Speech therapy with obturator/ dentistry dental implants

Speech Therapy
with
Obturator
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTION:INTRODUCTION:
 Speech and communication
 VP defects and speech
 Prosthodontist and speech therapist
 Speech therapy protocol

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 .

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)..

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

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

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.”

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

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

 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

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.

 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.

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.

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

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

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

Optimal Speech
Prosthodontist Speech Therapist
PatientParents
CONCLUSION:

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

Speech therapy with obturator/ dentistry dental implants

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