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Maxillofacial prosthetics: theory and practice phonetics 16

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Phonetics
Definitions
Phonetics is the study of sounds particularly those produced by human. It may
defined as the study of the medium of spoken language, that is, the production,
transmission and reception of the sounds of human speech.
Phonetics: the science of speech sounds (language independent.)
articulatory phonetics: study of how speech sounds are produced/articulated
acoustic phonetics: description of the physical properties of speech sounds:
voicing, aspiration, frication
auditory phonetics: deals with the perception of speech sounds
Phonology: the principles and patterns by which sounds are used in a language:
language dependent
Transcription: A standardized set of symbols for converting the continuous acoustic
stream into discrete, linguisticallyrelevant symbolic units.
Speech is a learned process that used the anatomic structures designed primarily for
respiration and deglutition. speech is a learned habitual neuromuscular pattern
depend on audio and orosensory feedback.
There are no organs special for speech per se. As a learned process, speech develops
over an extended period. Spoken language is produced by the movements of some
organs may be considered as organs helping in speech.
Organs helping in speech
The respiratory system, consisting of the lungs, the muscles of the chest, and the wind-
pipe (trachea)
The phonatory system, formed by the larynx
The articulatory system, consisting of the nose, the mouth (including the tongue, the
teeth, the roof of the mouth, and the lips)
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Respiratory System Phonatory System Articulatory System
Lungs Muscles of
the chest
Trachea
Larynx
Pharynx Roof
of the
mouth
Teeth Lips
Organs of Speech
Tongue
Vocal
cords
Tip
Uvula
Hard
palate
Teeth
ridge
Soft
palate
Blade Front Back Rims
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The larynx (voice box): phonatory system
The air from the lungs comes through the wind pipe or trachea, at the top of which is the
larynx.
In the larynx are two vocal cords, which are like a pair of lips placed horizontally from
front to back. They are joined in the front, but can be separated at the back, and the
opening between them is called the glottis.
The vocal folds are wide apart for normal breathing & voiceless consonants
Narrow closure: for a whispered vowel (/ahaha:)
Opening and closing: vibration for voiced sounds
Tightly closed for production of glottal stop
The State of the Glottis
When we breath in and out, the glottis is open. That is, the vocal
cords are drawn wide apart producing voiceless sounds.
If the vocal cords are held loosely together, the pressure of the air coming from the lungs
makes them vibrate; that is, they open and close regularly many times a second. Sounds
produced in this way are called voiced sounds.
13
Raised
Lowered
Nasal passage blocked
Oral sounds produced
Nasal passage open
State of the soft palate
Oral passage blocked Oral passage open
Nasal sounds produced
Nasalized sounds produced
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The Articulators: articulatory system
The organs of speech above the glottis are the articulators involved in the production of
consonants:
Active articulator : the lower lip and the tongue
Passive articulator : the upper lip, the upper teeth, the roof of the
mouth and the back wall of the throat (or Pharynx).
The roof of the mouth
The roof of the mouth can be subdivided into four parts:
the teeth-ridge or the alveolar ridge, i.e., the hard convex surface just behind the
upper front teeth
the hard palate, i.e., the hard concave surface behind the teeth-ridge
the soft palate, i.e., the soft portion behind the hard palate
the uvula, i.e., a small fleshy structure at the end of the soft palate
In the production of a consonant, the active articulator is moved towards the passive
articulator.
PLACE
ACTI VE
ARTI CULATOR
PASSI VE
ARTI CULATOR
Bilabial Lower lip Upper lip
Labio-dental Lower lip Upper teeth
Dental Tip of tongue Upper teeth
Alveolar Blade of tongue Alveolar ridge
Retroflex Tip of tongue Hard palate
Palatal Front of tongue Hard palate
Velar Middle of tongue Velum (soft palate)
Uvular Back of tongue Uvula
2/10/2011 47
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Sof t Pal at e and It s Impor t ance in Speech
The rapid and accurate positioning of the soft palate is essential for the production of the correct
sound. When speaking, (all sounds except for those of m, n and ngand vowels), the soft palate is
raised and form a competent velopharyngeal sphincter preventing all nasal escape of air which is
thus wholly directed through the mouth
Overextension of the maxillary denture in the post dam area: May cause irritation of the velum
and stiffness of its muscles
If the posterior border is overextended or does not make firm contact with the tissue at the
posterior palatal seal area : The K sound becomes altered toward the German Ch sound
Palato (velo) pharyngeal mechanism(Palato (Velo) Pharyngeal Sphincter)
The velopharyngeal mechanism is a coordinated valve formed by the muscles of the soft
palate and pharynx.
