SPEECH

CONTENTS

SPEECH

 Introduction

 Mechanism of speech production

 Production of sounds and role of teeth and other oral structure.

 Prosthodontic considerations

 Other causes of speech defects.

 Methods for speech analysis.

DEGLUTITION

 Introduction.

 Mechanism of deglutition

 Theories of deglutition

 Prosthodontic considerations

 Applied physiology

RESPIRATION

 Introduction.

 Mechanism of Respiration

 Prosthodontic considerations

SUMMARY AND CONCLUSION

REFERENCES

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INTRODUCTION:

 Speech in humans is a learned habitual neuromuscular

pattern. Speech is a very sophisticated, autonomous and

unconscious activity. Its production involves neural, muscular,

mechanical aerodynamic, acoustic and auditory factors. The

vitality factor of an individual speech is closely related to that of

his physical and mental state.

 Speech may be described briefly as the production of

the sound by the Larynx (phonation) and its modification by the

resonance of the air in various spaces between Larynx and Lips

(Articulation).

 Communication between animals may takes place

through the sense of touch or smell however the audible signals

are perhaps the most efficient means of communication making

the humans superior to other animals.

 The loss of teeth and the supporting structures alters the

main articulating cavity and produces a marked effect on the

speech pattern. An empharic approach to a phonetic factor in

denture construction frequently places the burden for

compensating for speech changes on the adaptability of the

tongue.

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 Speech mechanism is highly susceptible to degeneration

disease, therefore as a prosthodontist one should utilize the

studies in speech science field to augment their clinical

knowledge of their phonetic factors in denture construction.

Mechanism of speech production:

Human speech is the result of following physiologic process:

a. Respiration.

b. Phonation.

c. Resonance.

d. Speech articulation.

e. Audition.

f. Neurologic function.

g. Emotional behaviour.

Sounds are produced by controlling the air stream and

structural controls of speech sounds are the various articulations

made in the pharynx, oral and nasal cavities.

The essential characteristics of speech is the production and

organization of sounds into symbols.

Respiration:

The movement of air in the inspiratory and expiratory phase is

essential to the production of speech. At the beginning of the

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inhalation the nostrils dilate to fascilitate the intake of air, this air

passes through the nares, nasal cavity, pharynx and larynx. The soft

palate is relaxed to provide free passage way and pharynx is widely

opened. During speech the rate of air exchange per minute is

accelerated, the number of breaths per minute is decreased.

Speech is directly related to the exhalation and its mainly

involves 3 principle physiologic values.

1. True vocal folds of larynx:

The vibrating mechanism produces vocal tones and the vocal

folds serve as a value only in connection with speech sounds. The

larynx containing the vocal folds that serve intermittently during

speech. (It is composed of three single cartilages which are

connected by ligaments and moved by muscles. The true vocal folds

are causually related to voice as opposed to wisper) when in a

position of rest, the free edges of folds are in close approximation

and when a voice is desired the folds are opened and the air is

pushed against them from below. The overload of air pressure is

momentarily spend and tension restores the folds to a closed

position, this cycle will be repeated and the acoustic output will be

called voice.

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2. Palatopharyngeal region:

The pharynx may be divided into three parts:

1. Nasopharynx.

2. Oral pharynx.

3. Laryngeal pharynx.

The palatopharyngeal valve is located in the region in which

the respiratory and digestive tracts, cross each other. These will act

in swallowing and speech. These valves divide the pharynx into

nasopharyngeal and oropharyngeal cavities.

3. Oral cavity:

The oral cavity is capable of making changes both in the

capacity and size of the orifices. It is modified by many articulations

mainly the tongue. The three physiologic values serve to form a

number of more specific articulatory values such as:

1. Mandibular lip against maxillary lip.

2. Mandibular lip against maxillary teeth.

3. Tip of the tongue against the alveolar ridge.

4. Phonation:

During speech the breath stream from the lungs courses

through the trachea and into the larynx where sound is produced by

the vocal cords.

