PHONETICS IN COMPLETE DENTURES BASIC.ppt
- 2. PHONETICS IN COMPLETE DENTURE PHONETICS IN COMPLETE DENTURE
- 3. CONTENTS CONTENTS INTRODUCTION INTRODUCTION ANATOMY OF SPEECH ANATOMY OF SPEECH SPEECH PRODUCTION SPEECH PRODUCTION VALVING FUNCTION VALVING FUNCTION SOUNDS OF SPEECH SOUNDS OF SPEECH - TYPES OF SOUND - TYPES OF SOUND - CLASSIFICATION OF CONSONANTS - CLASSIFICATION OF CONSONANTS FACTORS RELATED TO THE DEVELOPMENT OF SPEECH SKILL FACTORS RELATED TO THE DEVELOPMENT OF SPEECH SKILL THE ROLE OF TONGUE THE ROLE OF TONGUE FACTORS IN DENTURE DESIGN AFFECTING SPEECH FACTORS IN DENTURE DESIGN AFFECTING SPEECH METHODS OF SPEECH ANALYSIS METHODS OF SPEECH ANALYSIS SPEECH TESTS SPEECH TESTS GENERAL REMEDIAL PROCEDURE FOR SPEECH DEFECTS GENERAL REMEDIAL PROCEDURE FOR SPEECH DEFECTS DISORDERS OF SEECH DISORDERS OF SEECH PHONETICS IN CLEFT PALATE PHONETICS IN CLEFT PALATE PHONETICS & IMPLANTS PHONETICS & IMPLANTS CONCLUSION CONCLUSION REFERENCES REFERENCES
- 5. Phonetics : The study of speech sounds, their production and combination and their representation by written symbols. OR The description and analysis of the sounds of a particular language. Phonemics : The description and classification of the phonemes of the specific language. Phoneme : A set of phonetically similar but slightly differing stand in a language that are heard as a same sound by native speakers and are represented in phonemic transcription by the same symbol. Eg : Phoneme |P| includes phonetically differentiated sounds represented by P in pin, spin, tip. TERMINOLOGIES
- 6. • Thyroarytenoid muscle • Inner edges – Vocalis • Elastic tissue, stratified epithelium • Vibrations Horizontal up to 4 mm Slightly vertical 0.2 – 0.5 mm • Average length Males – 15 mm Deeper pitch Females – 11 mm • Vestibular fold VOCAL CORDS ANATOMY OF SPEECH
- 7. MUSCLES
- 8. Sensory (language input) Motor (language output) Sensory Speaking a heard word Speaking a written word NEURAL BASIS OF THE SPEECH
- 9. MOTOR COMPONENT : MOTOR COMPONENT : 1. Respiration – Source (air in the lungs) 1. Respiration – Source (air in the lungs) 2. Phonation – vibrator (vocal cords) 2. Phonation – vibrator (vocal cords) Breath stream modified Breath stream modified 3. Resonance (selective amplification) 3. Resonance (selective amplification) 4. Articulation (shaping) 4. Articulation (shaping) Resonators – pharynx Resonators – pharynx - oral cavity - oral cavity - nasal cavity & - nasal cavity & paranasal sinuses paranasal sinuses
- 10. ARTICULATORS OF ORAL CAVITY Soft palate Active Lips, Mandible & Tongue Passive Teeth, Alveolar ridge, Hard palate Naso-oral balance Sound ‘K’
- 11. VALVING FUNCTION VALVING FUNCTION 1. 1. Glottal valve Glottal valve 2. Palatopharyngeal valve 2. Palatopharyngeal valve 3. Linguovelar valve 3. Linguovelar valve 4. Linguopalatal valve 4. Linguopalatal valve 5. Linguoalveolar valve 5. Linguoalveolar valve 6. Linguodental valve 6. Linguodental valve 7. Labiodental valve 7. Labiodental valve 8. Bilabial valve 8. Bilabial valve Interrupt, impede and constrict Interrupt, impede and constrict
- 12. SOUNDS OF SPEECH Vowels Diphthongs Consonants Combinations Vowels : • Continuous harmonic sounds • “aaaa – eeee – uuuu” • ‘a, e, i, o & u’ a, i, u are extreme • E & O are between these extreme positions
- 13. Diphthongs : • Diphthongs are blends of two vowels spoken within a single syllable without interruption of phonation. Eg: main, tine, tone Consonants : • Impeded, diverted or interrupted • Voiced or breathed • Most affected by dental or occlusal anomalies and dental interventions. Combinations : • Blend of consonant and vowel articulated in quick succession - identified as a single phoneme although the blend can be separated into two component sounds. Eg: Beauty.