Muscles forming the velo-pharyngeal sphincter
Muscles forming the velo-pharyngeal region are, :
1-Muscles forming the palate, these are:
-Levator veli palatini muscle -Tensor veli palatini muscle
-Palato glossus muscle -Palato pharyngus muscle
-Uvula muscle, which is the intrinsic muscle of the velum
2-Muscles forming the pharynx, these are:
-Superior constrictor muscle -Salpingo pharynges muscle
-Palato pharyngus muscle which has two portions, the pharyngo palatal
portion and the thyro-palatal portion
The levator veli palatini muscle and the superior constrictor muscles play the dominant
role in velo-pharyngeal mechanism especially during closure of the nasal cavity. The levator
veli palatini muscle is a long muscle and provides a wide range of movement necessary in
moving the velum from the relaxed rest position to a fully elevated position
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Palato (Velo) Pharyngeal mechanism
The velum acquires three positions to perform the valve action during swallowing and speech,
1-The relaxed position of the velum (uvula): Velopharyngeal opening:
This occurs during normal breathing and for pronunciation of vowels and
nasal consonants in a varying degrees. It is a relaxed position; the soft palate
drops downward to keep the oropharynx and nasopharynx opened.
2-Closure of the nasal cavity: It is required for swallowing and for production of
letters produced in the oral cavity. This mechanism is achieved as follows:
The middle third of the velum curves upwards and backwards in an attempt to contact the
posterior wall of the pharynx at or above the level of the plane of the palate at the level of
the atlas vertebra. This is done by the action of the levator veli palatini muscle. This is
aided by the contracted state of both the tensor veli palatine muscle and the uvulae
muscle that adds bulk to the nasal surface of the velum.
The pharynx shares in palato pharyngeal mechanism by:
*Movement of the posterior wall of the pharynx forwards. This is done by the
action of the superior constrictor muscle aided by the pharyngo palatalportion of
the palato pharyngus muscle.
*Movement of the lateral walls of the pharynx medially to close the last gap
between the lateral aspect of soft palate and lateral walls of pharynx. This is done
by the action of the salpingo pharynges muscle.
*The posterior pharyngeal muscles contracts strongly and produces a bunch-up
forming a prominent ridge or pad called Ridge of Passavant. This helps to
approximate the soft palate and pharynx,
Ridge of Passavant
The ridge of Passavant is a horizontal roll of muscles on the posterior wall of the pharynx
forming a bunching-up of the posterior pharyngeal wall. It is present at the level of the palate
which corresponds to the level of the atlas vertebra. It is usually more evident in patients with
soft palate defects as a compensating mechanism to aid in speech and swallowing. It also serves
as a guide for placement of soft palate prostheses
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3-Closure of the oral cavity
This is required to permit exit of air through the nasal cavity during sucking and
pronunciation of sounds as M and Ng as in sing. This mechanism is achieved as follows:
-The thyro-palatal portion of the palato pharyngus muscle pulls the soft palate
downward towards the tongue.
-The tensor veli palatini muscle flattens the dome-shape of the soft palate.
-The tongue is forced upward and backward.
-The palato glossus muscle contracts and completes the palate tongue approximation.
Velopharyngeal insufficiency:
Palato pharyngeal insufficiency is a condition characterized by abnormal anatomy of the
palate in the form of absence, short length or cleft in the tissues of the soft
palate.
This could be congenital, or due to acquired causes as resection of soft
palate or lateral pharyngeal wall. This condition results in inability to
perform palato pharyngeal mechanism.
Prosthetic rehabilitation is achieved by palato-pharyngeal obturator
(speech bulb) or by meatle obturator. Nasal sounds
Velopharyngeal incompetence:
Palato pharyngeal incompetence is a condition characterized by normal
anatomy but ineffective or absent motor function (tissues are
functionally impaired).
It is diagnosed by easily lifting the soft palate by a tongue depressor, by
nasal endoscopy or byairflow pressure measurements. Oral sounds
Prosthetic rehabilitation is achieved by a palatal lift device.
Several conditions can cause failure of closure of the valve, resulting in what is
designated as "palatopharyngeal (velopharyngeal) incompetence (insufficiency)
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Conditions that cause failure of closure of the valve
1. Neurologic disease : as poliomyelitis affecting oro-pharyngeal structures through affection
of any of the nerves of the pharyngeal plexus which includes fibers from the IX, X and
XI cranial nerves.
2. A congenital cleft of the palate .
3. A submucous cleft with inadequate bony structure and abnormal muscle fiber relationships
that impair closure,even if no palatal cleft is evident.
4. A variety of abnormalities of cavity relationships, e.g. short soft palate, excessively deep
pharynx;
5. Surgical resection of oral structures for treatment of cancer or traumatic injury .
6. Additional special cases : basilar skull deformities with associated congenital shortening
of the soft palate .
7. Congenital Iymphangioma with fixation of the soft palate
8. Diseases as multiple sclerosis or tumors, or due to traumatic head injuries.
Results
Palatopharyngeal incompetence leads to three primary speech consequences
1. Hypernasality,
2. Noise created by flow of air through nares during articulationnasal emission of air.
3. Impairment of palatopharyngeal valving that allows even minimal egress of air into the
nasal cavities would result in a distortion of articulation.
4. Reduced speech intelligibility
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Components of speech: speech mechanism
Respiration :
During respiration, inhalation and exhalation are approximately equal in duration and the
airflow is regular and repetitive.