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 During normal respiration the vocal cords are relaxed and the

space between them is wide open but may narrow during expiration.

The expired air will escape as a series of rapid puffs, in the

number of vibration of the vocal cords. Such changes in the pressure

of a expired air represent a sound.

The essential factor for sound is the vocal cords must be

sufficiently close together to touch during the part of their vibration.

This action is brought about by the contraction of the

arytenoids and criothyroid muscles.

The changes in the tension in vocal cords are adequate for

producing the normal speech.

If the air pressure is raised due to more forcible expiration

there will be increase in the pitch of the voice.

Disturbance in this system may adversely affect the action of

the vocal cords and cause disorders of the voice production.

E.g. Neurologic disorders.

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 Unilateral vocal cord paralysis (breathy voice).

Laryngeal nodules / ulcers (voice weakness).

5. Resonation:

It will take place in the nasal, oral and pharyngeal cavities

which are the prime resonating chambers. The following are the

resonating chambers present in the vocal apparatus.

1. The vestibule between true and false vocal cords.

2. Between larynx and root of the tongue.

3. Between pharyngeal wall, soft palate, uvula.

4. Between dorsum of tongue and posterior surface of the hard

palate.

5. Between dorsum of the tongue and anterior surface of the hard

palate.

6. Between the tip of the tongue and teeth.

7. Between the teeth and lips.

8. The nasal passage.

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6. Speech articulation:

The speech articulation is the process where the sounds which

are produced from a meaningful elements of speech by the

movement of the palate, teeth, tongue and lips.

The function of the articulating mechanism is to breakup and

modify the laryngeal tones and to create new sounds within oral

cavity.

The articulation is accomplished by the teeth, tongue, lips,

palate which breaks up sound as a air stream.

The air column which is selectively vibrated as it passes

through the vocal cords moves to the pharynx, oral cavity and nasal

cavities and radiates outward.

7. Audition

Speech communication entails three essentials:

a) Physiologic sequences requisite for producing.

b) Substative acoustic signals.

c) Perceived and disorders by the listener.

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 The hearing mechanism involves reception and interpretation

of the speech.

Distortion in speech articulation and voice quality may be

associated with reduction in the hearing activity.

8. Neurologic function:

Speech involves mechanisms which are complexly integrated

either sequentially or simultaneously by the central nervous system.

The integration of these signals into speech requires

neuromuscular coordination at the peripheral level as well as brain

function.

9. Emotional behaviour:

Speech is influenced by the patients emotional altitudes

towards the denture, the cosmetics etc.

Production of sounds and the role of teeth and other oral

structures:

 Speech production can be used as a guide to position of

the teeth, it is necessary to know how various speech sounds are

produced.

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 The voice sound is principally produced in the larynx

and the tongue is constantly changing its shape and position of

the contact with the lips, teeth and the alveolar process and hard

and soft palate.

1) These may be classified as:

2. Bilabial sounds.

3. Libio dental sounds.

4. Linguodental sounds.

5. Linguoalveolar sounds.

6. Linguopalatal sounds.

2) These may be classified depending on the characteristic

production and use of di fferent articulators and valves. Consonants are

produced by the interruption of air through the pharynx, mouth or by the

tongue teeth, lips.

1) Vowels a, e, i, o, u Voiced sounds are produced

without vocal cord vibration.

2) Plosives P, h, d, t, g, k Require complete stoppage of air

built up between soft palate and
pharyngeal wall.

3) Affricatives Ch, i These require partial stoppage of

air and require rapid release of air.

4) Nasals M, n Requires obstruction of mouth

with nasal passages open

5) Fricatives F, v, th Require partial stoppage of air

between soft palate and

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 pharyngeal wall

I.

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II. Bilabial sounds :

 The sounds b, p, m are made by contact of the lips.

 When pronouncing b and p air pressure is built up behind the

lips and released with a voice sound.

 Insufficient support of the lips may cause defective sounds.

 The anteroposterior position of the teeth will mainly affect

these sounds.

