PHONETICS IN COMPLETE DENTURE PROSTHESIS

CONTENTS

 INTRODUCTION

 ANATOMY OF THE LARYNX

 MECHANISM OF SPEECH PRODUCTION

o RESPIRATION

o PHONATION

o ARTICULATION

 VOWELS

 CONSONANTS

o RESONANCE

o NEURAL INTEGRATION

 PROSTHETIC CONSIDERATION

o OTHER CAUSES OF SPEECH DEFECT

o METHODS OF SPEECH ANALYSIS

o SUMMARY AND CONCLUSION

o REFERENCES

INTRODUCTION

 Human beings are the only creatures blessed by god with the unique gift of speech.

 Communication between animals may take place through the sense of touch or smell.however
the audible signals are perhaps the most efficient means of communication making the humans
superior than all.

 Speech may be described as the production of the sound by the larynx(phonation) and its
modification by the resonance of air within various spaces between the larynx and the
lips(articulation).Before discussing the mechanism of speech it is important to make clear a few
fundamentals about the physics of sound.

 Sounds vary in loudness-amplitude of vibrations of the source of sound may vary.

 Variations in pitch-ears interpretation of the variation in frequency of vibration.
 Variations in quality-eg:differences between sounds of different musical instruments.
 Duration is the fourth way that sound varies.

 Resonance-sound waves of a particular pitch are conveyed through a medium,specially air,meet

a structure or cavity whose natural frequency of vibration is the same as that of sound,it too will begin
to vibrate.

 A feeble sound may b re-inforced if it succeeds in causing a large structure to vibrate or

resonate.

ANATOMY OF LARYNX

 The larynx is situated in the anterior midline extending from the root of the tongue to the trachea.

 The length of the larynx is about 44mm in males and 36mm in females.

 The larynx is made up of a skeletal framework of 9 cartilages :

3 paired and 3 unpaired

 The unpaired cartilages are -Thyroid, Cricoid, Epiglottic

 Paired cartilages are- Arythenoid, Corniculate, Cuneiform

CAVITY OF THE LARYNX

Within the cavity of the larynx, there are two folds of mucous membrane on either side.

 UPPER FOLD-VESTIBULAR FOLD-OR-FALSE VOCAL CORDS

 LOWER FOLD-VOCAL FOLD

Space between the vestibular fold is known as Rima Vestibuli and the space between the vocal folds
is known as Rima Glottidis.
The vocal fold is attached anteriorly to the middle of inner aspect of thyroid cartilage and posteriorly to
the vocal process of arytenoids cartilages.

MECHANISMS OF SPEECH PRODUCTION

 Respiration
 Phonation
 Articulation
 Resonation
 Neurologic Function
RESPIRATION

 The movement of air in the inspiratory and expiratory phases is essential to the production of
sound.

 At the beginning of inhalation,the nostrils dilate to facilitate the intake of air.this air passes
through the nares,nasal cavity,nasal and oral pharynx and larynx.

 The soft palate is relaxed to provide a free passage way and the pharynx is widely opened.air
passes through the open rima glottides of the larynx into trachea,bronchi and then into the lungs.

 In general this process is reversed in exhalation.in speech the regular rhythm of inspiration and
expiration is disturbed.

 With inspiration occurring rapidly at the end of sentencesor at pauses between end of
sentences;and expiration is prolonged to last from pause to pause.

 Speech is directly related to expiration and not to inspiration.

PHONATION

 Voice has generally been thought to be caused by the passive vibrations of the vocal cords by the
current of expired air impinging upon them.

 During part of each vibration, the inner edge of the cords will be in contact thus closing the air space
altogether,then the cords are blown apart but their elasticity forces them together again and so the cycle
continues.

 The expired air escapes as a series of rapid puffs, the number of puffs being the same as the number
of vibrations of the vocal cords.

 Such changes of pressure in the expired air represent a sound.