During speech, the inhalation is shortened and the exhalation phase is prolonged and is
not repetitive. Prolongation of exhalation is achieved by the valve mechanisms along the
laryngeal, pharyngeal andoral components of the respiratory truct. These valves impede
the expired air and help to create speech signals.
If the vital capacity of the lungs is compromised, as in emphysema, speech will be perceived
as breathy. The reduced volume and pressure of expired air cause poor projection of voice.
Phonation :
Speech requires a multitude of position, varying tensions, vibratory cycles, and intricate
coordination of the vocal folds with other structures.
If vocal folds are partially or completely closed, they impede the expired air. With proper
degree of tension and pressure, the vocal folds may vibrated and thus impart phonation.
The tension and position of vocal folds will determine the pitch of the phonated sound.
If the larynx is resected the patient must learn to use the esophagus or a substitute mechanical
device (electrolarynx) as an alternative phonating system.
Resonation:
The sounds produced at the level of the vocal folds are augmented and modified by the
chambers above the level of the glottis. The pharynx, the oral cavity, and the nasal cavity
are providing tonal quality and act as resonating chamber by amplifying voice.
If palatopharyngeal closure is compromised, or if the structural integrity or size of oral,
pharyngeal or nasal cavities has been altered, a compromised voice quality will occur.
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Articulation:
The amplified, resonated sound is formulated into meaningful speech by the articulators,
i.e., by changing the special relationship of the tongue, the lips, the cheeks, the teeth and
the palate to each other.
The tongue is the single most important articulator of speech because of its ability to
changes in movement and shape.
Neural integration:
Speech in integrated by the central nervous system. At least 17000 different motor
patternsare required during speech.
A cerebrovascular accident may compromise the ability of patient to formulate
meaningful speech, evenall structures whichproduce speech are anatomically normal.
The ability to hear sounds (Audition) :
Hearing permits reception and interpretation of acoustic signals and allows the speaker to
monitor and control speech output.
Compromised hearing can preclude accurate feedback and affect speech.
Speech and Maxillofacial Prosthetics
Resonance and articulation are distorted by cleft lip and cleft palate.
A-Patients with cleft palate exhibit excessive nasal resonance because the inadequacy of the
velopharyngeal closure. This results in nasal sounds (hypernasality).
B- The sounds not affected by palatal clefts are the vowels (A,I, E,O and U) and nasal
consonants (M,N and NG).
C- The articulation of the other consonants is affected in varying degrees, depending on the
degree of oral pressure required for each sound. These sounds are deprived of their normal
explosive character (e.g. P and K) and give the voice a typical hollow nasal quality.
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Airstream mechanisms :Production of anysound involves the movement of an airstream
pulmonic airstream mechanism
Inwhich the lungs and the respiratory muscles set the air-stream in motion.
Most sounds pulmonic egressive: by pushing air through the lungs, through the
mouth and sometimes also through the nose.
glottalic airstream mechanism
Inwhich the larynx, with the glottis firmly closed, is moved up or down to initiate
the air-stream.
Velaric airstream mechanism:
Velaric in which the back of the tongue in firm contact with the soft palate is
pushed forward or pulled back to initiate the air-stream
These air-streams can be:
Egressive, i.e., the air is pushed out
e.g., Sounds of Englishand Hindi are egressive pulmonic air-stream.
Inegresive, i.e., the air is pulled in
e.g., Sindhi has some sounds with an inegressive glottalic air-stream.
6 possible airstream mechanisms:
pulmonic egressive - used in all languages
pulmonic ingressive - not found
velaric egressive - not found
velaric ingressive - used in e.g. Zulu (South Africa)
glottalic egressive - used in e.g. Navajo (N. America)
glottalic ingressive - used in e.g. Sindhi (India)
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Speech Sounds
In studying the physical properties of speech sounds we should understand:
- Manner of Articulation
- Place of Articulation
- Voicing
Manner of Articulation
concerns how the vocal tract restricts airflow
When producing obstruents, for example, articulators either:
- Totallystop the airflowthen release it (stops),
- create a partial closure leading to turbulence of the air particles (fricatives)
- combine these two types of closure (affricates).
Place of Articulation
refers to the location in the vocal tract
The number and variety of obstruents result directly from the fact that manners of
articulation can be exercised at various points in the vocal tract.
These point, places of articulation, are generally described in terms of where in the vocal
tract contact is made, rather than in terms of the identity of the active articulator involved.
Voicing
Each combination of manner and place of articulation may also be accompanied by vocal
cord (fold) vibration or voicing.
presence/absence of vocal fold vibration
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Classification of sounds
1- Surds: are any voiceless sounds
2- Vowels (Sonants): are open voiced sounds relatively unimpeded by the oral valves
The tongue is the principle articulator for the vowels "A, E, I, O, U".
The active articulators: the front, the back, the centre of thetongue
The passive articulators: the hard palate, the soft palate, the meeting point of the
hard and soft palates.
The vowel sounds are formed by a continuous air flow escaped through the
mouth. The shape of which is altered for the various vowels by raising or
lowering the tongue and by altering the shape of the exit through the lips. The air
was escaped through the mouth in the form of a single chamber for the A , O , U
sounds and a duple chamber for the I and E sounds. The division occurring
throughthe dorsum of the tongue touching the anterior part of the soft palate.