III. Labio-dental sounds:

 The sounds ‘f’ and ‘v’ are made between the

upper incisors and labiolingual center to the posterior 3 rd of

the lower lip.

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  If the upper anterior teeth are too small the ‘v’

sounds are pronounced like ‘f’.

 If the upper anteriors are too long, the ‘f’ sound

are pronounce like ‘v’.

IV. Linguo-dental sounds:

 The sounds ‘th’ are made with the tip of the

tongue extending slightly between the upper and lower anterior

teeth.

 These sounds are made actually closer to the

ridge than the tip of the teeth.

 Care observation of the amount of the tongue

that can be seen with the words “this, that, these, those” will

provide information as to the labiolingual position of the

anterior teeth.

 If 3mm of the tip of the tongue is not visible, it

suggests that the anterior teeth are probably too forward.

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  If 6mm of the tip of the tongue extends out

between the teeth when “th” sounds are made are probably too

far lingual.

V. Linguo-alveolar sounds:

 The sounds “t, d, s, z, v and l” are made with

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.

 The sibilants (sharp sounds) “s, z, sh, ch, I are

alveolar sounds because the tongue and palate form the

controlling valve.

 The upper and lower incisors are approach end

to end, but not touch.

VI. S. Sound:

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  These sounds are considered both linguo-dental

and linguo-palatal because they are produced with two different

tongue positions.

 When the tip of the tongue is against the palate

in the rugae area with a small space between the tongue and the

palate.

 If the opening of the space is too small then a

wide sound will result, and if the space is too broad and then ‘s’

sound will be pronounced as ‘sh’ sound.

PROSTHODONTIC CONSIDERATIONS OF SPEECH:

 Speech problems are usually identified immediately

following phonetic treatment.

 After denture insertion, it is some times difficult to

receive speech habits immediately, but gradual process of

retaining tongue positions good compensation can be achieved in

later periods.

 Speech adaptation to new complete dentures normally

takes place within 2-4 weeks after insertion.

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 During fabrication of denture, certain guidelines have to

be followed in order to achieve clarity of speech.

1) Effect of denture thickness and peripheral outlines

1) If the thickness of the denture base covering the palatal area is

more, then lipsing of the sounds will occur.

Allen (1958) found that an additional thickness of 1mm in the

anterior palatal area made speech awakward and indistinct.

2) The denture base thickness in the postdam area will irritate the

dorsum of the tongue which will impede the speech and there

is a possibility in producing feeling of nausea and denture may

be unseated during sounds, which requires sudden

repositioning of the tongue to control and stabilize it.

The upper denture base in posterior region must be kept

thin and the posterior border should be merge with soft

tissues.

3) If the lingual flange of the lower denture is too thick in the

anterior region, will encroach the space needed by the tongue

and this results in faulty production of ‘s’ sound.

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 It can be corrected by arranging the artificial teeth, in same

position as the natural teeth will occupy and shaping the lingual

flange so that there will be enough tongue space to establish.

2) Effect of tooth position on speech

If the lower anterior teeth are arranged too lingually, the

tongue is forced to arch itself upto a higher position and the airway

is to be too small and there will be faulty pronunciation in ‘s’ and ‘z’

sounds.

If upper anteriors are too short of occlusal plane the word ‘v’

will more likely pronounce as ‘f’. If upper anteriors are arranged

below the occlusal plane the word ‘f’ will be pronounced like ‘v’.

The labiodental sounds like ‘f’, ‘v’ are helpful in determining

the anteroposterior positioning of the upper incisors and the occlusal

plane.

3) Effect of dental arch form on speech:

If the arch is narrow, which will crample the tongue which

affects the size and shape of the air channel results in faulty

articulation of the consonants like ‘t, d, l, n, s, t’ where lateral

margins of the tongue makes contact with palatal surfaces of the

upper posterior teeth.

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 The correction can be done by the slight thickening of the

denture base in the center of the palate, so that tongue doesnot have

to extend up as far as into narrow palatal vault.