 The vibration of the cords is mostly horizontal-max-4mm and only slightly vertical(0.2-0.5mm).
consequently each point on the cord describes an ellipse with the long axis horizontal and the short
axis vertical.

 The first essential for phonation is that the cords must be sufficiently close together to touch during
part of their vibration

 Rotating the arytenoids cartilages medially by means of contraction of transverse arytenoids and
lateral cricothyroid muscles brings about this action.

 The reverse effect of separating the cords and widening the space between them is carried out by
contraction of the posterior cricoarytenoids which rotate the arytenoids laterally.

 Changes in the pitch of voice

 Firstly,frequency of vibration of cords,

contraction of muscles within the cords(part of the thyroarytenoid)increases their tension because
their attachments are prevented from moving inwardsby the action of other muscles of larynx.
Contraction of posterior cricoarytenoids host the arytenoids cartilages at a fixed point and the
infrahyoid group perform a similar function for the anterior attachment.

 Secondly, the cords are also changed in shape so that the thickness of the parts of the cord in
contact is varied.
 Sometimes the edges are thin and sharp pointed at other times thick and well rounded.
 Cords lengthen and pitch increases their lengthening is achieved by tilting the front of the cricoid
cartilage up and the back of it down so that the posterior and anterior insertions of the cords are put
further apart or a similar effect but in the reverse direction is produced by tilt of the thyroid cartilage.

 Thirdly, further increase in tension are brought about by increasing the strength of contraction of the
external laryngeal muscles so that they merely do not hold the attachment but actually pull on them
outwards.
 Therefore the energy of these muscles is used to increase the tension of the cords which in turn
increases their rate of vibration.

 The fourth factor that alters the pitch of the voice is the air pressure.Iif the air pressure is raised by a
more forcible expiration, the pitch and the loudness of the sound increases.

 LOUDNESS
Increased pressure of expired air is the chief factor which increases the loudness of speech.
In low intensities of the voice,the time taken for abduction(outward excursion)of cords is shorter than
for adduction(return to midpoint)
But when the voice is loud the reverse is true.
With low intensities the glottis is not closed for as long or as firm as for high intensities.

RESONATION AND ARTICULATION

Resonation takes place in the prime resonating chambers.they are

 Nasal cavity
 Oral cavity
 Pharyngeal cavity
The oral chamber may be divided into the following spaces any or all of which may take part in the
resonation of sound.
 Between the dorsum of tongue and posterior surface of hard palate.
 Between the dorsum of tongue and anterior surface of hard palate.
 Between the tip of the tongue and the teeth
 Between the teeth and the lips
Nasal cavity is used as the primary resonating chamber for only 3 english sounds M,N and ng as in
song,rang,etc.
The choice of the chamber is made by placement of soft palate.
When the soft palate contracts against the pharyngeal wall,the oral cavity becomes the resonating
chamber and when it contracts against the tongue,nasal cavity is the resonating chamber

ARTICULATION
It is accompanied by the teeth tongue lips and palatewhich break up the sound as the air stream
emerges.the lips and tongue being the only movable factors.
Vowels – A,E,I,O,U.
Vowel sounds are produced when the air stream vibrates the adducted vocal cords with resonation
playing its part.
The space that extends upwards and forwards from the vocal folds and particularly forwards from the
pharynx can be divided by humping the tongue. The hump may be far in front as in saying “e” or far
back as in “oo”(tooth)
This space can be further altered in size by raising or lowering the mandible.
It has been found that the vowels consist of sounds having a fundamental note which varies from
vowel to vowel and also depends on the quality of each particular voice and two main harmonics
which may be of unequal loudness.this is known as the double resonance theory.
In the vowel sounds the lower of the two pitches is produced by resonance in the pharynx and the
upper by the mouth resonance.

