CHAPTER 7 PHONETICS IN COMPLETE DENTURE Terminology Mechanism of speech The vowel sounds The consonant sounds Factors in denture construction affecting phonation Denture thickness and peripheral outline Vertical dimension Occlusal plane Anteroposterior positions of the incisors The post dam Width of the dental arch Relationship of the upper and lower anterior teeth The use of phonetics in complete denture construction Speech tests 9TERMINOLOGY Phonetics is the'scientifie study-of= sounds, particularly those produced by the human beings. Voice is the audible sound originat- ing in the vibrations of the vocal cords and reinforced by the resonance of air cavities situated in the head and chest. The apparatus by which it is pro- duced consists o 1- The lungs, chest walls, muscles of expiration, 2- Larynx in which are situated the vo- cal cords. 3- The chest cavity below, and phar- ynx, mouth and nose above MECHANISM OF SPEECH The voice is principally produced in the larynx, whilst the tongue by con- stantly changing its shape and position of contact with the lips, teeth, alveoli and hard and soft palates, gives the sound form and influences its qualities. The oral cavity and the sinuses act as resonant chambers, and the muscles of the abdomen and thorax control the vol- ume, and rate of flow of the air stream passing into the speech mechanism. The soft palate in conjunction with the pharynx controls the direction of the air stream after it passes from the larynx. Inall the vowels, and most con- sonant sounds, the air stream is con- fined entirely to the oral cavity, but a few nasal sounds do occur, e.g. M, N, and NG, in which the air is expelled mainly through the nose. The former are produced by raising the soft pal- ate into close contact with the pharynx, thus sealing off the nose and forcing the air to proceed through the mouth. 120 apter jonetics in complete denture With the nasal sounds the soft palate is pressed downwards and forwards and the dorsum of the tongue humped upto ~ meet it, thus sealing off the oral cavity and forcing the air stream to proceed through the nose, The vowel sounds A, E, I, O, U are formed by continuous air flow, the alteration in size of the mouth and the change in shape and size of the lip opening giving the various sounds their characteristic form. The consonant sounds are pro- duced by the air stream being stopped in its passage through the mouth by the formation of complete or partial seals or stops. These are produced by the tongue pressing against the teeth or palate, or by the closing of the lips. The sudden breaking of the seal brought about by the withdrawal of the tongue, or the opening of the lips, produces the sound. In many sounds there is a build up of air pressure behind the stop which when the seal is released pro- duces an explosive effect. Examples of these are: the lip closure of the P and B sounds; the tongue and anterior hard palate contact in T and D sounds. In some cases the seal or stop is not complete, but the channel through which the air stream must pass is made ex- tremely narrow: an example of this is the production of an S, Z, or C soft sound, in which the tongue separates itself from the anterior aspect of the hard palate by about 1 mm.,, forming a thin slit-like channel through which the air stream hisses. Speech, therefore, is largely a mat- ter of the control of the size and shape of the mouth, which is chiefly gov- emned by the position of the tongue and its contact with the teeth, alveoli and palate, any alteration of structures in the mouth will adversely affect speech proportionate to the location and mag- nitude of alterations,japter Fortunately for the prosthodontist, h sesses remarkable qual ties of adaptability, and rapidly become: accustomed to changes occurring in the mouth. After the extraction of teeth, or the insertion of a denture, some differ- ence may be noticed in the quality of the speech, but improvement quickly follows as the tongue adjusts itself to the new conditions. In extreme cases, such as the edentulous state or when poorly designed complete dentures are worn, the previous tone and quality are not always re-established. The tongue’s adaptability is illustrated by the number of individuals wearing dentures, de- signed with little regard to their effect on phonation, who exhibit no obviously apparent speech defects; the reason be- ing that in the construction of those den- tures the general principles of setting up were followed, coupled with regard to the aesthetic requirements and the at- tainment of the correct vertical dimen- sion. This has produced the occlusal plane at a level corresponding to that of the natural dentition, the anterior teeth in approximately the same position an- teroposterirly as the natural teeth, and the new dental arch conforming to that of the previous arch, thereby allowing the correct tongue space. Thus the ar- tificial