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4) Effect of vertical dimension on speech:

Fymbo (1936) pointed out that defective speech is most

frequently associated with increased vertical dimension which may

result in difficulty in pronouncing sounds like ‘b, m, p, f, v’.

Landa (1947) recommended various phonetic tests to

determine proper vertical dimension using sounds such as ‘s, c, z’.

Silverman (1956) stated that sibilient sound ‘s’ as a mean for

determining the correct vertical dimension. He established the

“closest speaking space” and used this as clearance area between the

dentures.

The bilabial sounds like ‘m’ is helpful in determining the

vertical dimension, when this sound is pronounced there will be

passive contact between the upper and the lower lip, which aid in

obtaining the correct vertical dimension.

5) Whistle and Swish sounds:

Silverman (1967) stated that the Whistle and Swish sounds are

produced during speech due to air abnormally passing over the

tongue and through the interincisal space. These sounds may be

caused due to decreased overjet.

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6) Effect of denture esthetics on speech:

Speech is some times related to patients emotional attitudes

towards the denture esthetics.

Lawson (1973) stated that when there is any change in patient

mouth, then there will be anxiety reaction will occur some patients

dissatisfied with their teeth appearance in denture and to overcome

this problem they shows abnormal movement of lip, jaws, and

tongue during speech.

7) Speech considerations in RPD:

Speech problems caused by RPD are not commonly

encountered largely because of the phenomental adaptive ability of

speech mechanisms. The problems in normal speech does arise in

RPD due to:

a) Change in contour of speech area.

b) Improper positioning the upper anteriors.

c) The thickness of the denture base.

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Speech Defects and Causes

Speech Defects Causes

P, b, w, m - Over extension of labial

flange.

- Too labial placement of

anterior teeth.

- Increased vertical
dimension of occlusion.

F, v - Facial or lingual
placement of maxillary anterior teeth.

- Placement of lower teeth

over or unsupported lower lip.

Th - Increased VDO.

- Too labially placed

maxillary anteriors.

T, d, s, z, l, n - Anterior or posterior
maxillary teeth placed too far lingually.

- Defective alveolar
contour.

- Increased or decreased
VDO

K, g - Defective in posterior
extension of denture.

Clicking - Increased vertical

dimension of occlusion.

Clatter - Lack of retention and

stability.

Whistling - Maxillary bicuspid to far

lingually.

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 - Defective palatal
contour.

Lisping - Maxillary bicuspid far

buccally.

- Palatal denture base is

too thick.

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Other causes of speech defects:

1. Congenital aquired palatal defects. E.g. cleft palate.

2. Malocclusion is a obvious cause of speech defects.

- Severe openbite leads to defective

pronounciation of consonants f, v, p, b, m because upper

anteriors are failed to articulate with the lower lip.

- Difficulty in pronouncing f, z with severe

openbite will be due to the amount of air escaping between the

hard palate and tip of the tongue will be larger.

3. Recessive mandible is another dental defect which affects

normal pronounciation of sounds like p, b, m, s, th.

4. Macroglossia will leads to lisping of the consonants.

5. Respiratory problems cause defects in speech.

Methods of speech analysis:

Basically 2 methods are used:

1. Perpetual or acoustic analysis.

2. Kinematic method for movement analysis.

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 1) An acoustic analysis is based on the broad band spectrum
recorded by a sonograph during the altering of the different
phrases.

By this an objective opinion of the performance of certain

sounds may be achieved.

2) Kinematic analytical methods are 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 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 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.

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 DEGLUTITION

INTRODUCTION

 The most extreme movements of the posterior part of

the floor of the mouth occur during swallowing. Failure to

properly adapt the denture base in this region will keep the

patient from attaining maximum function with the complete

denture.

 In order to incorporate the swallowing into the

impression technique, the mechanism of the swallowing must be

understood.

 The oral cavity and pharyngeal regions are the

introductory sections of the digestive tube.

 The passage of the food through this tube from the oral

cavity and to the pharynx and oesophagus starts as process of

deglutition.