POSITIONS OF ORAL RESONATORS

In pronouncing the “ah” the positions of the oral structures seem unimportant. The characteristic
feature is the narrowing of the space between the epiglottis and the pharyngeal wall.the wide opening
of the mouth accentuates all the overtones.
In the vowel sound in “see”,“set”,“sit”,the pharynx is widened and the tongue is arched in the middle
and closely follows the shape of the hard palate.
The “u” of “muff” is associated either with a flat tongue or with a slight arching at the back.
The throat cavities are constricted in “aw” and “oo” sounds and the lips play a part in differentiating
these vowels.

Consonants
Consonants are produced by an interruption of the passage of air through the pharynx or mouth,by the
tongue,teeth or lips before being released.
Consonants may be voiced or produced without vocal cord vibration in which case they are called
breathed
For example: “b” is voiced and “p” is breathed.
“z” is voiced and “s” is breathed.

CLASSIFICATION OF CONSONANTS
I They are classified depending on their characteristic production and use of different articulators and
valves.
PLOSIVE-are produced when an overpressure of air has been built up by contact between the soft
palate and the pharyngeal wall and released in an explosive way.
Example: P and T, B and D, G and K.
FRICATIVES-also called as sibilants.
Characterized by their sharp and whistling sound quality-these are created when air is squeezed
through the nearly obstructed articulators.
Example:S and Z, F and V, and th.
AFFRICATIVES-these consonants are a mix between plosive and fricatives as in –they require only a
partial stoppage of the air like the fricatives but also require the rapid release of air like the plosives.
Example: “ch” and “j”.
NASALS-produced without oral exit of air
Example: “M”, “N” and “ng”.
LIQUID-consonants as the name implies are produced without friction.
Example: “L” and “R”.
GLIDES- sounds characterized by gradual changing articulator shapes
Example: “W” and “Y”.
II Another method of classifying the consonants are according to the structure which cause the
interruption of the current of expired air.
1. BILABIAL SOUNDS
Made by contact of the lips.
Insufficient support of the lips by the teeth.
Improper anteroposterior positioning of the teeth cause these sounds to be defective.
Example: “B” “P” “M”.
In “B” and “P”, air pressure is built up behind the lips and released with or without a voice sound.

2. LABIODENTAL SOUNDS
Made between the upper incisors and the labiolingual center to the posterior third of the lower lip.

3. LINGUODENTAL SOUNDS
These sounds are made with the tip of the tongue extending slightly between the upper and lower
anterior teeth.
Example: “th” in this.

4. LINGUOALVEOLAR SOUNDS
Made with the valve formed by the contact of the tip of the tongue with the most anterior part of the
palate or the lingual side of the anterior teeth.
Example: “T”, “D”, “S”, “Z”, “V”, “L”, “J”, “ch”, “sh”.
The sibilants-“S”, “Z”, “sh”, “ch” and “J” are alveolar sounds because the tongue and alveolus forms a
controlling valve.
When pronouncing these sounds the upper and lower anteriors should approach end to end but should
not touch.
The “s” sound is an important one as it is said to cause the most number of prosthodontic problems.
The “s” sound is heard when 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 of the tongue with a small cross-sectional area.
The tongue dorsum is flat and contacts the lateral surface of the palate
The mandible is depressed and slightly protracted until the incisal separation of 1-1.5mm is obtained.
The “S” sound is considered dental and alveolar speech sound because they are produced equally well
with two different tongue positions.
With the tip of the tongue against the alveolus in the rugae area, a small space is formed from where
the air escapes.
The size and shape of this small space will determine the quality of the sound.
Part of the sibilant sound is generated when the teeth are being hit by a concentrated air jet.
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 an “sh”, some what like a lisp.
Therefore creating of a sharp “s” requires accuracy of the neuromuscular control system for the
creation of the groove and the directioning of the air jet.

5. LINGUOPALATAL SOUNDS
Truly palatal sounds
Example: those in year, she, vision and onion.

6. LINGUO UVULAR SOUNDS

Like “K” “G” “ng”.