dentures replacing the lost tis- sues have conformed closely to the state which existed naturally, the main differ- ence being the increase in bulk, a factor for which the tongue must compensate However, some knowledge of phonetics in relation to dentures is necessary, in order to correct the speech defects tt may occur in denture wearers, and also to act as a guide for the more construction of complete dentures urate The vowel sounds These sounds are produced by a continuous air stream passing through the oral cavity which is in the form of a Phonetics in complete denture single chamber for the A, 0, U sounds anda double chamber for the | and E sounds, the division occurring through the dorsum of the tongue’ touching the soft palate in the post dam region. The tip of the tongue, inall the vowel sounds, lies on the floor of the mouth either in contact with or close to the lingual sur- faces of the lower anterior teeth and gums. The application of this in denture construction is that the lower anterior teeth should be set so that they do not impede the tongue positioning for these sounds; that is, they should not be set lingual to the alveolar ridge. Since the vowels E and I necessitate contact ie tween the tongue and soft palate, the upper denture base must be kept thin, and the posterior border should merge into the soft tissue in order to avoid irri- tating the dorsum of the tongue, which might occur if this surface of the den- ture was allowed to remain thick and square-ended. The consonant sounds these sounds may For conveniei be classified thus : (a) Labials Formed mainly by the lips (B, P, M) (Fig. 7.1). . (7.1): Mid sagittal representation of the letter B, P, M(6) Labiodentals Fone by the lips and teeth "FV; Ph” (Fig. 7.2). Fig. (7.2): Mid sagittal representation of the letter F, V, Ph () Linguodentals Formed by the tongue and teeth “Th” (Fig. 7.3). Fig, (7.3): Mid sagittal representation ‘and palatogram of the letter Th (d) Linguopatatals Formed by the tongue and palate. (i) Tongue and anterior portion of the hard palate “D, T, C soft (Fig. 7.4) $,Z (Fig. 7.5),R (ji) Tongue and portion of the hard pal ate posterior to that of (i) “I (Fig. 7.6), LR. (Fig. 7.7) CH, SH, (iii) Tongue and soft palate “ (hard), K, G” (Fig. 7.8) 122 Fig, (7.4): Mid sagittal representation and palatogram of the letter D, T, C Fig. (7.5): Mid sagittal representation and palatogram of the letter S, Z Fig. (7.6): Mid sagittal representation and palatogram of the letter CH, J . (7.7): Mid sagittal representation and palatogram of the letter L, R Fig. (7.8): Mid sagittal representation of the letter K, GChapter 7 : Phonetics in complete denture (e) Nasal (e.g. M, N, NG ~ also belonging to the other groups). Note the separation between the uvula and posterior pha- ryngeal wall (Fig. 7.9). Fig, (7.9): Incomplete closure of the soft palate with the posterior pharyngeal wall during pronounciation of the nasai sounds Unless careful consideration is giv- en to the following aspects of denture construction, speech defects will occur varying from the almost simple to the unpleasantly obvious. FACTORS IN DENTURE CONSTRUCTION AFFECTING PHONATION 1, Denture thickness and peripheral outline The prosthodoatist’s aim is to pro- duce dentures which are mechanically functionally, aesthetically pleasing and permit normal speech. The most satis factory attainment of the first two re- quirements may cause slight de the patient’s speech but this should not be allowed to happen and some compro- mise will often be required to balance these three aims, 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 resulting from unduly thick denture bases. 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 with the movements of the tongue, lips and cheeks during the production of speech sounds. Any interference with the freedom of these movements may result in indistinct phonation, especially if the function of the lips is in any way hindered. Most important is the thickness of the denture base covering the palate, for here no loss of natural tissue has’ oc- curred, and the base reduces the amount of tongue space and the oral air volume. The production of the palatolingual group of sounds involves contact be- tween the tongue, and either the palate, the alveolar process, or the teeth. With the consonants T and D (Fig. 7.4), the tongue makes firm contact with the an- terior part of the hard palate, and is sud- denly drawn downwards, producing an explosive sound, any thickening of the denture base in this region may cause incorrect formation of these sounds. When producing the R and L con- sonant sounds (Fig, 7.7), contact occurs between the tongue and the most ante- rior part of the hard palate, including the lingual surfaces of the upper inci- sors to a slight degree. In the case of the S, C (soft), and Z sounds (Fig. 7.5), a slit-like channel is formed between the tongue and palate through which the air hisses. If the artificial rugae are over- pronounced, or the denture base too thick in this area, the air channel will be obstructed and a noticeable lisp may occur as a result. To produce the Ch and J sounds (Fig, 7.6) the tongue is pressed against a larger area of the hard palate, and in addition makes contact with the upper alveolar process, bringing about the ex- 123plosive effect by rapidly breaking the seal thus formed. The Sh sound is simi- __lat in formation, but the air is allowed to escape between the tongue and pal- ate without any explosive effect, and if the palate is too thick in the region of the rugae, it may impair the production of these consonants. 