 Deglutition is influenced by three factors:

1. Degree of fineness of food.

2. Intensity of taste.

3. Degree of lubrication of bolus.

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Mechanism of deglutition:

 It is a reflex response triggered by impulses by the

glossopharyngeal nerve which is a sensory nerve to the pharynx.

 Deglutition is initiated by a voluntary action of

collecting the oral contents on the tongue and propelling them

backwards into the pharynx.

 The total number of swallows are:

- 200-600 times/hr while eating and

drinking.

- 350 times/hr while awake without eating

and drinking.

- 50 times /hr while sleep.

 In general deglutition will be carried out in three

phases:

1) Oral (stage) phase: Voluntary phase, initiates the swallowing

process.

2) Pharyngeal (stage) phase: Involuntary phase, constitutes the

passage of food from the pharynx to oesophagus.

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 3) Oesophageal (stage) phase: Involuntary phase, promotes the

passage of food from oesophagus to stomach.

Oral stage:

After mastication, the food is rolled into a bolus, which lies on

the curve of the tongue, as the swallowing commences by closing the

mouth and voluntary contraction of the mylohyoid muscles, which

throws the bolus back between the pillars of the fauces onto the

post-pharyngeal wall. This region of the pharynx has rich sensory

innervation from the glossopharyngeal nerve. When the local nerve

endings are stimulated afferent impulses are setup which reflexly

produce the complex coordinated movements occurring in the

involuntary phases of swallowing.

Pharyngeal stage:

In this stage soft palate is elevated and the bolus thrown

against the post-pharyngeal wall to close of the nasal cavity. The

larynx raises with the elevation of the hyoid and the pharynx is

obliterated. The vocal cords are approximated and breathing is

momentarily inhibited. The pharynx reopens to permit the passage of

the bolus, the epiglottis, guards the laryngeal opening until the bolus

reaches the oesophagus which simultaneously opens upto receive it.

Oesophageal stage:

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 In this stage the bolus is propelled along the oesophagus by

the peristalitic waves of the muscles. Gravity plays a little part in the

process as the rate of progress along the oesophagus is not affected

by posture.

Theories of Deglutition:

A) Theory of constant proportion:

This theory suggests that the passage of the food through the

upper digestive tract in three phases:

- Oral phase.

- Pharyngeal phase.

- Oesophageal phase.

B) Theory of oral expulsion:

This theory suggests that the bolus of the food is passed to the

stomach by oral expulsion by the contraction of tongue and

mylohyoid muscles.

C) Theory of negative pressure:

This theory holds that the tongue is brought forward to create

a negative pressure and this pressure is accomplished by larynx. Due

to this negative pressure food is sucked from the mouth to the

oesophagus.

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D) Theory of integral function:

The concept that the process of deglutition is performed

successively by the contraction of the oral, pharyngeal, and

oesophageal muscles.

Prosthodontic considerations of deglutition:

I. Significance in making mandibular impression:

 The complicated neuromuscular system of swallowing

involves several muscles, whose actions during swallowing must

be considered when making impression for mandibular denture.

 Anatomically and functionally mylohyoid muscle forms

the floor of the mouth. The anterior fibers of the muscle are thin

and weak and have a low attachment below the residual ridge on

the inner surface of the mandible and the posterior fibers of the

mylohyoid muscle are thick and strong and attached to the high

as the crest of the residual ridge in the molar region.

 The posterior fibers of the mylohyoid muscle helps in

raising the tongue hyoid larynx column and acts as a curtain

which moves both upward and inward during swallowing.

 The posterior border of the mylohyoid muscle runs

inward, downward and forward.

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 Behind this border is the retromylohyoid space, which is

formed by the superior constrictor, the glossopharyngeal and

mylopharyngeal and the buccopharyngeal muscles. All these run

posteriorly combined with the pterigopharyngeal muscle form the

superior constrictor muscle in the wall of the pharynx.

 The posterior part of the lingual flange of the denture

covers the posterior part of the mylohyoid muscle and extends

into retromylohyoid space.