- 14. CLASSIFICATION OF CONSONANTS Manner of production Laterals Plosives Fricatives Liquids Retroflexes Glides Nasals Affricatives Plosives : • Overpressure contact between soft palate and pharyngeal wall. Eg: |p| & |b|, |t| & |d|, |k| & |g| Fricatives : • Air stream is forced through a constriction resulting in turbulent, noisy air flow. Eg: s & z; sh & zh, f & v, θ & δ. • Sibilants – ‘s’ like sound • Misarticulation of sibilants – lisping / sigmatism.
- 15. Affricatives : • Combination of plosives and fricatives |ts| in cheese |dz| in jungle. Nasals : • Produced without oral exit of air |m|, |n| & | ng| Glides : • Gradual changing articular shape |w| & |j| • Little impedance to air stream • Approximants Retroflexes : • The tip of tongue is bent backward
- 16. Laterals : • Body of the tongue is raised and air streams past to right and left of the tongue. • Laminar air flow. Eg : | l | • |r| & |l | - semivowels – least impedance. Liquids : • Produced without friction • Nasal and semivowels • Continuants Fricatives, Nasals and Semivowels.
- 17. ACCORDING TO LARYNGEAL ACTION Voice less / surd • Aperiodic sound produced by impedance within oral cavity Voiced / sonant • Counterpart of surds • Produced in similar manner with vibration of adducted vocal folds. Plosives Plosives Fricatives Fricatives Affricatives Affricatives Voice less Voice less p t k p t k s f s f θ θ |ts| |ts| Voiced Voiced b d g b d g z v z v δ δ |dz| |dz|
- 18. Pressure characteristics : • Variation in amount of intraoral breath pressure • Fricatives, affricatives and plosives – pressure consonants • Continuants > non continuants • Voiceless > voiced Place of production : • Most meaningful
- 19. • Upper incisors and labiolingual center to the posterior third of the lower lip. • /F/ & /v/ LABIODENTAL
- 20. • Tip of tongue extending slightly between upper and lower anterior teeth. • Sounds are made closer to alveolus. • /Th/ in ‘this’, ‘theta’ LINGUODENTAL CONSONANT
- 21. 10 sounds – divided into 5 types depending on distinct place and manner of production a) t & d ; n LINGUOALVEOLAR
- 22. b) Fricatives s & z Formation of a midline groove of the tongue
- 23. c) Fricatives |s | & |z| ‘sh’ & ‘zh’ • Broader groove compared to s & z • Can be discussed as linguopalatal
- 24. d) |ts| & |dz| linguoalveolar or palatal affricatives Tongue placement plosives air exploded through constriction.
- 25. e) Lateral |l| • Tip of tongue in contact with alveolus • Lowered lateral margins – facilitates air flow .
- 26. • |r| & |j| - produced by lingual approximation to some portion of the palate. • |r| tip of the tongue is often pointed to an immediately post dental area. • Tongue blades are arched and tip points down. • Phoneme adjacent to |r| will determine the contour of the tongue. LINGUOPALATAL
- 27. |j| - Linguopalatal glide Tongue raised toward the front of hard palate but in the course it moves to a position appropriate for articulation of phoneme.
- 28. Linguovelar |k|, |g| & |ng| •Contact of the middle of the tongue with soft palate.