2- Vertical dimension The formation of the labials P, B and M require that the lips make con- tact to check the air stream. With P and B, the lips part quite forcibly so that the resultant sound is produced with an ex- plosive effect, whereas in the M sound, lip contact is passive. For this reason M can be used as an aid in obtain- ing the correct vertical height sincea strained appearance during lip contact, or the inability to make contact, indi- cates that the bite blocks are occluding prematurely. With the C (soft), S and Z sounds the teeth come very close to- gether, and more especially so in the case of Ch and J; if the vertical dimen- sion is excessive, the dentures will ac- tually make contact as these consonants are formed, and the patient will most likely complain of ‘clicking teeth” With low vertical dimension (ex- cessive interocclusal distance) the lat- ter S will be distorted to “Ch” with high vertical dimension (reduced inte- rocclusal distance) the latter S will also be distorted. 3- The occlusal plane The labiodentals, F, V and Ph, are produced by the airstream being stopped and explosively released when the lower lip breaks contact with the incisal edges of the upper anterior teeth. If the oc sal plane is set too high the correct po: tioning of the lower lip may be difficult, if on the other hand the plane is too low, the lip will overlap the labial surfaces of 124 the upper teeth to a greater extent than is required for normal phonation and the wund might be affected. 4- The anteroposterior position of the incisors (Fig. 7.10) In setting the upper anterior teeth, consideration of their labiopalatal pos tion is necessary for the correct forma- tion of the labiodental F, V and Ph. If they are placed too far palatally the con- tact of the lower lip with the incisal and labial surfaces may be difficult, as the lip will tend to pass outside the teeth, the appearance usually prevents the op~ erator from setting these teeth forward of their natural position. If the anterior teeth are placed too far back some ef- fect may be noticed on the quality of the palatolinguals, S, C (soft), and Z in which the tip of the tongue makes slight contact with the upper and lower incisors: this will result in a lisp due to the tongue making contact with the teeth prematurely. The tongue will more readily accommodate itself to an- teroposterior errors in the setting of the teeth than to vertical errors. w o Fig, (7.10): A diagram to show the upper tificial anterior teeth (b) are placed nearly in the position which was occu- pied by the natural teeth (a) 5- The post-dam area Errors of construction in this region involve the vowels J and E and the pal atolingual consonants K, KG, Gand C (hard). In the latter group the air blast is checked by the base of the tongue beingChapter 7 : Phonetics in complete denture saised. upwards and backwards to.make_ contact with the soft palate. A denture which has a thick base in the post-dam area, or that edge finished square in- stead of tapering, will probably irritate the dorsum of the tongue, impeding speech and possibly producing a feel- ing of nausea. Indirectly the post-dam seal influences phonation, for if it is inadequate the denture may become unseated during the formation of those sounds having an explosive effect, re- quiring the sudden repositioning of the tongue to control and stabilize the den- ture; this applies particularly to singers. Incidentally, speech is usually of poor quality in those individuals whose up- per denture has become so loose that it is held in position mainly by means of tongue pressure against the palate. Careful observation will show that the denture, in such cases, rises and falls with tongue movement during speech Before passing to the next factor it should be mentioned that the con- sonants M, N, NG also belong to the nasal group in which the air stream is allowed to escape into the nasal cavity through a slight channel formed by the incomplete approximation of the soft palate and pharynx (Fig. 7.9) 6- Width of dental arch Ifthe teeth are setto an arch whichis too narrow the tongue will be cramped, thus affecting the size and shape of the air channel; this results in faulty phona- tion