 During swallowing the buccinator muscle contracts

naturally to the buccal to the flange and which is molded and

recorded in a displaced position.

 The lingual border of the tray has been molded by the S-

shaped curve produced by the action of the hyoglossus muscle

and mylohyoid muscle.

 The anterior part of the mylohyoid muscle molds the

anterior part of the border of the lingual flange results in S-

shaped curve.

Swallowing Threshold:

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 The position of the mandible at the beginning of the

swallowing act has been used as a guide to establish vertical

dimension of occlusion.

 This is based on a theory that when a person swallows,

the teeth come together with a very light contact at the beginning

of the swallowing cycle.

 This technique involves building a cone of soft wax on

the lower denture base in such a way that it contacts the upper

occlusal rim when the jaws are open too wide.

 The flow of saliva stimulated by food and the repeated

action of swallowing, the saliva will gradually reduce the height

of the wax cone to allow the mandible to reach the level of the

vertical dimension of occlusion.

II. Significance in Establishing the neutral zone:

 A soft material that can be molded is used for the

establishing neutral zone.

 The molding compound is softened and adapted to the

top of the lower tray, shaped to a wax rim.

 The tray and molding compound are placed in patients

mouth and patient is instructed to swallow.

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 The action of muscles and tongue during swallowing

mold the soft compound into neutral zone and shape the polished

surface of the denture.

III. Establishing centric and vertical jaw relation:

 The moulding compound is covered with a thin film of

petroleum jelly and placed on lower occlusal rim and occlusal

rims are placed in to the mouth.

 The patient is instructed to deglutate, during swallowing

the mandible is guided to centric relation and the correct vertical

dimension is measured.

IV. Traumatic occlusion and impairment in swallowing:

 Lack of occlusal harmony between the upper and lower

occlusal surfaces of the teeth in centric occlusion is a frequent

cause of disturbance in the deglutition.

 Preceding this centric occlusal contact of the teeth in

the deglutative process, the anterior 3 rd of the tongue presses

against the lingual surface of the upper anterior teeth and anterior

3 rd of the palatal vault.

V. Inadequate denture retention and swallowing:

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 The upper denture is lacking in retention and stability

due to faulty posterior palatal seal.

 The pressure of the tongue against the lingual inclined

planes of the upper anterior teeth loosens the upper denture by an

leverage.

 Some patients complain that their difficulty in

swallowing is caused by the lower denture as they donot realize

that tongue is consciously raised to prevent the upper denture

from dropping and the mylohyoid muscle is displacing the lower

denture upward.

Applied physiology for deglutition:

1. Dysphagia:

This refers to the condition which leads to difficulty in the

swallowing. The causes may be:

- Obstructive : which results from the

neoplasms of esophagal or pharynx.

- Disordered function of striated muscles: the

muscles of the XII cranial nerve (which innervates tongue

muscles) the nucleus ambigus (which innervates pharyngeal

33
 muscles) i.e. in medualla oblongata, so that lesion in this

region frequently causes dysphagia e.g. poliomyelitis.

- Cranial nerve damage: Damage to the

cranial nerve IX, X and XII leads to dysphagia.

- Disordered function of smooth muscles:

Loss of the ganglion cells in auerbatch’s plexus may result in

irregular and uncoordinated oesophageal movements, leads to

dysphagia.

2. Paralysis of the muscles of the palate or the pharynx results in

failure to seal off nasopharynx from the buccal cavity and

during swallowing.

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 RESPIRATION

Introduction:

 The respiratory process consists of several parts, the

first of which is known as ventilation or process of getting air

into and out of the lungs.

 The ventilating process involves many structures

including the abdomen, the thorax and the maxillofacial (tissues)

structures.

 The activity of the maxillofacial musculature which is

proper to respiration is in a continuous state of function.

 All our body tissues require oxygen for their activity

and release carbon dioxide as their waste product.

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Mechanism of Respiration:

 Respiration has two stages which are:

1) Internal respiration : In this oxygen is used and carbon

dioxide is released by the cells.

