Speech patterns of edentulous patients and morphology of the palate in relation to phonetics

An Introduction
In the production of speech sounds, the tongue contacts various portions of the teeth, the alveolar ridge, and the hard and soft palate. When these structures are covered or replaced by a denture, proprioceptive feedback may be changed. Therefore,phonetics may be affected by the presence of a denture.

There are conflicting data on how denture wearers achieve speech improvement. Allen stated that neglect of phonetics in complete denture construction may be attributed to the fact that edentulous patients tend to return to their normal speech patterns after insertion of dentures.

This Study aims at to investigate:

( 1)The changes in the speech patterns of patients with new complete dentures before and at various times after insertion of the new dentures & (2) any relationship between speech production and the palatal contour of the denture.

CHANGES IN SPEECH PATTERNS OF EDENTULOUS PATIENTS WITH NEW COMPLETE DENTURES AFTER VARIOUS TIME PERIODS :

Selection of subjects. Ten edentulous patients wearing satisfactory new complete upper and lower dentures were selected.

All of these dentures had 14 artificial teeth in each dental arch. Five subjects were women and five were men, having an average age of 49 years. All were Caucasians with reasonably normal occlusions and oral structures, and they all had approximately the same square-tapering dental-arch form.

Test material. Ten stimulus sentences were used with the consonants ch, j, sh, th, s, Z, t, n, d, and 1 in initial, medial, and final positions in the words.

these sounds are produced when the tongue contacts various parts of the teeth,the alveolar ridge, and the hard palate of the maxillary denture. Examiners evaluated only those sounds which had been recorded. The recordings were made at four different time intervals. Recording time order.

The speech of each subject was recorded at the following times: ( 1) prior to the insertion of the new dentures, (2) one hour after the insertion of the new dentures, (3) 24 hours after the insertion of the new dentures, and (4)one week after the insertion of the new dentures.

Recording procedure.
The subject practiced reading the ten stimulus sentences two times each. The readings were then recorded for each patient. The recordings were made on tape at a speed of 7&1/2 inches per second on a Sony Model T. C-350 recorder,* and a Sony F96 microphone was used. The patients were instructed to monitor their level of speaking so that the tape recorders volume meter did not peak into the distortion zone.

The recordings made for each patient at each of the four time sessions totaled 400 recorded sentences, which were edited and randomized onto a master tape. Forty combinations in random order were made for each sentence spoken by the ten patients at four different recording sessions. Therefore, ten different master tapes with ten different stimulus sentences were made to determine the intelligibility of speech.

Judging and rating. A psychophysical method was used for evaluating the intelligibility of the speech of the edentulous patients. Nineteen examiners were selected. These examiners had been trained in speech.

The ten edited master tapes were presented to these examiners independently. They evaluated each sentence on a 1 to 7 point scale. Sentences rated as 1 were the poorest and as 7 were the best. Instructions and rating sheets were given to all examiners to enable them to evaluate the tapes. The examiners were unaware of the randomized order of the sentences and were asked to evaluate only the quality of the speech.

ANALYSIS OF THE PALATAL CONTOURS OF PATIENTS WITH COMPLETE DENTITIONS AND OF THE MAXILLARY COMPLETE DENTURES TESTED

The ten dentulous subjects had at least 14 teeth in each dental arch. They had reasonably normal speech, occlusion, anatomic tooth form, and oral structures. They also had square-tapering dentalarch form.

Two diagnostic casts of the maxillary arch of each dentulous subject and the lingual surface of the palate of the complete denture of each edentulous patient were made for analysis of palatal contour, making a total of 40 diagnostic casts. The three screws on the cast-supporting jig were then adjusted until the three reference points on the cast made an even contact with the stylus rod (Fig. 1). The cast, while in the supporting jig, was then placed into another mix of dental stone, making sure that all three screws contacted the flat base. With this procedure the base of the cast parallel to a plane was determined by the three reference points.

