SPEECH consideration in

orthodontics
BY:BABITA YADAV ,JUNIOR RESIDENT -1
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
Introduction

• Speech defined as complex pyscho-physiological process for putting thoughts into

words and organisation these words into sequence with grammatical context.

• The physiological media of speech are respiratory ,phonatory, and articulatory.

• The teeth in conjunction with the lips and tongue ,play an important role in the

articulation of consonants by air flow obstruction and modification.

• Fymbo conducted first scientific investigations 410 students on speech
analysis and malocclusion.
 Parts of speech
Speech consists of four parts-

1.Voice –sounds produced by air passing between the vibrating vocal cords of the

larynx.

2.Articulation-the movement of the speech organ i.e,lips ,tongue ,teeth.

3.Rhythm-variation of quality,length,timing, and stress of a sound ,word , pharse.

4.Language-knowledge of words used in communication.

• Sound consist of two parts- Consonants & Vowels.

• Consonants sounds:
 1.Palatolingual Sounds
A. Formed by tongue and hard palate-
1. ‘S’
• Created by the hiss of air as it escapes from the median groove of the tongue
when the tongue is just behind the upper incisor.
• The location of groove can be determined with the help of palatogram.
• If groove is shallow- S SH
• If groove is deep- whistling
2. T, D, N and L
• The tongue must be placed firmly against the anterior part of the hard palate.
B. Formed by tongue and soft palate- K, Ng and G

• Formed by raising the back of the tongue to occlude with the soft palate and
then suddenly depressing the middle portion of the back of the tongue,
releasing the air in a puff.
 2.Linguodental Sounds
• Th

• Tip of tongue is grasped between the incisal edges of the upper and lower
incisor teeth. Air is forced into the channel formed by the palate and the dorsum
of the tongue, then the tip of the tongue is retracted into the oral cavity.
• Phonetic Abberation- Th T

1. Inadequate interocclusal distance

2. Setting anterior teeth far too lingually

 3.Bilabial Sounds
• B, P and M

• Formed by stream of air coming from the lungs which meets with no resistance
along its entire path until it reaches the lips.

• Depends upon a correct interarch distance and a correct labiolingual positioning

of the anterior teeth.
 4.Labiodental Sounds
• F and V

• Formed by raising the lower lip into contact with the incisal edges of
the maxillary anterior teeth and forcing air through it.

• Depends upon the labiolingual and superoinferior position (occlusal

plane) of the maxillary anterior teeth.
Speech is mainly produced by two valves:

1.Articulation components of the oral cavity ,palate ,teeth,lip seal,tongue.

2.Velophargyngeal valve,soft palate,and phargyngeal walls.

• The ability to adapt and compensate appears to play a significant role.

• Bloomer summarised ;

• NORMAL STRUCTURE +NORMAL FUNCTION=NORMAL SPEECH

• ABNORMAL STRUCTURE +ADAPTIVE FUNCTION=NORMAL SPEECH

• ABNORMAL STRUCTURE + NO ADAPTIVE FUNCTION= ABNORMAL

SPEECH

• NORMAL STRUCTURE + ABNORMAL FUNCTION= ABNORMAL

SPEECH
Harvold suggested by which malocclusion and speech is interrelated;

1.Cause and effect relationship

INTER-RELATIONSHIP

2.Malocclusion 3.Genetic or metabolic

SPEECH SOUND RELATED MALOCCLUSION

{s},{z} [SIBILANTS]-LISP Anterior open bite ,large gap between

incisors

{t},{d} Linguoalveolar – Irregular incisors,especially lingual

DIFFICULTY IN PRODUCTION position of maxillary incisors.

{f},{v} labiodental fricatives- Skeletal class III

DISTORTION

{Th},{sh},{ch} Linguodental Anterior open bite

fricatives -DISTORTION
 Assessment of speech
To investigate speech distortions;

1.Objective evaluations using sonographic techniques.

2. Semi-objective evaluations by speech pathologists or professionals.

3.Subjective evaluations by laypersons or patients themselves can be routinely

conducted. The clinician while talking to the patient informally performs the
subjective assessment.

• The combination of objective, semi-objective and subjective methods is

recommended to minimize bias during speech evaluation.
 A.TEETH
• Severely crowded ,irregular incisors and lingual position of maxillary incisors

may have difficulty in production of linguoalveolar sounds{t,d}.

• Linguoalveolar fricatives followed by lingual palatal phonemes {j,sh,ch} are most

affected by space in the dental arch.

• Tooth position represent 50-60% of all articulatory speech disorders.

 b.Anomalies of tongue

• Ankyloglossia –sounds affected are linguoalveolar - {l,t,d,n,s} and {z}

because of restrictions of tongue tip.

• Macroglossia-dentolingual {th},linguoalveolar{t,d,n,l} and palato-

lingual{ch,j,sh}
• The 3 dental or occlusal anomalies classically noted to have a negative impact

on sound production are;

1.Openbite

2.Mandibular prognathism

3.Mandibular retrognathism.
 1.Anterior open bite
• Flymbo suggested that 63% of those with openbite had defective speech.

• Strong relationship with lisping.

• Laine found anterior open bite was associated with an anterior misarticulation of
the {S} sound.

• Open bite, as little as 2 mm, is associated with sound production errors.

• Production of the /s/ , / z/, /th / and /t/ sounds is most affected by an open-bite
malocclusion.
 2.class ii malocclusion

• Bilabial sounds { p,b,m} may be distorted, being produced by the upper

incisors articulating with lower lip-labiodental manner.