2) External respiration: It includes the absorption of oxygen and

removal of carbon dioxide from the body as a whole.

- Ventilation : the movement of thorax,

inflation and deflation of the lungs constitute ventilation.

- Exchange of gases: It occurs alveolar air

and pulmonary blood capillaries.

- Transport of gases: It occurs from the lungs

to tissues and vice versa.

During respiration the lungs can be expanded and contracted in two

ways:

1. By the downward and upward movement of the diaphragm to

lengthen or shorten the chest cavity.

2. By elevation and depression of the ribs.

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1 st method:

- During inspiration contraction of

diaphragm pulls the lower surfaces of the lungs downward.

- During expiration, the diaphragm simply

relaxes and the elastic recoil of the lungs, chest wall and

abdominal structures compress the lungs.

- During heavy breathing, however the

elastic forces are not power enough to cause the necessary

rapid expiration, so that the extra required force is achieved

mainly by the contraction of the abdominal muscles which

pushes the abdominal contents upward against the bottom of

the diaphragm.

2 nd method:

- This method for expanding the lungs is to

raise the rib cage.

- This expands the lungs because the natural

resting position, the ribs slants downwards thus allowing the

sternum to pull backwards towards the vertebral column.

- But when the rib cage is elevated, the ribs

project almost directly forward so that the sternum moves

37
 forward away from the spine making the anteroposterior

thickness of the chest about 20% greater during maximum

inspiration and the muscles that depress the chest cage are

expressed as the muscles of expiration.

Sternocleido mastoid muscle – Lift upward on the sternum.

Anterior serrati – Lifts many of the ribs.

Scaleni – Lift first two ribs.

The muscles that pull the rib cage downward during the

expiration are:

- Abdominal recti.

- Internal intercostals.

Almost all respiratory muscle contraction occurs during

inspiration whereas expiration is almost passive process caused

elastic recoil of the lung and chest cage structures.

The external and internal intercostals act to cause inspiration

and expiration angled downward and external intercostals are

elongated forward and downward.

As they pull the upper ribs forward in relation to the lower

ribs and this causes leverage on the ribs to raise them upwards there

by causing inspiration.

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 The internal intercostals exactly opposite functioning as the

expiratory muscles because they angled between the ribs in the

opposite direction and causes opposite leverage.

The structures which have a particular responsibility for

maintaining the airway and for protection of the lungs are:

1. Lungs: It is mainly associated with the voice but it also

protects the lung from water, food and debris. It is essential valve

at the proximal end of the airway which opens and closes quickly

and is protected by an cartilaginous framework. This framework

permits, the whole laryngeal structures to move in many

directions when respiration and swallowing are executed.

2. Nasal structures: The nasal cavity is largely occupied by

the turbinates which are coiled scrolls of bone covered with a

specialized epithelium and sub divide the air passage into a series

of semitubular channels. They acts as “Air conditioners” which

filter and warm the incoming air. The nasal cartilages surround

the external nares and maintain the airway.

3. Pharynx: The pharynx is an undifferentiated muscular

conducting tube for air and food. It is lined with secretory

epithelium and lies between the nasal and the laryngeal end of the

airway.

39
Normal pulmonary valves:

 Tidal volume : Volume of air inspired or

expired during each normal breath, 500ml in Youngman.

 Inspiratory reserve volume: Extra volume of air

that can be inspired over and above the normal tidal volume,

3000ml.

 Expiratory reserve volume: The extra amount

of air, that can be expired by the forceful expiration after the end

of normal tidal expiration normally 1100ml.

 Residual volume: It is the volume of air

remaining in the lung after the most forceful expiration normally

about 1200ml.

Prosthodontic considerations of respiration:

 The movement of air in the inspiratory and expiratory is

essential to the production of speech. The steam of air is

modified in its course from the lungs by the maxillofacial

structures and gives rise to a sound symbols which recognize

as speech.

 Respiratory changes are prominent in emotional states,

frequently asthamatic attacks were occurred.

40
 While manipulating impression procedures and recording

frequently cause shortness of the breath and gagging.