Sectioning and cutting

All sectioning was accomplished with the use of a dental cast trimmer.* One of the casts was cut in frontal sections, and the others were cut in sagittal sections (Fig. 2). Analysis of the palatal contour. It was assumed that the palatal contours of the various sections would adapt for analysis to the parabolic quadratic equation On the frontal sections, the X axis was determined by the base of the cast, and the Y axis was drawn through the midsagittal line of the cast. On the sagittal sections, the X axis was determined by the base of the cast, and the Y axis was constructed through the gingival margin on the palatal side of the left central and lateral incisor teeth.

On the frontal sections, curvature A starts at the lingual surface of the gingival margins of the teeth and terminates at the inflection with the B curvature. The B curvature starts at the inflection with the A curvature and terminates at the vertex of B and C curvatures. Curvatures C and D are corresponding curvatures to B and A, respectively. On the sagittal sections, curvature E starts at the lingual surface of the gingival margin of the teeth and terminates at the inflection with the F curvature. Curvature F starts at the inflection with the E curvature and terminates at the distal end of the cast.

Analytic formula. The measurements were analyzed according to the following mathematical formula by means of computer analysis y = ax + bx + c. Three sets of (x, y) values as obtained from the measurements (tracing paper)were substituted into the equation, and then three sets of linear equations were made. Therefore, three unknown coefficients (a, b, and c) in the above quadratic equation can be solved simultaneously.

After the a, b, and c values have been calculated, the quadratic equation can be analyzed as follows: (1) a expresses the curvature of the parabola; (2) Y =c - (b/4a) expresses the y value at the vertex; (3) X = - (b/2a) expresses the x value at the vertex.

The inflection of the two parabolas can be determined using the following mathematical formulas : Assuming that two quadratic equations inflect at a certain point, their determinates be equal.

Therefore:

expresses the X value at the inflection. Now, if this X value is substituted into the above equation, the Y value at the inflection can be solved simultaneously. These data determine the curvature of the palatal contours, to ascertain whether any difference exists between the palatal contours of the dentulous subjects and the maxillary dentures, and to measure the palatal vault height and tooth height.

RESULTS: Changes in speech patterns of edentulous patients

Nineteen examiners responses (a total of 7,600 responses) were unscrambled from the random order arrangements. These rated scores were then tabulated on work sheets, and the means were computed for the 19 listeners.

The reliability of the judges was handled by an analysis of variance in a treatment-by-subject design with the use of the Spearman-Brown method. The reliability of the 19 listeners was at the 0.991 level. In other words, not only did each judge rate with very high consistency, but the judges were also consistent among themselves.

In Fig. 5 are the mean scores of the responses given by the 19 listeners for all the sounds spoken by each subject at the four different recording sessions. The F values for the time conditions are statistically significant at the one per cent level of confidence, as shown in Table II.

The four conditions and each of the ten sounds were treated by an analysis of variance in a treatment-by-treatment-bysubject design. Fig. 5 shows that there was consistent progressive improvement of intelligibility of speech sounds for all subjects with increased length of denture-wearing time. However, each subject showed different degrees of improvement. Neither the correlation between women and men in the intelligibility of speech nor the correlation between age and intelligibility of speech of the patient was significant.

the mean scores for each of the sounds: ch, sh, j, zh, s, .z, t, n, d, and 1. The F values for the sounds were statistically significant at the one per cent level of confidence. The summary of these confidence scores is in Table II1 The z/z sound had the lowest rated intelligibility, and the 1 sound had the highest rated intelligibility as the mean for the four-time recording sessions. The sh sound had the lowest intelligibility before the subject wore a denture. After insertion of the denture, all sounds showed an increase in intelligibility except the s sound, which stayed nearly the same.