- 29. BILABIAL Lip closure |p|, |b| & |m| I/O breath pressure is impounded behind closed lips Lip rounding |w| Moves to appropriate position
- 30. Glottal consonant |h| • Turbulence created when breath stream passes between partially approximated vocal folds. • Palatopharyngeal valve is closed • Tongue & lip position do not influence
- 31. Tongue – Principal articulator : • Key to speech learning • Divided into 3 parts
- 32. DEVELOPMENT OF SPEECH SKILL 1. Speech sound mastery • 2 ½ yr : 27 phonemes • 8 yrs : All consonants 2. Intelligence AGE(in months) AGE(in months) CONSONANTS CORRECTLY CONSONANTS CORRECTLY USED IN WORDS USED IN WORDS Between 3-4 Between 3-4 m,b,p,w,h m,b,p,w,h Between 4-5 Between 4-5 n,t,d,k,g,j n,t,d,k,g,j Between 5-6 Between 5-6 f,v,s,z f,v,s,z Between 6-7 Between 6-7 l,th l,th Between 7-8 Between 7-8 r,wh,s,z r,wh,s,z
- 33. 3. Hearing loss • Deaf or profoundly hard of hearing : Slow acquisition of symbol system Intelligible speech • Less severe: Loss of vocal melody Control of intensity Fricatives and affricates 4. Impairment of motor control • Cerebral palsy, neuromuscular impairment • Spastic cerebral palsy • Athetosis, chorea, dystonia • Apraxia
- 34. 5. Specific language disability • Difficulty in handling symbol system • Sequencing and recall • Dyslexia – reading disability 6. Psychosoical factor • Number of people in family • Relative position of child • Socioeconomic status
- 35. Allen (1958) Morton (1963) Denture thickness and peripheral outline • Decrease in air volume and loss of tongue space. • Thickness of denture base at the center of the palate. • Overextended periphery – encroach on movable tissues. Tanaka (1973) • Palatal contour – adversely affects affricatives and fricatives. • Significant improvement in speech with time. Non anatomic papilla – source of turbulence,tactile locating point. FACTORS IN DENTURE DESIGN AND SPEECH
- 36. Vertical dimension : Meyer M. Silverman (1953) Method : • Head position • Centric occlusion line • Closest speaking line Reevaluation of VD – Clicking of teeth • |m| - passive lip contact • Strained lip contact or inability to contact lips : increase VD No vertical overlap
- 37. Effect of tooth positioning : (Boucher) • Insufficient support of lips. • Anteroposterior positioning of anteriors. • Problems in bilabials (p & b). If placed far palatally • Contact with lingual side of lower lip. • Problems in labiodentals (f & v). Occlusal plane • Too high : V F • Too low : F V
- 38. Linguoalveolar sounds : • Incisors approach end-end but not touch. • Check for relative positions of incisors. • Failure to approach end-end possible error of overjet • Linguodental sounds : This, That • Amount of tongue that can be seen • If < 3 mm : Anteriors too far forward. Excessive overbite • If > 6 mm : Teeth placed too far lingually. Linguopalatal and linguovelar – less problem.
- 39. Postdam area : • Thick base at postdam area • Posteriorly squared instead of chamfered Irritation dorsum of the tongue Impeding speech and feeling of nausea. • Inadequate PPS Unseating of dentures on production of those sounds having explosive effect. Sudden repositioning of tongue to stabilize and control dentures Poor quality speech
- 40. Width of the dental arch : Too narrow – cramped tongue as well air channel. Faulty articulation of sounds requiring contact of tongue blades to posterior teeth and alveolus. Position of artificial teeth – close to natural dentition. Christoph Runte et al (2001) Poorer execution of |s| sound Labial > palatal Immediate phonetic adaptation – max. incisors – original position
- 41. METHODS OF SPEECH ANALYSIS a) Perceptual / acoustic • Broadband spectrogram -Recording by Sonograph • Objective opinion of performance b) Kinematic movement analysis • X-ray mapping • Cineradiography • Optoelectronic articulatory movement tracking • Electropalatography Failure of conventional means Why ? • Basis for future comparison • Identify problems
- 42. • Tongue contact patterns • 60-80 contact electrodes • EPG main unit • Computer • Record touched and untouched electrodes at high frequency mapping. Continuous palatography : Plastic artificial palate protruding electrodes copper wire amplifier and read out unit motion pictures frame by frame analysis. ELECTROPALATOGRAPHY
- 43. Palatograms : • Leslie Allen (1958) • No two individuals contacted exactly the same area – similarity to constitute a pattern. • S and SH – individual similarity and distinct pattern. Study of vowels : • Tongue – palatal contact for all except with |O| • Phone |e| occurs singly • U = (ee – oo) i = (i – ee)
- 44. Palatograms for consonants : • Occurs in consort with vowels Eg: t or d occlusive articulation e a follows j & k. e precedes s, n and l. • Isolation of consonants on palatograms Consonant produced initially vowel Consonant + O = may not be a standard English word.