NEURAL INTEGRATION

 A very complex and imperfectly understood neurophysiological mechanisms govern the

production.
 Movements of the cords require such precision thatfeedback control is very important.
 The afferent side of thr reflex feedback arises partly from the mucosal mechanoreceptors and
mostly from corpuscular nerve endings in the joints of the larynx.
 These nerve endings are capable of rapid adaptations to changes in stress in joint capsule.
 Laryngeal muscles are thought to contain a small number of primitive muscle spindles and a larger
number of spiral nerve endings presumably controlled by stretch reflexes,the tone of the muscles.
 The principal motor nerves for the muscles of speech are
o trigeminal nerve(mandibular division) innervates the muscles of soft palate.
o facial nerve innervates the muscles of the periphery of the mouth
o glossopharyngeal nerve innervates the muscles of pharynx.
o vagus nerve innervates the muscles of soft palate, larynx and pharynx.
o hypoglossal nerve innervates muscles of the tongue.
 The motor innervation involved is derived from three pathways-
o the corticobulbar pathway which permits the conscious control of precise movements
required.
o Example: articulation of speech
o The extrapyramidal pathway which also conveys certain voluntary impulses as well as
control of muscle tonus.
o Cerebellar pathway from cortex to speech muscles the route of automatic coordination.
PROSTHETIC CONSIDERATIONS

 Speech problems are usually identified immediately following prosthetic treatment.

 When compared to younger individuals, elderly complete denture wearers experience greater
difficulty in adapting their speech to new prostheses and also need a longer time to regain their natural
speech.
 A frequent cause is impaired auditory feedback.
 It is important to listen to and analyse the patients speech sounds before the rehabilitation starts and
even more important to inform patients that the temporary speech sound deterioration may result from
the oral rehabilitation treatment.
 Speech adaptation to new complete dentures normally takes place within 2-4 weeks after insertion.
 If the maladaptation persists, special measures should be taken by the dentist and if the problem
continues by a speech pathologist.
 During the fabrication of dentures, certain guidelines must be followed in order to achieve clarity of
speech.

Effect of denture thickness and peripheral outlines

 One of the reasons for loss of tone and incorrect phonation is the decrease of air volume and loss of
tongue room in the oral cavity from unduly thick denture bases.
 Especially in the palatal region because here no loss of natural tissue has occurredthe production of
palatogingival group of sounds involve contact between the tongue and either the palate, the alveolar
process or the teeth
For example:consonants like”t” and “d” where the tongue makes firm contact with the anterior part
of the hard palate and is suddenly drawn downwards producing an explosion sound.
 Therefore any thickening of the denture base in this region may cause incorrect formation of these
sounds.
 When producing the SCZRL consonant sounds, where contact occurs between the tongue and the
most anterior part of the hard palate including the lingual surfaces of the upper and lower incisors with
the creation of the slit like channel between the tongue and the palate through which air hisses.if the
artificial rugae are over pronounced or the denture base too thick in this area,a noticeable lisp may
result.
 The periphery of the denture must not be overextended so as to encroach upon the movable tissues
since the depth of the sulci will vary wit the movements of the tongue, lips amd cheek during
phonation. Any interference with the freedom of these movements may result in indistinct speech
especially if the function of the lips is hindered.
 Allen in 1958 found that an additional thickness of even 1mm in the anterior palatal area made
speech awkward and indistinct.
 A denture which has a thick base in the post dam area or that edge is finished square instead of
tapering will probably irritate the dorsum of the tongue impeding speech and probably producing a
feeling of nausea.
 Errors of denture construction in this area involve vowels like “I” and “E” and palatolingual
consonants like “G” “ng” “K”.
 If the post dam seal is inadequate the denture becomes unseated during the formation of those sounds
having an explosive effect, requiring the sudden repositioning of the tongue to control and stabilize the
denture. Therefore the denture base must be kept thin and the borders extended only until the
physiological limits dictated by the functioning of the tissues.
 If the lingual flange of the lower denture is too thick in the anterior region, it will encroach on the
space needed by the tongue and this results in faulty production of “s” sound.