. The 45 possible comparisons (t tests) among the ten sounds were analyzed. The 22 combinations of sounds were statistically significant at the one to five per cent level of confidence. The speech sounds ch, j,sh, zh, and s were significantly different when compared to all of the other sounds. This summary is in Table III. Acoustic distortions occurred more frequently in the ch, j, h, zh, and s sounds than in the Z, t, n, d, and 1 sounds. The correlation between the palatal vault height and speech intelligibility was not significant.

Palatal contour

Sagittal sections. This study showed that a reverse curve exists in the sagittal sections of the casts of dentulous subjects. This curve, starting at the lingual surface of the gingival margin of the incisor teeth, has a shallow inclination and is convex.Then, at its inflection, the curve becomes concave (Fig. 7). The inflection (junction of E and F curves) of this reverse curve was 11 to 13 mm. behind the incisor teeth and 6 mm. superior to them, which is approximately in an imaginary plane passing through the long axis of the cuspid teeth. This area of the inflection has the steepest inclination. Snow and Allen pointed out that this convexity in the anterior palatal region is important for producing the s and sh sounds. However, the curvature in the casts of the maxillary dentures studied was either lacking or more shallow (Fig. 7).

Frontal section. The frontal sections exhibited two types of curves. In the bicuspid region, there was just one continuous concave curve from tooth to tooth on the dentulous subjects (Fig. 8). This same type of curve was observed on the casts of maxillary dentures except that it was more shallow (Fig. 8). In the first and second molar sections, a double reverse curve was noted from tooth to tooth. The inflections of the first molar sections occurred medially 2.29 mm. from the tooth and superiorly 3.22mm. from the tooth. The inflections in the second molar sections were 3.52 mm. medial and 4.38 mm. superior from the tooth.

This means that the alveolopalatal tissues became progressively thicker the more posterior they were from the bicuspid teeth. The steepest inclination existed in the middle third of the palate on either side, as shown in Fig. 8. The majority of the maxillary dentures were lacking the double reverse curve, and the concave part in the center of the palate was shallower. Many authors state that the convexity of the alveolopalatal tissue in the molar areas is important for proper speech. It may be that more attention should be given to the contour of palates in dentures in order to improve speech production.

Palatal vault height.

The palatal vault height was greater in the casts of dentitions than in dentures. The measurements of the palatal vault height are shown in Table IV. The

mean difference between the height of the vaults in maxillary complete dentures and natural palates was 3.46 mm. in the bicuspid section, 6.10 mm. in the first molar section, and 4.91 mm. in the second molar section. The available tongue space was reduced by the complete dentures. The lowest vault height in the bicuspid section was 6.2 mm.and this patients speech intelligibility was rated as one of the

DISCUSSION:

Changes in speech patterns at four recording sessions. Intelligibility of the speech of edentulous patients with new complete dentures was tested at four different time intervals. This study showed that these dentures had palatal contours quite different than those palates of subjects with natural teeth.

. In spite of the faulty palatal contours of the maxillary complete dentures, the results indicated that there was a significant improvement in the intelligibility of the speech at each of the recording sessions in progression with new complete dentures

The interesting part of this study is that most of the edentulous patients showed an improvement when the denture was first inserted. That is, the patients were found to speak better immediately after receiving the new dentures than without any teeth.

The improvement of speech with the increased length of time wearing the new dentures was probably a function of the feedback mechanism. That is, the patient was better able to feel the placement of his tongue and was able to readjust his speech mechanism (tongue to palate) during speech production.

Bouchers stated that the adaptability of the tongue to compensate for changes is so great that the majority of patients master tongue manipulation for the production of sound within a few weeks. Thus, the insertion of a denture may cause a temporary change in the articulation of the speech sounds,and adaptability of the tongue may progress slowly.

Intelligibility changes of speech sounds and relation of the palatal contour of complete dentures. The results of this study showed that there is a difference in intelligibility of different speech sounds. Acoustic distortions occurred more frequently in the s, sh, ch, zh, and j sounds than in the z, t, n, d, and 1 sounds. The zh sound had the poorest rating for intelligibility.