- 45. Sequence of palatograms : 1. s & sh palatograms are made sh line – guide for waxing posterior alveolar area s line – anterior alveolar area • Formation of groove • Whistling or hiss – larger goove • Lisp (th for s) or indistinct ‘s’ – inadequate groove • Sears – creation of groove 2. Palatograms for plosives (t, d) are made 3. Palatograms for ch & j are made • Midanterior alveolar wax up may flow on palate bit posteriorly.
- 46. TWO PHILOSOPHIES Placing the artificial teeth in Placing the artificial teeth in the same relative position as the same relative position as the dentition the dentition Entire alveolar area wax up Entire alveolar area wax up Placing artificial teeth Placing artificial teeth according to mechanical according to mechanical advantage advantage Limited value Limited value • Severe resorption – anterior ridge gives no clue to natural tooth position. Speech tests : Test I – Test of random speech Test II – Test of specific speech sounds Test III – Asking patient to read a short para
- 47. Remedial procedures for speech defects : John M.Palmer 1974---- 5 steps • Pre treatment speech assessment • Accommodation period – 4 weeks • Analysis of static – dynamic relationships • Structural ( denture) adjustments • Clinical speech consultation ( if needed) Work of prosthodontist – primarily articulation and resonance influences the role of dentition in valving & speech production
- 48. DISORDERS OF SPEECH Hypernasality (Rhinolalia aperta) Hyponasality (Rhinolalia clausa) Denasality Eg: m, n & ng b d g Morning bordig Nasal balance
- 49. Replacement of intended oral consonants formed farther down the vocal tract. To prevent adverse effect of defective articulator. Distortion Eg: Vowel pop for pipe Consonants cah for car DISORDERS OF ARTICULATION Substitution Eg: teef for teeth Omission Eg: bow for boat
- 50. Testing for nasal balance : • Vowels = resonated sound + little air flow. • ee and oo hypernasality • |m| hyponasality • Undue nasal bridge vibration. • Alternate occlusion and opening of nostrils • Nasal emission of air with voiceless consonants
- 51. Test for articulation : • Recording of abnormal sounds Phonetic symbols on paper or electronically on tape, disc or spectrogram. • Talking when nostrils open or closed. • Wrinkles on nasal alae. • Abnormal tongue movement – palatal defect Eg: ‘n’ in banana.