3- Consonants: are articulated speech sound. Theymay classified
According to laryngeal action and manner of production
A- Stops (plosives):
Characterized by complete stoppage of the air stream by valves, building up of
pressure in oral cavity, and sudden release and explosion of the breath (e.g. P,B).
B -The fricatives:
Characterized by friction of the air stream, being forced through loosely closed
articulators or narrow passageway e.g. /S/, /f/, /z/.
C- The affricates: also called "affricatives" are combinations of two consonants
e.g. d3
D- Nasal: It is produced by complete oral closure, but in this case there is no
closure of nasal passage. soft palate is lowered and air passes through the nose.
E.g. N, M
E-The Glides: Involves relatively little impedance of air stream their distinctive
characteristic is that they vary acoustically physiologically during their duration
e.g. H, W, J , Hw.
F- Semi vowels: Involve the least impedance of breath stream, e.g. R, L.
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according to the Place of Articulation :
This method of classification is probably most meaningful to the prosthodontist
since it highlights those consonants most affected by dental conditions
The place of articulation simply means the active and passive articulators
involved in the production of a particular consonant.
They are:
Bilabial : The two lips are the articulators. E.g., /p/, /b/, /m/
Labio-dental: The lower lip is the active articulator and the upper teeth are the
passive articulators. These sounds are produced by the air stream being stopped and
explosively released when the wet-dry line of the vermilion border of the lower lip
breaks contact with the incisal edge of the upper anterior teethE.g., /f/, /v/
Lingu- Dental: the tip of the tongue is the active articulator and the upper front
teeth are the passive articulators. This soundth(as in thin , then) is the result of
air flow restricted by the tongue against the incisal edge of upper and/or lower
incisors.
Lingu- Alveolar: Tongue and anterior portion of the hard palate (e.g. S, C
soft, Z, D, T, R, L).
The tip or blade of the tongue is the active articulator and the teeth-ridge is the
passive articulator.
With T and D, the tongue makes firm contact with the anterior part of the hard
palate, and suddenly drawn downwards, producing an explosive sound.
When producing the S , C soft, Z , R and L sounds, contact occurs between
the tongue and the most anterior part of the hard palate, including the lingual
surface of the upper and lower incisors, any thickening of the denture base in
this region may cause incorrect formation of these sounds.
The lower lip is brought into contact with the incisal edges
of the upper anterior teeth during production of the F, V
and Ph sounds.
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Post-alveolar: The tip of the tongue is the active articulator and the back of the
teeth-ridge is the passive articulator.
Retroflex: the tip of the tongue is the active articulator, and it is curled back. The
back of the teeth-ridge or the hard palate is the passive articulator.
Palato-alveolar: The tip, blade, and front of the tongue are the active articulators
and the teeth-ridge and hard palate are the passive articulators.
Lingu-Palatal: Tongue and portion of the hard palate posterior to that of
above (e.g. J, CH, SH, L, R)
Faulty phonation of these consonants sounds may be results from thickening
of this part of the denture base covering the hard palate.
With the C soft, S, Z, CH and J sounds the teeth come very close together;
if the vertical dimension is excessive, a clicking teeth will results with these
sounds.
The front of the tongue is the active articulator and the hard palate is the
passive articulator.
Lingu- Velar: Tongue and soft palate (e.g. C hard, k, G, NG).
Difficulty in pronouncing these sounds results if the posterior border of the
upper denture is thick and does not merge into the soft tissues.
The back of the tongue is the active articulator and the soft palate is the
passive articulator. E.g. /k/, /g/
Uvular: The rear part of the back of the tongue is the active articulator and the uvula
is the passive articulator. There are no uvular sounds in English.
Glottal: Produced at the glottis. E.g., [h]
Nasal (e.g. M, N, NG).
In these consonants sounds the air stream is allowed to escape into the nasal cavity.
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Speech Records
1- Subjective method.
2- Objective method.
1- Subjective method (auditory perceptual evaluation)
1- Through listening using a high quality stereo cassette recorder and a chrome bias
cassette.
2- Speech recordingswere carried out in a caustically treated room.
3- The subject is asked to counting from 1 -20, to pronounce specific speech sound, asked
about his name, age and his job, how the denture feels, how his speech sounds to him,
and which seem most difficult to pronounce.
4- Two different phoniatristsevaluated the speech samples.
5- Each audience evaluated the tapes for omissions, additions, substitutions or distortions
and marked any error on sheet containing transcriptions of speech materials.
6- Number and type of errors were recordedfor each subject.
2- Objective method (instrumental analysis):
This was done through:
Vocal 2 apparatus
Palatography ,ElectroPalatography
Cinefluorography
The sound spectrograph
(sonagraph,
spectrometer)
Computerized Speech Lab (CSL)
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Techniques for Studying Speech Tests
Palatography is a technique for studying tongue contact with the
alveolar ridge and palate during the production of phonemes or
syllables
Cinefluorography does for the cephalometric roentgenogram; it
permits multiple measurements representative of continuous speech.
