1.phonetics in cd

PHONETICS IN COMPLETE
DENTURES
Dr Zarir Ruttonji

CONTENTS
1. Introduction
2. Definition
3. History
4. Mechanism of sound production
5. Types/Classification of speech sounds
6. S sounds and their prosthodontic considerations
7. Different parts of oral cavity and their influence on speech
8. Prosthodontic implication in denture design affecting speech
9. Speech tests
10. Speech analysis
11. Speech defects
12. Conclusion
13. List of references

DEFINITION
• Speech:- The faculty or act of expressing or
describing thoughts, feelings, or perceptions
by the articulation of words.
• Phonetics:- The branch of linguistics that deals
with the sounds of speech and their production,
combination, description, and representation
by written symbols.
http://www.thefreedictionary.com

HISTORY
• In 1949 ‘Sears’ recommended grooving the palate
just above the median sulcus of the patient.
• In 1951 ‘Pound’ was successful in improving
phonetics by contouring the entire palatal aspect
of the maxillary denture to simulate the normal
palate
• ‘Landa’ suggested the use of ‘s’ sound to
determine the adequacy of ‘free way space’ &
‘M’ sound to establish a desirable ‘rest position’.

• 1953 & 1956, ‘Silverman’ used ‘speaking method’ to
measure patient’s vertical dimension in natural teeth
with dentures & without dentures.
• ‘Morrison’ suggested the use of the word, ‘sixty six’ &
‘Mississippi’ to determine closest speaking space
• 1967, ‘Kaire’ reported & determined the palatal
pressure of the tongue in the pronunciation of selected
palatolingual speech sounds, by electronic means under
predetermined vertical dimensions of occlusion.

1. The motor( lungs, associated muscle
that supply the air).
MECHANISM OF SPEECH PRODUCTION
Normal speech depends on proper functioning of 5 essential
mechanism
2. The vibrator ( vocal cord that give
pitch to the tone).
3. The resonator ( consist of the oral,nasal,
pharyngeal cavity and paranasal
sinuses).
4. The enunciators or articulators( lip,
tongue, palate and teeth)
5. The initiator( motor area of the brain)

COMPONENTS
OF SPEECH
RESPIRATION
PHONATION
RESONATIONS
ARTICULATIONS
NEUROLOGIC
INTEGRATIONS
AUDITION
COMPONENTS OF SPEECH
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39

RESPIRATION
• The movement of air in
the inspiratory and
expiratory phase is
important in production
of speech.

PHONATION
• Air from the lungs
courses through the
trachea.
• Sound is produced in
the larynx
• Vibration of vocal cord
takes place

RESONANCE
Sound that is produced by
the vocal cord is
modified by various
chamber.
• Resonators are
– pharynx
– oral cavity
– nasal cavity
– Paranasal sinuses

SPEECH ARTICULATION
• Sound that is produced
is formed into
meaningful words
• Tongue,lips,palate,
teeth and mandible
play are very important
role.

NEUROLOGIC INTEGRATION
Factors for speech
production are highly
coordinated, some
sequentially and some
simultaneously by the
central nervous system.
• Speech is a learned
function and requires
adequate hearing, vision,
and normal nervous
system for its full
development.

TYPES OF SPEECH
• 1.VOWELS: a,e,i,o,u. they are voiced sounds,
• 2.CONSONANTS: may be either voiced or produced
without vocal cord vibration, in which case they are
called breathed sounds. eg: p, b, m, s, t, r, z etc…
• 3.COMBINATION: Is blend of a consonant and
vowel, articulated in quick succession that they are
identified as single phonemes.
EX:- WORD
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

CLASSIFICATION OF SPEECH
• According to Boucher
• Vowels.
• Consonants.
– Plosives/stops
– Fricatives
– Afficatives
– Nasal
– Liquid
– Glides

STRUDS:-
1. Voiceless sounds
2. Produced by the separation of
vocal cords
Eg:- s,h,sh,zh
ACCORDING TO SONORITY
SONANTS
1. Voiced sound
2. Produced by vibration of a portion of the
vocal cords
3. Oral resonators modify the airstream
4. All vowels and vowel like sounds are
representatives.
CONSONANTS:-
1. Articulated speech
2. Airstream has to be modified at the
proper place and time for producing
these sound
3. Most important for dentist
John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132