EFFECT OF TOOTH POSITION ON SPEECH

 If the lower anterior teeth are arranged to lingually the tongue is forced to arch itself up to a higher
position and the airway is to be too small and there will be faulty pronunciation in “S” and“two sound
lisps”.
 If the upper anteriors are placed too far lingually the contact of the lower lip with the incisal and
labial surfaces will be difficult which will hamper the pronunciation of the “f “v” and “ph” sounds.
 If the occlusal plane is set too high, correct positioning of the lower lip may be difficult and the
sound “v” will be pronounced like”f”.
 If the plane is too low, the lip will overlap the labial surfaces of the upper teeth and the sound “f”will
be pronounced as “v”.
 These labiodental sounds “f” and “v” are helpful in determining the anteroposterior positioning of
the upper incisors and occlusal plane.

Effect of vertical dimension on speech

 Formation of the bilabials like “P” “B” and “M” require that the lip make contact to check the air
stream. With “P” and “B” the lips part quite forcibly so that the resultant sound is produced with an
explosive effect whereas in “m” sound the lip contact is passive. For this reason “m” can be used as an
aid in obtaining the correct vertical height since a strained appearance during lip contact or the inability
to make contact indicates that the bite blocks are occluding prematurely.
 With “C” “S” and “Z” sounds the teeth come very close together(interincisal distance is 1-1.5).
Therefore if the V.D. is excessive the dentures will contact the and the patient will complain of
clicking of teeth.
 Fymbo(1936) pointed out that defective speech is most frequently associated with increased vertical
dimension and may result in difficulty in pronouncing sounds like “B”“M” “P” “F” “V”.
 Landa(1947)recommends various phonetic tests to determine proper vertical dimension using sounds
like “S” “C” “Z”.
 Silverman(1956)stated that sibilant sound “S” can be used as a means for determining the correct
vertical dimension. He established the “closest speaking space” and used this as clearance area
between the dentures.
 whistle and swish sounds-in 1967, silvermann stated that the whistle and swish sounds are produced
during speech due to air abnormally passing over the tongue and interincisal spaces.]
 These sounds may be caused due to decreased overjet.
Effect of denture esthetics on speech-speech is sometimes related to emotional attitudes towards
denture esthetics.
 Lawson(1973) stated that when there is any change in the patients mouth, then there will be an
anxiety reaction.Some patients who are dissatisfied with their teeth appearance in the denture
overcome this problem by the abnormal movement of the lips, jaws and tongue during speech.

OTHER CAUSES OF SPEECH DEFECTS

 Congenital or acquired palatal defects. Example: cleft palate

 Malocclusion is an obvious cause of speech defects
 Severe open bite leads to defective pronunciation of consonants “F” “V” “P” “B” “M” because upper
anteriors fail to articulate with the lower lips.
 Difficulty in pronouncing “S” and “Z” with severe open bite will be due to amount of air escaping
between hard palate and the tip of tongue will be larger.
 Recessive mandible is another dental defect which affects normal pronunciation of sounds like “P”
“B” M” “S” “th”.
 Macroglossia leads to lisping of consonants
 Respiratory problems also cause defects in speech.

Speech Test:
 Phonetic tests should be made at the time of try in. Speech test should follow after satisfactory,

1. esthetics

2. correct centric relation

3. proper vertical dimension

4. balanced occlusion

1st Test: Random Test

Engage patient in conversation and obtain a subjective speech analysis by asking the patient

how he feels, how his speech sounds to him.

2nd Test:

Words to be tested;

1. S & Sh : Sign, ship, six, mississippi, sure

2. T, d, N, L: Tornado, near, Locator

3. Ch, J : Joe, Joined, charles, church.

4. K : Committee, Convention.

5. F, V : Vivacious, fifty five

3rd Test:

Patient asked to read a paragraph containing abundance of S & Sh sounds.

If unsatisfactory, palatal contouring for words with palatography recommended.