 Every effort must be made to provide easy, comfortable

breathing during treatment. Attention must be directed to

providing a patent airway by good chair posture, by bringing

head forward so that gravity forces, keeps salivary fluid and

impression materials forward out of the mouth.

 Patient should be directed to breath slowly and deeply with a

regular rhythm.

 Mathew (1971) stated that the cleft palate speech is usually

characterized by low intraoral pressure, nasal emission of air

and reduced intelligibility of sound.

 The fricative consonants have two peak with adequate

palatopharyngeal closure and single peak with incompetancy.

This change in the record apparently represent greater

respiratory effort during production of consonants as well as

the inability of the palatopharyngeal mechanism to discretely

control the direction of airflow.

 The insertion of a speech prosthesis has a little effect on

respiratory volume unless adequate palatopharyngeal closure

is achieved. This reduces the respiratory volume the amount of

41
air utilized by speakers with palatal clefts is still higher than

the amount used by normal speakers.

42
SUMMARY AND CONCLUSION

 The action of maxillofacial pharyngeal musculature is play an

important role in the function of speech, deglutition and

respiration.

 The musculature of the tongue, face, the pharynx and floor of

the mouth must be regarded in the dental prosthesis, but not

only the physiologic action but also functional activity of

respiration, deglutition and speech were considered.

 The interrelationship and intimate interdependence between

mastication, deglutition, respiration and phonation are from

neurophysiologic point of coverage overwhelmingly complex

and extremely fascinating.

 Speech is a dynamic process in which prosthodontists are

involved. It is crucial to differentiates the speech defects

which are denture related and other coexistent conditions.

 Deglutition is a part of digestive process, initiated voluntarily

and completed by involuntarily process. It allows functional

impression to be made without excessive pressure. The border

will conform to the physiological limits and hence will allow

for perfect harmony between the dentures and oral tissues.

43
 The activity of the maxillofacial musculature which is proper

to respiration in a continuous state of function. The

maxillofacial structures are capable of delivering large volume

of air adequate for metabolic needs. These structures protect

the lungs by treating the inspired air under varying

physiological conditions.

44
REFERENCES:

1. Prosthodontic Treatment for Edentulous Patients – Boucher’s,

Zard, Bolender, Carlsson, 11 th edition, 2001.

2. Complete Denture Prosthodontics – John J. Sharry, 1968.

3. Jenkin’s Textbook of Physiology and Biochemistry of Mouth

– 4 th edition, 1977.

4. Applied Oral Physiology – Levelle Christopher L.B., 2 nd

Edition, 1988.

5. Textbook of Medical Physiology – Guyton and Hall, 9 th

Edition, 1996.

6. Concise of Medical Physiology – S.K. Choudhari, 2 nd edition,

1993.

7. Synopsis of Complete Denture – Thomas M. Copper, James

M. Terry.

8. Textbook of Removable Partial Denture - Mc Cracken’s.

9. Clinical Speech Considerations in Prosthodontics – J.

Prosthet. Dent. January 1973, 29-39.

10. An approach to Prosthodontics through speech science and

physiology of speech – J. Prosthet. Dent. May 1962, 409-419.

45
11. Wistle and Swish sounds in denture patients – J. Prosthet.

Dent. 1967; 17: 144-147.

12. Considerations in Maxillary speech prosthesis – J. Prosthet.

Dent. 1969; 22: 255-257.

13. Mastication and swallowing – An overview – Br. Dent. J.

1992; 173: 197-206.

14. The use of swallowing in making complete denture

impressions. J. Prosthet. Dent. 1968; 19: 208-218.

15. Polished surfaces in complete denture – J. Prosthet. Dent.

1964; 14: 854-865.

16. Effect of cleft palate prosthesis on the respiratory effort. J.

Prosthet. Dent. 1971; 26: 213-217.

17. Clinical Dental Prosthetics – H.R.B. Feen, 1 st edition, 1986.

18. Applied Physiology – Samson Wright’s, 13 th edition, 1982.

46