CLASSIFICATION OF
CONSONANTS:
Divided into groups depending on their
characteristic production and use of different
articulators and valves. They are as follows.
• Plosive consonants: These sounds are
produced when overpressure of the air has been
built up by consonants between the soft palate and
pharyngeal wall and released in an explosive way.
Ex: P (pay), B (bay), T (to), D (dot)

• Fricatives: are also called sibilants and are
characterized by their sharp and whistling sound
quality created when air is squeezed through the nearly
obstructed articulators.
Ex: S (so), Z (zoo)
• Affricative consonants: are a mix between plosive
and fricative ones.
Ex: Ch (chin), J (jar)

• Nasal consonants :are produced without oral exit of
air. Production involves the coupling of nasal cavity as
resonators.
Ex: M (man), N (name), NG (bang)

• Liquid consonants(semi vowels) : are , as the name
implies , produced with out friction.
Ex: R (rose), L(lily)
• Glides: that is sounds characterized by a gradually
changing articulator shape
Ex: W (witch), Y (you)

CLASSIFICATION OF CONSONANTS BASED
ON THE PLACE OF THEIR PRODUCTION
• Consonant sounds are most important from the dental
point of view. They may be classified according to the
anatomic parts involved in their formation:
(1) Palatolingual sounds, formed by tongue and hard or soft
palate,
(2) Linguodental sounds, formed by the tongue and teeth,
(3) Labiodental sounds, formed by the lips and teeth, and
(4) Bilabial sounds, formed by the lips.
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

PALATOLINGUAL SOUNDS FORMED BY TONGUE AND
HARD PALATE
Word like S, T D N and L belong
to this catogory
S- the sound ‘s’ as in sixty six- is
formed by a hiss of air as it escapes
form the median groove of the
tongue when the tongue is behind
the upper incisor
If groove is decreased s is softened towards sh
(Lisping)
If groove is deep a whistling will be heard
when s is pronounced

CLINICAL SIGNIFICANCE
1. Thus we can say that the sound S
can be used to check the
proper placement of the
anterior teeth
2. Also the thickness of the
denture base can be adjusted in
case the sound S is not
produced correctly

3. Silverman also used
this word to establish
and check a proper
vertical dimension of
occlusion
Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

T, D, N and L word
Rugae area is very important
for the production of these
sounds
Tongue must be placed firmly
against the anterior part of the
hard palate for the production
of these words

• Therefore…. Should rugae be duplicated in the
denture or no is the question that arises….
Slaughter say.. The smoothness of the denture is
disturbing and the tongue looses its capacity for local
orientation
Landa says that rugae is useless or even detrimental
because it adds more bulk to the denture…
Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

• If teeth too lingual – T will sound like D
• If teeth too forward - D will sound like T

PALATOLINGUAL SOUNDS FORMED BY
TONGUE AND SOFT PALATE
Consonant k, ng and g are
representative of the palatolingual
group of sounds.
Sound is 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 realising the air
in a puff

• If the posterior borders are over extended or if there is
no tissue contact k becomes ch sound.

LINGUODENTAL SOUNDS
Consonant Th is representative of the
linguodental group of sounds
Dental sounds are made with the tip of
the tongue extending slightly between
the upper and lower anterior teeth.

LINGUODENTAL SOUNDS
• Sound is actually made closer to the alveolus
(the ridge) than to the tip of the teeth.
• Careful observation of the amount of tongue
that can be seen with the words - this, that,
these and those will provide information as to
the labio-lingual position of the anterior
teeth.

• If about 3mm of the tip of the tongue is not visible, the
anterior teeth are probably too far forward,
• If more than 6mm of the tongue extends out between
the teeth when such sounds are made, the teeth are
probably too lingual
.

LINGUOALVEOLAR SOUNDS
Formed with the valve
formed by contact of the tip
of the tongue with the most
anterior part of the palate (the
alveolus) or the lingual sides
of the anterior teeth.
T, D, S, Z, V & 1 are
representative of the
linguoalveolar group of sounds
Robert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223)

LINGUOALVEOLAR SOUNDS
• Sibilants (sharp sounds) s, z, sh, ch & j
(with ch & j being affricatives) are alveolar
sounds, because the tongue and alveolus forms
the controlling valve.
• Important observations when these sounds are
produced are the relationship of the anterior
teeth to each other.