The sound spectrograph (sonagraph, spectrometer) It graphically portrays the regions of
energy concentration characteristic of the various phonemesspoken during 2.5 seconds of
continuous speech.
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The f act or s in dent ur e const r uct ion af f ect ing phonat ion
1- Shape, , thickness, material and contours of a denture base
thick denture bases may cause :
loss of tonguespace - loss of toneand incorrect phonation.
2- Thickness and contour of its palatal portion:
- The thickness of the denture base covering the palate should not be thick.
- The artificial rugae should not be over-pronounced.
3- Extension and peripheral outline:
- The periphery of the denture must not be overextended. Prober thickness of the facial and
lingual flange
4- Vertical dimension
- Highvertical dimension cause clicking teeth with Ch and J sounds
5- The occlusal plane
If the occlusal plane is set too high the correct positioning of the lower lip may be
difficult. If the plane is too law, the lip will overlap the labial surfaces of the upper
anterior teeth and the F, V and Ph sounds might be affected.
6- The shape and size of teeth.
7- The anteroposterior postion of the incisors
The labiopalatal position of the upper anterior teeth is important for the correct formation
of the labiodental F,V and Ph and some palatolinguals S, C soft and Z, lisping with
result if the anterior teeth are placed too far palatally.
8- Relationship of the upper anterior to the lower anterior teeth
Consonants S, Ch, J , and Z requires near contact of upper and lower incisors so
that the air stream is allowed to escape through a slight opening between the teeth.
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In abnormal protrusive and retrusive jaw relationships, some difficulty may be
experienced in the formation of these sounds, and the anteroposterior adjustment
of the upper and lower anterior teeth become necessary.
9- The post-dam area
Errors of construction in this region involve the vowels I and E and some palatolingual
consonants K,NG, G and C had.
If the denture base was made thick in the post-dam area, or the edge finished square
instead of tapering, the dorsum of the tongue will be irritated, impeding speech and
nausea may occurs.
Indirectly the post-dam seal influences phonation by increase the denture retention,
because in case of loss upper denture the patient tries to suck maxillary denture into
position, using tongue to hold it, hence, mouth does not open widely, speech becomes
muffeld.
10- Width of dental arch
The artificial teeth should be placed in the neutral zone.
If the arch form of the denture is too narrow the tongue will be cramped, thus affecting
the size and shape of the air channel and the lateral margins of the tongue make contact
with the palatal surface of the upper posterior teeth. These results in faulty phonation of
some consonants as T, D, S, M, N, K, G, and H.
11- Denture's retention and stability,
12- Patient adaptation in phonetics
People can learn to adapt their speaking habits to correct errors that may be caused by
faulty tooth placement in dentures.
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Important of different sounds in denture construction:
Application of vowels (sonants) (A,E,O,I,U)
There will be little or no troubles with vowels sounds if the denture is phonetically
adjusted in consonant sounds (Rothman, 1961).
The tip of the tongue in all vowel sounds lies on the floor of the mouth either in contact
with or close to the lingual surfaces of the lower anterior teeth and gums.
The application of this in denture construction is that the lower anterior teeth should
not be set lingual to the alveolar ridge so that they do not impede the tongue positioning
for these sounds;.
Since the vowels E and I necessitate contact between the tongue and soft palate, the upper
denture base must be kept thin.
The posterior border should be tapered and merge into the soft tissue in order to avoid
irritating the dorsum of the tongue, which might occur if this surface of the denture was
allowed to remain thick and square-ended.
The vowel A , Ah as in Father is useful to locate the vibrating line, which is
helpful in determining the correct place of the post dam area.
For construction of speech aid prosthesis, in case of cleft palate and neuromuscular
deficient of the soft palate and pharynx.
Importance of labial sound(e.g. B, P, M).:
a- Orientation of the anterior teeth
b- Thickness of the labial flange.
Insufficient support of the lips by the teeth and denture base can cause these
sounds to be defective. Therefore the anteroposterior position of the anterior teeth
and thickness of the labial flanges of dentures can effect the labial sounds.
The anterior teeth and the denture flange must support the lips for these sounds.
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C- A correct vertical dimension
It plays an important role in the normal formation of the labial sounds as by
increasing the vertical dimension patient can not close the lips comfortably to
form the air seal, and by decreasing the vertical dimension patients lips will
prematurely contact causing distortion of the labial sounds.
Effects of labiodental consonants (e.g. F, V, Ph)
1- Position of the maxillary and mandibular anterior teeth
a- Upper anterior teeth too long or too far posterior or too far anterior.
b. Lower teeth: Too far posterior, a space develops between the lip and the teeth
during pronunciation of words containing labiodental sounds.
c. Too far anterior; the lower lip crowds into the lower denture off the residual ridge
during pronunciation of labiodental sounds.
2- Vertical dimension: Increasing or decreasing of the V.D. affects the pronunciation of
the labio dental sounds.
