representative of the
palatolingual group of sounds.
 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 realising the air in a puff.

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

34.  Vowel sounds are produced by the vocal cords
imparting their vibrations to the expiratory column
of air with the tongue and lip position imparting
the overtone structure.
 After the insertion of a prosthesis, the greatest
alteration in the quality of vowel sounds occur in
the front of the mouth .Therefore, rugae should
not be placed on dentures, so that the anterior part
of the denture base can be as thin as possible.
 Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223)

35.  Setting the lower teeth too far lingually crowds the
tongue in the floor of the mouth and makes the
production of vowel sounds awkward.
 When the tongue is broad, as after a prolonged
edentulous period, crowding of the tongue may be
experienced even when the teeth are set in the
correct positions.
 A cross-bite arrangement of the posterior teeth
may be necessary for such patients.
 Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961

36.  In a,e pronounciation the sides of the tongue touch the
molar and premolar teeth and adjoining mucosa.
 In the prevention of stigmatismus lateralis, there is the
need for palatal eminences in the molar and bicuspid
regions.
 A common test utilizing the vowel sound a is useful in
locating the vibrating line for correct placement of the
posterior palatal seal.
 A sound - soft palate raised -valvopharyngeal sphincter
formed - allowing vibrating column of air to pass
through oral cavity - vibrating line demarcated
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet
Dent;1961;11:214-223)

37. PROSTHODONTIC IMPLICATION IN DENTURE
DESIGN AFFECTING SPEECH

38.  Speech detoriated in direct proportion to the thickness of the
palate.
 Front vowels are more affected by palates than back vowels
(I,E )
 Consonants were affected by artificial palates more than
twice as much as vowels.
 Decreased air volume and loss of tongue space in the oral
cavity due to thick dentures.
 Thicker denture base specially at the palate would affect the
clarity of the sounds t,d,s,c,z,r.
 Lisping will occur with the word like s,c,z

39.  Bilabials are mostly affected P B and M
 If both rims touch prematurely it indicated
excessive vertical dimension.
 In try in stage teeth clicking will be heard.

40.  Labiodental sounds 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

41.  F and V sounds are hampered. Labiopalatal
positions of the teeth is very important
 The S sound requires near contact of the upper
and lower incisor teeth so that the air stream is
allowed to escape through a slight opening
between the teeth.
 The whistle and swish sounds are produced
during speech due to air abnormally passing over
the tongue and through the interincisal space

42.  Palatolingual consonants are affected (K, NG
and G)
 Thick post dam areas will irritates the
dorsum of the tongue
 Patient feels nausea like effect while
speaking
 If inadequate the plosive sound of the word
is hampered

43.  If teeth are set into an arch that is too narrow
the tongue will be cramped which affects the
size and the shape of the air channel
resulting in faulty occlusion of the consonant
like d,n,l,s,t.

44.  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.

45.  Two categories
 1) Perceptual / acoustic - Based on broad
band spectrogram, recording by Sonograph
 2) Kinematic movement analysis :
• Ultrasonics
•X-ray mapping
• Cineradiography
• Optoelectronic articulatory movement
tracking
• Electropalatography

46.  Compare previous denture to new one to diagnose
design difference.
 Listen to patient and try to produce the distorted
sound to yourself.
 Soft wax might be useful for necessary
modifications.
 Have patient’s hearing checked.
 If problem cant be solved by dental methods refer
to speech pathologist.

47. 1. Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic
treatment For EdentulousPatients.
2. Chierici, Lawson; Clinical speech consideration inprosthodontics. J Prosthet
dent;1973;29;1:29-39
3. Robert Rothman; Phonetic consideration in dentureprosthesis, J Prosthet
Dent;1961;11:214-223)
4. Meyer M Silverman :The speaking method inmeasuring vertical dimension; J
prosthet dent1953;3:193-199. W.
5.Farley, David & D. Jones, John & J. Cronin, Robert. (1998). Palatogram
Assessment of Maxillary Complete Dentures. Journal of prosthodontics :
official journal of the American College of Prosthodontists.
6. Tanaka, Hisatoshi. "Speech patterns of edentulous patients and morphology
of the palate in relation to phonetics." The Journal of prosthetic
dentistry 29.1 (1973): 16-28.
7.Palatal pressures of the tongue in phonetics and deglutition Kaires, Anthony
K. Journal of Prosthetic Dentistry , Volume 7 , Issue 3
8.Prosthodontic Considerations of Speech in Complete Denture IOSR
Journal of Dental and Medical Sciences Volume 15, Issue 11 ,Nov 2016
9. An analysis of the tongue factor and its functioning areas in dental
prosthesis Kessler, Barnett Journal of Prosthetic Dentistry , Volume 5 ,
Issue 5