Upper and lower incisors should approach end to
end but not touch.
Failure indicates a possible error in the horizontal
overlap of the anterior teeth
Ref :- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

LABIODENTAL SOUNDS
• F and V are
representatives of the
labiodental group of
sounds.
• Formed by raising the
lower lip into contact
with the incisal edge
of the maxilliary
anterior teeth.

Upper anterior teeth are too
short (set too high up), V
sound will be more like an F.
• If they are too long (set too
far down), F will sound
more like a V.
Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J
Prosthet Dent;1961;11:214-223)

BILABIAL SOUNDS
• B,p and m are
representatives of the
bilabial group of
sounds.
• Formed by the stream
of air coming from the
lungs which meets
with no resistance
along its entire path
until it reaches the lip.

1. Used to asses the correct
interarch space
2. Correct labiolingual
positioning of the anterior
teeth
3. Labial fullness of the rims
can also be checked
Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

PHONETICS IN RECORDING JAW
RELATION
• Also called as the speaking
method
• Sibiliant sounds like S and M is
used.
• S sound gives the approximate
closest speaking space
• M sound gives us the freeway
space
• Approximately 2mm of space
must be there between the two
occlusal rims
Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet dent 1953;3:193-199

S-SOUND AND THEIR PROSTHODONTIC
COSIDERATIONS
• Say now shibboleth; and he said
sibboleth, for he could not frame to
pronounce it right…..”
(THE BIBLE )

1. Thickness of denture
2. Antero-posterior position of teeth
3. Vertical dimension of occlusion
4. Width of dental arch:
5. Relationship of upper teeth to the lower anterior teeth
by “S-POSITION

DIFFERENT PARTS OF ORAL CAVITY AND
THEIR INFLUENCE ON SPEECH
TONGUE: LIPS
PALATE TEETH

PROSTHODONTIC IMPLICATION IN
DENTURE DESIGN AFFECTING
SPEECH
1. Denture thickness and peripheral outline
2. Vertical dimension
3. Occlusal plane
6. Anteriorposterior positioning of teeth
5. Post dam area
7. Width of dental arch
4. Relationship of the upper and lower teeth
Fenn, clinical dental prosthetics, 3rd edition pg 138

DENTURE THICKNESS AND
PERIPHERAL OUTLINE
• If the denture bases are
too thick.
• Lisping will occur with
the word like S C and Z
• Palatolingual sounds
most affected. (T,D).
Ref:-Fenn, Clinical dental prosthetics, 3rd edition pg 138

VERTICAL DIMENSION
• Bilabials are mostly
affected P B and M
• If both rims touch
prematurely it
indicated excessive
vertical dimension.
• In try in stage teeth
clicking will be heard.
Ref:-Fenn, clinical dental prosthetics, 3rd edition pg 139

OCCLUSAL PLANE
• Labioldental sounds F and
V are affected.
• If occlusal plane is too
high the correct positing of
the lower lip is difficult
• If the occlusal plane is too
low there is overlap of the
lower lip on the labial
surface of upper teeth
Ref:-Fenn, clinical dental prosthetics, 3rd edition pg 138

ANTERIORPOSTERIOR
POSITIONING OF TEETH
• F and V sounds are
hampered.
• labiopalatal positions of
the teeth is very
important
• Teeth if placed to
palatally the lower lip
will not meet the insical
edge of the upper teeth.
Ref:-Fenn, Clinical Dental Prosthetics, 3rd edition pg 138

POST DAM AREA
• Palatolingual consonants are affected (K,
NG and G)
• Thick post dam areas will irritates the
dorsum of the tongue
• Patient feels nausea like effect while
speaking
• If inadequate the plosive sound of the
word is hampered
• This area is very important in singers
who wear complete denture

WITDH OF DENTAL ARCH
• If teeth are set into an
arch that is too narrow
the tongue will be
cramped
• Consonants like T, D, N
K and S are affected

RELATIONSHIP OF THE UPPER
AND LOWER INCISORS
• The chief concern is the
S CH, J and Z sound.
• These sounds need a
near contact of the
upper and lower teeth so
that the air stream is
allowed to pass.

SPEECH TEST
• The speech test should be made after satisfactory
esthetics, correct centric relation, proper vertical
dimension and balanced occlusion have been attained
and after wax up for esthetics has been completed.