3- These labiodental sounds serve as an excellent test or guideline for determining the
proper plane of occlusion and the placement of anterior
The Linguo-Dental (e.g. Th)
Effects of positioning of anterior teeth on the pronunciation of th.
If about 3mm of the tip of the tongue is not visible, the anterior teeth are probably too
far forward or there may be excessive vertical overlap and the th sound will be
more like d sound.
If these or those are pronounced as dese or dose, so, try to incline the
upper centrals lingually.
If more than 6 mm. of the tongue extends out between the teeth the teeth are
probably set too far lingually and the th will be pronounced t
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Inadequate intra-occlusal distance or too much occlusal vertical dimension may
cause sensation of the tongue biting when the th sound is formed and also, the th
sound will be T or D sounds
Proper adjustment of the occlusal plane isnecessary for these sounds.
Linguo-alveolar consonants
A) T, D, and N sounds:-
a- Position of the anterior teeth:
If the teeth are set too far lingually, the T will sound more like a D.
If the anterior teeth are set too far anteriorly, the D sound will be more like a T sound.
b- Thickness of the palatal denture base:-
The palate of the denture base that is too thick in the rugae area : T will be more like a D and
the D, C, N sounds will be difficult to pronounce.
B) The Linguo-alveolar S, Z, and, C (soft), sounds: -
The upper and lower incisors should approach each other end-to-end, but they should not
touch that indicate a possible error in the amount of horizontal overlap of the anterior
teeth.
Always check on the total length of the upper and lower teeth (including their vertical
overlap)
Vertical length of anterior teeth during the pronunciation of sibilants. A, correct; B,
excessive vertical overlap; C, inadequate vertical overlap
Horizontal overlap of the anterior teeth during the pronunciation of sibilants. A. shows
correct amount of overlapping, B. showing excessive amount of overlapping, C. deficient
amount of overlapping.
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These sounds are made with the tip of the tongue against the palate in the rugae area with
small space or slit like channel for the escape of air between the tongue and hard palate.
The size and shape of this small space or channel will determine the quality of the sound.
If this channel is too shallow (broad and thin) : Lisping Sh sound
if the depth of the channel is further decreased or obstructed: Lisping (th or etts)
If the channel formed between the hard palate and the tongue is too narrow and deep :
Whistling
The application of whistling
A cramped tongue space, especially in the premolar region, forces the dorsal
surface of the tongue to form too small, deep opening for the escape of air :
Setting of teeth over the ridge
If the upper anterior teeth are placed too far forward (labially) or the lower
anterior teeth are too far back (lingually) : the tongue will be forced to arch itself
up to a higher position, so that the airway would be too small (narrow and deep) a
whistle could result.
If the space formed between the anterior palatal denture base and the tongue is too
narrow and deep : thicken the center of the palate so that the tongue does not,
have to extend up so far into the narrow palatal vault
if the lingual flange of the lower denture is too thick in the anterior region : can be
corrected by placing the artificial teeth in the same position that the natural teeth
occupied and shaping the lingual flange of the lower denture, so that it does not
encroach upon the space needed by the tongue.
If the interincisal space is abnormal : thicken the center of the palate so that the
tongue does not, have to extend up so far into the narrow palatal vault
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If the occlusal vertical dimension is too great the teeth will come together in
contact prematurely and they will "click" during connected speech while
pronouncing the "s" sound.
In case of S , C soft and Z sounds, a slit-like channel is formed between the
tongue and the palate through which the air hisses. If this channel is
obstructed by thickening the anterior part of the upper denture covering the
hard palate, by placing the anterior teeth too far back, or by lack of near
contact of the upper and lower incisors, a noticeable lisping may be produced.
However , if the channel is too narrow, due to cramped tongue, too narrow
dental arch, or placing the anterior teeth too far anteriorly whistling will result.
The procedurefor correcting whistling is to thicken the center of the palate so
that the tongue does not have to extend up, so far into the narrow palatal
vault. This allows the escape way, for air to be broad and thin.
A lisp with denture can be corrected by reversing the procedure and providing
a narrow concentrated airway for the S sound.
The correct positioning of the anterior teeth (antroposteriorly) important for
proper sounds of S, C (soft), Z, R, and L and for preventing both lisping and
whistling.
The application of lisping
1- The anterior part of the upper denture, covering the hard palate is thick.
2- The maxillary anterior teeth are placed too far back.
3- Lack of near contact of the upper and lower incisors
4- The level of the occlusal plane
a- In caseof too low occlusal plane the S sound will be developed as Sh
due to spreading of the tongue to cover the lower anterior teeth.
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b-In case of too high occlusal plane the S sound will be developed as th
due to the protrusion of the tongue during pronunciation of S.
5- class II and class III jaw relationship hinder the production of S sound
somewhat difficult.
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The following relationships are particularly important to the production of clear speech.
(1) Tip of the tongue to the palate.
Contact between the tip of the tongue and the palate is required in the production of /s/, /z/, /t/, /d/
and /n/. Consequently, a change in the shape or thickness of the denture contact surface resulting
from the fitting of new dentures will require a modification of tongue behaviour in order to
produce sounds which are the same as before. In the vast majority of cases, the necessary
modification occurs without any difficulty in a relatively short period of time.