of such consonants as T, D, S, M, N, K, C and H, where the lateral mar gins of the tongue make contact with the palatal surface of the upper posterior teeth. Every endeavor should be made, consistent with the general mechani. cal principles, to place the linguai and palatal surfaces of the artificial teeth in the position previously occupied by the natural dentition (Fig. 7-11) cial posterior teeth (b) are placed nearly in the position previously occupied by the natural teeth (a) 7- Relationship of the upper ante- rior to the lower anterior teeth The chief concem is that of the S sound which requires near contact of the upper and lower incisors so that the air stream is allowed to escape through a slight opening between the teeth. In abnormal protrusive and retrusive jaw relationships, some difficulty may be experienced in the formation of this sound, and it will probably necessitate adjustment of the upper and lower an- terior teeth anteroposteriorly, so that approximation can be brought about successfully. The consonants Ch, J and Z require a similar air channel in their formation. THE USE OF PHONETICS IN DENTURE CONSTRUCTION Phonetics can be used to facilitate other phases of denture construction. (a) The use of the fricatives f and » when arranging anterior teeth, is an aid in determining the proper position of the maxillary incisors, During the arrangement of anterior teeth, the pa: tient is asked to repeat “five, fifty-five, five f e” while the operator ob: serves how the lower lip kes contact 125with the incisors. Normally, the lower ~lip-contacis the invisal=edger-of these — teeth in pronouncing these sounds. If the teeth have been oriented superiorly, the lower lip will contact the opposing lip instead of the teeth. If they are ori- ented to the lingual, the lip will contact the labial surfaces instead of the incisal edges, and if they are oriented toward the labial, the lip will contact the lingual surfaces instead of the incisal edges (®) The pronounciation of letter s to establish the closest speaking space in determining proper vertical dimen- sion, is an excellent adjunct in arriving at an occlusal mandibular position that is compatible with both the rest posi- tion and phonetics. (c) Palatography, in addition to its use in contouring the palate and ar- ranging teeth, palatography can also be used on an existing denture to analyze defective speech. Palatogram or palatography is a graphic representation of the area of the palate contacted by the tongue dur- ing speech. This is performed by dust- ing the palatal surface of the upper denture with talc powder and ask the Patient to pronounce the desired letter (lingo palatal letters) the tongue will touch the palatal surface at a specific area from which the talc powder will be eliminated (place of production of the letter) every letter have a specific area for production and specific pala- togram, SPEECH TESTS The phonetic aspect of denture construction, at least, deserves equal consideration with esthetics and me- chanics and should be checked at the time of the stage try-in when it is pos- sible {o alter palatal contour to accom- 126 Chapter 7 : Phonetics in complete denture modate speech articulation. The trial “denture evaluation should Tot be co sidered complete until a phonetic test has been made and enunciation proved satisfactory to both the patient and the operator. The speech tests should be made after satisfactory esthetics, cor- rect centric relation, proper vertical di- mension, and balanced occlusion have been attained and after waxing for es- thetics has been completed. Waxing of the palatal portion of the trial denture should be confined to the area adjacent to the teeth, with just enough wax added to ensure a smooth surface between the trial base and the collars of the teeth. It is presumed that the base is comforta- ble, well-adapted, and approximate the tissues with nearly the same fidelity as anticipated for the completed denture bases. Before the speech tests are start- ed, the mandibular trial denture should be secured with denture adhesive. The first test is of random speech and is best accomplished by engaging the patient in conversation and obtain- ing a subjective speech analysis by ask- ing the patient how the dentures feel, how his speech sounds to him, and which words seem most difficult to be pronounced. The second test is of specific speech sounds. This is best accomplished by having the patient pronounce six or eight words containing the sound and then combining these words into a sen- tence. If the patient can complete the speech test distinctly with no difficulty and if this random speech satisfies him and the operator, the contour of the pal~ ate is considered satisfactory. If how- ever, problems are encountered in one or more of the areas tested, then palatal recontouring is indicated and can be ef- fectively accompanied by palatogram.