1 sound had the highest rated intelligibility. This was found to be true when the sounds were compared during each of the four time periods. However, intelligibility improved with the increased length of time wearing the new dentures for each speech sound except the s sound. Particular attention should be paid to the s sound.

There are many factors involved in speech production that must be considered in denture construction. Most prosthodontists agree that correct placement of artificial teeth gives the best results in correct speech. The tooth position of the dentures in this study could not be observed because pre-extraction records were not available.

. However, the results showed that, when the sounds were made without the dentures, the rh and j sounds had the lowest scores for intelligibility, but when the denture was first inserted, intelligibility of these sounds improved greatly. Therefore, positioning of the artificial teeth in complete dentures should be considered an important factor in speech production.

The results of this study showed that there was a difference in the palatal contour of the complete dentures and the palates of the subjects with natural teeth. The greatest difference was on the lingual surface beIow the gingival margin ofthe teeth. After extraction of the natural teeth, this area changes greatly, and it is difficult to reproduce on the finished denture.

The palatal contours of the casts of natural teeth showed a convex curve while the palates of dentures showed a concave curve (Figs. 7 and 8). The height of the teeth from the tip of the lingual cusp to the gingival margin was greater in the natural teeth than in the complete dentures. These areas are important in the articulation of the consonants, especially the s, z, sh, zh, and j sounds

The border surface of the tongue, acting as a blade,is used in the production of these sounds. Generally, the tongue is spread to touch the lingual surfaces of the premolars and molars and the alveolopalatal surface adjacent to them. The tip of the tongue is used for producing the fricative and affricative sounds. The airstream is forced between the tongue and the palate.It is then deflected over the upper edge of the

Faulty acoustic effects of the s, sh, zh, j, and ch sounds may result if the airstream escapes over one or both sides of the tongue, when the tongue tip is in contact with teeth or palate, or when the tongue tip cannot compress the air-stream between the tongue and the palate. Therefore, faulty palatal contours of dentures or changes in the dental arch width due to incorrect positioning of the artificial teeth may affect the intelligibility of these speech sounds.

To obtain normal speech in denture construction, Sears, Allen, and Mehringer introduced a procedure to develop a normal tongue-palatal pattern (palatography) in the wax maxillary trial denture. However, observation of the palatograms indicates that no two persons contact the same area while pronouncing given consonants. Also, this is a static recording of the tongue during articulation of sounds. Analysis of this information requires a highly developed knowledge of phonetics.

SUMMARY AND CONCLUSIONS

Phonetics is one of the important factors in complete denture construction. Frequently, however, this factor is neglected because of the adaptability of patients. The need to consider phonetics is not recognized in most instances until a patient complains of inability to produce certain sounds with the dentures. Usually, only a small number of patients are thus troubled. To aid the dentist in minimizing these speech problems, the adaptability of speech production of edentulous patients was tested.

A psychophysical method was used for evaluating the speech of the edentulous patients with new complete dentures. The palatal contours of the dentures were analyzed and studied to determine if any relationship existed between palatal contour and speech intelligibility Variations in speech

Conclusion:

On the basis of analysis of the data collected, the following conclusions were made: 1. )Most of the patients showed speech improvement when the dentures were first inserted. 2. )With increased length of time of wearing the new dentures, the speech intelligibility was improved. 3. )The speech of patients can be improved by experience with their new dentures.

4. Individual sounds showed different levels of speech intelligibility, and this level improves with the length of denture usage. 5. Acoustic distortions occurred more frequently in the s, sh, ch, zh, and j sounds than in the t, t, n, d, and 1 sounds. 6. The s sound is a poor prognostic sound for intelligibility of speech. 7. Th palatal ridge formation (palatal contour) of complete dentures will affect the acoustic distortion of affricative and fricative sounds.

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