The sound most commonly affected in this way is /s/, a sound which is generally produced with
the tongue tip behind the upper anterior teeth. A narrow channel remains in the centre of the
palate through which air hisses. If the palate is too thick at this point, or if the incisors are
positioned too far palatally, the /s/ may become a /th/. If the denture is shaped so that it is
difficult for the tongue to adapt itself closely to the palate, a channel narrow enough to produce
the /s/ sound will not be produced and a whistle or /sh/ sound may result. This is most likely to
be the consequence of excessive palatal thickening laterally in the canine region.
.(2) Lower lip to incisal edges of upper anterior teeth.
The lower lip makes contact with the incisal edges of the upper anterior teeth when the sounds /f/
and /v/ are produced. If the position of these teeth on a replacement denture is dramatically
different to that on the old denture there is likely to be a disturbance in speech.
(3) Lateral margin of the tongue to posterior teeth.
Contact between thelateral margins of the tongue and the posterior teeth is necessary to produce
the English consonants /th/, /t/, /d/, /n/, /s/, /z/, /sh/, /zh/ (as in measure), /ch/, /j/ and /r/ (as in
red). Air is directed forwards over the dorsum of the tongue and may be modified by movement
of the tongue against the teeth or anterior slope of the palate to produce the final sound. If the
contact can only be achieved with difficulty, movement of the tip of the tongue may be restricted
with consequent impairment of speech. This difficulty arises if the posterior contact surfaces are
too far from the resting position of the tongue as a result of the occlusal plane being too high, the
occlusal vertical dimension too great or the posterior teeth placed too far buccally.
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In extreme cases, it may not be possible for the tongue to produce a complete lateral seal and so a
lateral sigmatism develops.
(4) The relationship of mandible to maxilla.
The mandible moves closest to the maxilla during speech when the sounds /s/, /z/, /ch/ and /j/ are
made. Normally, at this time, there will be a small space between the occlusal surfaces of the
teeth. However, if the occlusal vertical dimension of the dentures is too great, the teeth may
actually come into contact so that the patient complains that the teeth clatter.
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Some phonatic complaints associated with prosthesis
1- Loss of tone and incorrect phonation
Causes: - Decrease of air volume and loss of tongue room resulting from too narrow
dental arch.
- Unduly thick denture bases (especially this part covering the palate).
- Overextended denture and periphery.
Treatment: - Broaden and widen arch form.
- Use narrow teeth.
- Reduce the thickness of the denture base.
- Adjust denture periphery.
2 -Drooling
Causes: - Arch form too constricted.
- Reduced vertical dimension.
- Poor muscle support.
Treatment: - Widen and boarden the arch form
- Restore proper vertical dimension.
- Teeth should be placed to support soft tissue more firmly.
3- Limited jaw mobility and low intensity of speech production:
Causes: Denture looseness; patient tries to suck maxillary denture into position, using
tongue to hold it, hence, mouth does not open widely, speechbecomes muffled,
and jaws move little.
Treatment:
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- Check dentures for lack of adaptation, improper border extensions, insufficient
posterior palatal seal and deflective occlusal contacts. Then correct the defect.
4- Phonetic Sh instead of S
Treatment: - Have a slight vertical overlap.
- Increase vertical dimension.
-Set lower so incisal edges can approximate maxillary teeth to within 1
mm.
5-Clicking sound
causes: - High vertical dimension.
- Use of porcelain teeth.
- Poor retention of the denture.
Treatment:
- Decrease the vertical dimention.
- Use risen teeth.
- Treat the cause of poor retention.
6-Lisping and whistling: mensioned before.
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Low front vowel: []
To pronounce a
sound, the dorsum of the
tongue arched with the
blade contacting the lower
alveolar ridge and the tip
resting behind the lower
incisors, the position
for E sound is
essentially the same,
except the dorsum is
arched a little higher, with
the blade in heavier contact
with the alveolar ridge and
the tip raised slightly.
To pronounce I
sound, the tongue
is pulled back with
the dorsum
flattened at the
beginning of the
sound, but raises to
the E position for
the completion.
High front vowel: [i]
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To pronounce
U , the tongue
first assumes the
E position then
falls back with the
dorsum flattened
for the second part
of the sound.
High back vowel: [u]
For the O sound, the
tongue is in its flattest
and lowest position with
no palatal contact.
(For the consonantal
speech the tongue
contacts the front,
middle and back
portions of the hard
palate in pronouncing
many of them.)
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A- The labial sounds P, B, and M: In case of the plosive (P
and B) the palatopharyngeal valve is closed. Lips are closed and then
opened suddenly with the expulsion of impounded air, while in case of
the nasal (M) sound, the pal atopharyngeal valve is opened, part of
this voiced air escape from the nose (resonating nasally)
1- The Labial Or Bilabial Consonants
In the production of the fricatives f, v, and ph sounds, forcing the breath
stream through contact made by the incisal edges of the max.
incisors and the lower lip. the lower lip is brought into contact with
the incisal edges of the maxillary anterior teeth. The lip may curt
over the labial surface of the maxillary teeth to a height of 1-2 mm.