• Subtenly and Jensen found that tongue position was adapted to compensate for

Class II Div 1 ,rather than mandibular movement.

3.Class iii malocclusion
• Sibilant and labio-dental speech sounds are most commonly affected.
{s,z,t,d,n,l}.
4.Cleft lip and palate

• Hypernasality and defective articulation are the most pre-dominant

speech disturbances in cleft patients.

• Velopharyngeal insufficiency is seen.

 SPEECH AND ORTHODONTIC
APPLIANCE
• Among the adverse effects of orthodontic treatment,speech difficulty is one of the
major complications.

• Different types of orthodontic appliances such as fixed appliances, orthodontic

retainers and palatal expanders could influence the clarity of speech.

• The /i/, /a/, and /e/ vowels as well as /s/, /z/, /l/, /t/, /d/, /r/, and /ʃ/

consonants could be distorted by appliances.

• Although most speech impairments could return to normal within weeks, speech
distortion of the /s/ sound might last for more than 3 months.
 Mechanism of speech disturbances caused by
orthodontic appliances
Labial fixed appliances
• In 1956, Feldman reported that speech errors could be caused immediately after
labial fixed appliance insertion, because
1.The placement of labial appliances can lead to a direct interaction between the
labial brackets and the lips as well as the anterior teeth, altered touch perception ,
pain, and tension of articulators may cause speech distortions during the early stage
of use.
2. The irregularity in the anterior region of the mouth can result in tongue
protrusion , which can affect the articulation of the /s/ sound .
3. The transpalatal appliances and lingual auxiliaries used in combination with
labial appliance may be the main reason for a high degree of speech
distortion,which can be confirmed by the findings of studies conducted by Rai et al.
 1.LABIAL FIXED APPLIANCE
• Labial fixed appliances could lead to a slight impact on speech and most of the
speech recovery was reported to occur within 1 month . Vowels such as /i/, /u/,
and /a/ and consonants such as /s/ ,/t/ , /f/, and /l/ were the primarily affected
ones.

Studies on labial appliances, it was reported that the speech disturbances caused
by labial appliances could last for more than 1 month

• Runte et al.reported that the fricative sound could be affected when maxillary
incisors were tipped 30° palatally.
 2.LINGUAL FIXED APPLIANCE
• Compared with labial appliances, lingual appliances induced increased speech difficulty.

• Lingual fixed appliances could cause a significant deterioration in speech immediately

after insertion ,and some speech difficulties could last for more than 3 months especially
for the distortion of /s/ sound. Vowels such as /i/, /a/,and /o/ and consonants such as
/s/ ,/t/, /l/, /r/, and /d/ were those most affected by lingual appliances.

• After the insertion of lingual appliances, the contact area of the tongue can be shifted
further palatally, subsequently inducing the distortions of some consonants such as
alveolar sounds and palatal sounds, which require tongue movement.
 3.ORTHODONTIC RETAINER
• Both Hawley retainers and vacuum-formed retainers could lead to speech
difficulties, and speech disturbances caused by Hawley retainers were more
obvious and could last for a longer period.

• Hawley retainers often caused speech impairments of /s/, /z/, /t/, /d/, /i/, /ʒ/,
and /ʃ/ sounds, and vacuum-formed retainers could cause apparent changes of
/e/, /i/, /s/, and /ʃ/ sounds.

• The recovery of speech distortions in the vacuum-formed retainer group occurred

within 1 week, while the speech distortion of /s/ sound caused by Hawley
retainers sound could last for 3 months.
• First, some types of retainers such as the vacuum-formed retainer cover the occlusal surface of teeth and
increase the vertical dimension between the maxillary and mandibular teeth, causing speech distortion of
the /s/ sound .

• Secondly, the acrylic base of retainers often covers the lingual surface of the incisors and palate and thus,
alveolar consonants such as /s/ and /t/ and palatal consonants such as /j/ can be affected. Therefore, the
thickness of the base plate and the extent of the acrylic coverage appear to be important factors
underlying speech difficulties

• Erb et. al,concluded that thin retainers roughened in the anterior alveolar region could produce the lowest
occurrence of speech distortions.

• Thirdly, retainers may reduce the dimensions of the oral cavity, thus altering the vocal tract during
articulation.

• Additionally, the tongue position may retrude to a backward and low position.
 4.Functional appliances
• The severity of the speech distortion might be related to the extension of the
resin base of removable appliances.

• Sergl and Zentner investigated the acceptance of eight different types of

removable functional appliances and found that an activator with a large resin
base and extensive interocclusal opening could lead to severe speech
impairments.
5.Palatal expander

• Palatal expanders could affect the alveolar sounds such as /s/, /z/, /t/
and /d/, and the affected articulation could not be returned to baseline
until the removal of appliances.
 Recommendations for clinicians
The clinical recommendations are summarized as follows:

1. Prior to orthodontic treatment, patients should be forewarned about speech problems

that may be induced by orthodontic appliances. Advice regarding the adaptation time
should also be given.

2. Orthodontists should advise the patients to speak more slowly and to accept some
speech distortions during the period of adaptation.

3. Orthodontists should closely evaluate the phonetic function of the patients during
treatment. In some cases, speech therapy under the instruction of speech pathologists may
be effective when the patients have ongoing and severe difficulties with speech.
 Conclusion

• Since normal sound production and the oral cavity interact in a dynamic

relationship, the orthodontist should possess the ability to recognize and

determine how dental anomalies and orthodontic treatment relate to sound

production.
THANK YOU