Type of Problems:

‘Slushy speech’ or ‘Whistling S’ generally articulatory and can be classified as,

1. Omissions e.g. ink for sink

2. Substitution e.g. think for sink

Common in prosthodontic population

3. Distortion e.g. ink for sink

Distorted and unintelligible ‘S’

Whistling ‘s’

e.g. Patient with dysarthria, paralysis and prosthodontic population.

Speech sound deviations according to structural deviations:

Tooth position Tongue behaviour Airflow change Speech effect

Incisor labial Stretching apex Broad airstream Sh  S

Incisor lingual Jammed apex Lateralized Lateral lisp

Lateral molars Orientation or fulcrum loss Variation Slushy

Covered palatal area Orientation or feedback loss Variation Imprecise

General Remedial Procedures:

1. Make sure the speech problem is caused by the denture. Take the help of speech pathologist.

2. Establish a waiting period for accommodation i.e. 4 weeks according to Lord should follow

initial placement of dentures.

3. If the problem persists, consider altering the structures of dentures i.e. the tooth positions (if

malpositioned tongue may be getting either jammed or stretched against the anterior teeth).

4. Examine the role of palatal rugae, remodeling the papilla / rugae can be considered. Placement

of a roughtened spot in the area of rugae serving as a guide/ tactile landmark as a guide for the

tongue ‘home on in’.

5. In patients with excessive ridge resorption, it might be necessary to add bulk to denture base in

ridge region. Also, it may be necessary to remove the bulk in some cases to allow for

movement of tongue.

6. Last, change in mandibular denture i.e. in molar region, it may at times hamper the tongue

movement because of encroachment.

METHODS OF SPEECH ANALYSIS

1. PERPETUAL OR ACOUSTIC ANALYSIS
An acoustic analysis is based on the broad band spectrum recorded by a sonograph during the uttering
of different phrases.
By this an objective opinion of the performance of certain sounds may be achieved.

2. KINETIC METHOD FOR MOVEMENT ANALYSIS

 Ultrasonics
 X-ray mapping
  Cineradiography
 Optoelectronic articulatory movement tracking
 Electropalatography(EPG)
They play an essential part in both experimental and routine clinical evaluations of speech defects and
treatment effects.
They are also helpful in determining the tongue contact positions and movements.
Sears (1949) suggested that the use of palatogram to study the lingual contact on the palate . This can
be done by placing a pressure indicating substance on the palatal surface of the denture and ask the
patient to pronounce words like “S” “T” “D” “N” “L”
The tongue will mark indicator paste and provide a visible area of contact between tongue and palate.
This can be compared with normal and adjustments of denture contour were can be made.

CONCLUSION

 Speech patterns are invaluable as an aid in denture fabrication.

 The restoration of oral functions is one of the major objectives in the science of prosthodontics.
 Since the neuromuscular patterns for speech are the least affected by the removal of the teeth they
can be incorporated under neutral functional conditions into other record making procedures
 Every patient’s condition should therefore be evaluated to assure that the denture can provide an
optimal environment for the rapid co-ordinated muscle movements requisite for acceptable speech.

References

Allen L.R. “Improved phonetics in denture construction”. J Prosthet Dent1958; 8(5): 753-763.
Boucher’s Prosthodontic treatment for edentulous patient 11th edition
Kessler B. “An analysis of the tongue factor and its functioning areas in dental prosthesis”. J. Prosthet.
Dent. 1955; 5(5): 628-635.
Martone A.L., and Black J.W. “The phenomenon of function in complete denture prosthodontics- An
approach to prosthodontics through speech science Part V. Speech Science Research of Prosthodontic
significance”. J Prosthet Dent 1962; 12(4): 628-636.
Rothman R. “Phonetic considerations in denture prosthesis”. J. Prosthet Dent. 1961; 11(2): 214-223.
Sharry J.J Complete denture prosthodontics ; third edition
Silverman M.M. “The speaking method in measuring vertical dimension”. J. Prosthet. Dent. 1952;
3(2): 192-199.
Sheldon winkler. Essentials of complete denture prosthodontics;2nd edition