- 52. GENERAL CONSIDERATIONS OF VELOPHARYNGEAL CLOSURE Swallowing All 3 constrictors are fired, contact at lower level Age up to 8 yrs below Palatal Plane Head position deeper nasopharynx Sex males longer soft-palate • Greater elevation • Less amount of contact • Higher positioning of inferior point of contact
- 53. RELATION TO MAXILLOFACIAL DEFECTS Acquired • Accidental or surgical • Nervous system – cerebral palsy, lateral sclerosis, poliomylitis, myasthenia grevis, myotonic dystrophy • Functional • Atypical articulation Urban speech nasal snort Congenital •Cleft palate, lip •Short palate, •Large velophoryngeal space, •Limited velar mobility, •Submucous cleft palate
- 54. •Correction of palatal defect itself •Goal •Fistula / hole – flanged acrylic button •Velar defects – palatal lift Prosthesis Device CORRECTING DISORDERS OF SPEECH Prosthodontist Surgeon Substitution
- 55. COMPENSATION Raising the pitch > 2 syllables / sec Pressure Articulator position Velum Pharyngeal wall Speech modification Increased / Atypical function Superiorly > posteriorly Mesial movement Horizontally > vertically
- 56. Total laryngectomy : Rehabilitated by • Training in oesophageal speech. • Using electronic artificial larynx • Asai technique Epithelial lined tube Excellent sound quality Aspiration of saliva and food
- 57. 1. Oral and facial balance, mastication and speech. 2. Preservation of what is remaining. 3. Maximum retention and support. 4. Mouth preparations. 5. Minimum weight and size. 6. Material used. 7. Avoid displacement of soft tissues. 8. Least displacement. 9. Superior portion – nasal secretions. Oral portion – tongue movements. 10. Placement of speech bulb – at greatest activity REQUIREMENTS OF SPEECH APPLIANCES
- 58. SPEECH AND IMPLANT PROSTHESIS Functional speech problems when giving an implant prosthesis Removable artificial gingiva made of resin or silicone—Parel et al 1986
- 59. Labio dental – f & v Bilabial closure S, Z, L ‘th’ in | | | | COSMETIC MODIFICATION OF ORAL CAVITY
- 61. LIST OF REFERENCES LIST OF REFERENCES Medical Physiology – Guyton Medical Physiology – Guyton Oral Bioscience – David B Ferguson Oral Bioscience – David B Ferguson Clinical Oral Physiology – Timothy Miles Clinical Oral Physiology – Timothy Miles Essentials of Oral Physiology – Bradley Essentials of Oral Physiology – Bradley Complete Denture Prosthodontics – John Sharry Complete Denture Prosthodontics – John Sharry Diagnosis & Treatment in Prosthodontics – William Laney Diagnosis & Treatment in Prosthodontics – William Laney Prosthodontic Treatment for Edentulous Patients – Zarb Boucher Prosthodontic Treatment for Edentulous Patients – Zarb Boucher Maxillofacial Prosthesis – Varooujan Chelian Maxillofacial Prosthesis – Varooujan Chelian Osseointegration & Occlusal rehabilitation – Hobo Osseointegration & Occlusal rehabilitation – Hobo J oral Rehabil 1995 ; 22 ; 295 – 99 J oral Rehabil 1995 ; 22 ; 295 – 99 Quintessence Int 1994 ; 25 : 341 – 45 Quintessence Int 1994 ; 25 : 341 – 45 J Oral Rehabil 1985 ; 12 : 69 – 79 J Oral Rehabil 1985 ; 12 : 69 – 79 J Prosthet Dent 2001; 85 : 485 – 95 J Prosthet Dent 2001; 85 : 485 – 95 J Prosthet Dent 1999 ; 81 : 579 – 85 J Prosthet Dent 1999 ; 81 : 579 – 85 J Prosthet Dent 1987 ; 57 : 53 – 7 J Prosthet Dent 1987 ; 57 : 53 – 7 J Prosthet Dent 1974 ; 31 : 605 – 14 J Prosthet Dent 1974 ; 31 : 605 – 14 J Prosthet Dent 1973 ; 29 : 16 – 28 J Prosthet Dent 1973 ; 29 : 16 – 28 J Prosthet Dent 1963 ; 13 : 236 – 9 J Prosthet Dent 1963 ; 13 : 236 – 9 J Prosthet Dent 1958 ; 8 : 753 – 63 J Prosthet Dent 1958 ; 8 : 753 – 63 Br Dent J 1961 ; 5 : 406 – 11 Br Dent J 1961 ; 5 : 406 – 11
- 63. Next Journal Club Next Journal Club on on Saturday (29/7/06) Saturday (29/7/06) by by Dr. Renuka Prasanna Dr. Renuka Prasanna