TEST 1:TEST OF RANDOM SPEECH
• Engage the patient in a conversation and obtaining a
subjective speech analysis by asking the patient say
how he feels, how his speech sounds to him and what
words seem most difficult to pronounce.

TEST 2: TEST OF SPECIFIC SPEECH SOUNDS
• This is best accomlpished by having the patient say 6-8
words containing the sound and then combining these
words into a sentence.The following is the list of
sounds to be tested

S,Sh Six, sixty, ships, sailed
Mississippi, sure ,sign, sun,
shine
Sixty six ships sailed
Mississippi. Sure sign of sun
shine
T,D,N,L Locator, located, tornado, near,
Toledo
Locator located tornado near
Toledo
Ch,J Joe, Joyce, joined, George,
Charles, church
Joe and Joyce joined
George and Charles at
church
K Committee, convented, political,
convention, Connecticut
The committee convented at
the political convention in
connecticut.
F,V Vivacious, Vivian, lived, five,
fifty, five, fifth, avenue
Vivacious Vivian lived at five
fifty-five fifth avenue

TEST 3: TEST OF READING A PARAGRAPH
Make the patient read a paragraph containing abundance
of S, Sh, Ch sounds.

SPEECH ANALYSIS
• 2 categories
• 1) Perceptual / acoustic
• Based on broad band spectrogram, recording by
Sonograph
• Objective opinion of performance
(Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

2) Kinematic movement analysis :
– Ultrasonics
– X-ray mapping
– Cineradiography
– Optoelectronic articulatory movement tracking
– Electropalatography
Ref:- Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

PALATOGRAPHY
• What is palatography?
• a group of techniques to record contact between the
tongue and the roof the mouth to get articulatory
records for the production of speech sounds.

PREREQUISITE FOR MAKING
PALATOGRAM
1. The artificial palate made must be uniformly adapted,
no adhesive must be used.
2. Patient who have severe gagging must not be used for
making palatograms.
3. The patient has to be trained to open his mouth
after uttering the desired word.
4. The tracing material must not be distasteful and
its consistency should permit easy application

5. The palate has to be thoroughly dried before the
medium is applied and the medium must have a
contrasting colour so that it can be easily identified
6. Talc is considered the best material that can
be used for palatogram, although activated
charcoal, chocolate powder where also used

PALATOGRAM OF
VOWELS.
PALATOGRAM OF
CONSONANTS.

TERMINLOGIES RELATED TO
SOME SPEECH DISTURBANCES
1. APHASIA (DYSPHASIA): Means defective speech due
to damage of cortical area required for speech making.
(Broca’s area, Wernicke’s area).
2. DYSARTHRIA: Motor speech problems caused, not due
to sensory loss or mental retardation.
3. SPEECH AND LANGUAGE RETARDATION: Delay
in acquistion of communicating skills

DISORDERS OF SPEECH
Hypernasality Hyponasality
Denasality
NASAL BALANCE
Eg: m, n & ng
b d g
Morning  bordig

ARTICULATOR DEFETCS
Distortion
Eg: Vowel  pop for pipe
Consonants  cah for car
Substitution
Eg: teef for teeth
Omission
Eg: bow for boat

RELATION TO MAXILLOFACIAL DEFECTS
Acquired
Accidental or surgical
Nervous system – cerebral
palsy, lateral sclerosis,
poliomyelitis, myasthenia
gravis, myotonic dystrophy
Congenital
Cleft palate,
Short palate,
Large velopharyngeal
space,
Limited velar mobility,
Submucous cleft palate

CORRECTING SPEECH DEFECTS
RELATED TO IMPLANT PROSTHESIS
• A fully bone anchored prosthesis in maxilla can cause
phonetic problems,
• Normal pronunciation is possible after approximately 3
months,
• removable appliances like artificial gingival extensions
made of silicones or resin materials should be given.

REFERENCES
1. John. Sharry. Complete denture Prosthodontics 3rd
edition; Phonetics.
2. Zarb- Bolender:Speech consideration with complete
dentures ;Prosthodontic treatment For Edentulous
Patients.
3. Fenn, Clinical Dental Prosthetics, 3rd edition pg 138.
4. Chierici, Lawson; Clinical speech consideration in
prosthodontics. J Prosthet dent;1973;29;1:29-39.
5. Robert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223).
6. Meyer M Silverman :The speaking method in
measuring vertical dimension; J prosthet dent
1953;3:193-199.

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