2- Labio-dental Consonants:
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b. Lower teeth: Too
far posterior, a space
develops between
the lip and the teeth
during pronunciation
of words containing
labiodental sounds.
c. Too far anterior; the
lower lip crowds into
the lower denture off
the residual ridge
during pronunciation
of labiodental
sounds.
Incorrect position of lower anterior teeth.
3- The Linguo-Dental Consonants:
The fricatives l inguodental sounds, as th in this, are
made with the tip of the tongue extending slightly between
the upper and lower anterior teethmaking incomplete
articulation to constrict the air stream. For the oral
emission on this pressure consonant the palatopharyngeal
valve is closed
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3- The Linguo-Dental Consonants:
Effects of vertical positioning of anterior teeth on
the pronunciation of th. A. The tongue is prevented
from extending properly between the teeth.
B. The tongue extending between the teeth when they
are properly positioned
T, D, and N sounds
The Linguo-alveolar S, Z, and, C (soft), sounds
The fricatives (sh) and z (of measure)
The phonemes / tf (ch) / and /dz(dg)/
The consonant /L/
2/10/2011 28
The 10 lingua-alveolar consonants are divided into
five groups, each group having its distinctive place
and manner of production
4- Linguo-alveolar consonants:
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The tip of the tongue contacts the alveolar ridge, with the sides of the tongue
in tight contact with the teeth and gingivae. In the case of plosive /t/ and
/d/, the palatopharyngeal valve is closed; impounded breath pressure
is suddenly exploded orally. In the case of nasel /n/ the
palatopharyngeal valve is open, and the voiced breath stream is
emitted nasally.
4- Linguo-alveolar consonants:
A) T, D, and N sounds:-
B) The Linguo-alveolar S, Z, and, C (soft), sounds: -
4- Linguo-alveolar consonants:
The S, Z and C sounds (sibil ants): the tongue and anterior part of the
palate formthe controlling valve. They result from the formation of a
narrow midline groove of the tongue through which air is directed against
the incisal edge of the teeth; the lateral margins of the tongue contact the
teeth and gingivae and the blade of the tongue nearly touches the alveolar
ridge. The palatopharyngeal valve is closed so that the air stream for
these continuants can be emitted orally
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These sounds are
made with the tip of
the tongue against
the palate in the
rugae area with small
space or slit like
channel for the
escape of air between
the tongue and hard
palate. The size and
shape of this small
space or channel will
determine the quality
of the sound.
C) The fricatives (sh) and z (of measure)
fricatives / (sh) and z (of measure) are produced similarly to
/s/ and /z/ except that the tongue groove is broader than in /s/ and /z/.
While the lateral edges of the tongue contact teeth and gingivae, the tip
and blade of the tongue approximate the alveolar ridge The
palatopharyngeal valve is closed so that air can be directed
forcefully between the nearly closed teeth. The lips are often rounded
and protruded. The breath stream for production of / (sh) / is voiceless,
for / z (measure) / is voiced
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D) The phonemes / tf (ch) / and /dz (dg)/
linguo-alveolar affricates. The palatopharyngeal
valve is closed in order to accomplish the pressure
required for the combination of a forceful plosive and a
prolonged fricative. The air stream in /t (ch) / is
voiceless, in / dz (dg)/ voiced
E) The consonant /L/
is a voiced semivowel. The tip of the tongue is in
contact with the alveolar ridge, The palatopharyngeal
valve is closed during its production. If the tip of the
tongue is positioned posteriorly with more palatal than
alveolar contact, varying degrees of so-called dark /L/
are produced.
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6- The Linguopalatal Consonants:
Two consonants are produced by lingual
approximation to some portion of the palate
posterior to the alveolar ridge.
1. The consonant /r/ is a voiced semivowel
2. The consonant /j/ is a voiced linguapalatal glide
6- The Linguopalatal Consonants:
The consonant /j/ is a voiced linguapalatal glide. It
is initiated with the tongue raised toward the front of the
hard palate, The palatopharyngeal valve is closed
and the teeth are nearly approximated.
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7-Linguovelar Consonants
Linguo palatal sounds formed by the dorsum
of the tongue and soft palate) so-called back-
consonants or gutturals, /k/, /g/, and /ng The
velar sounds (K,g and ng) have no effect on
dentures
7-Linguovelar Consonants
Linguo palatal sounds formed by the dorsum
of the tongue and soft palate) so-called back-
consonants or gutturals, /k/, /g/, and /ng The
velar sounds (K,g and ng) have no effect on
dentures
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8- Glottal Consonants
Two consonants in which the
constriction is at the level of the
glottis (the space between the
vocal folds) are /h/ and /? /.
The /h/, is an unvoiced fricative
sound. The palatopharyngeal
valve is typically closed. Tongue
and lip positions do not
influence the character of the
phoneme.
The second consonant, /? /,
is a glottal plosive produced
by sudden impedance and release
of the breath stream at the glottis.
sounds. It is commonly
produced by infants.

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