Denture Try-In Phonetic Tests

[Affinity]

Can any of the removable gurus share some tips for some phonetic testing during the try-in stage. What are you looking for when having the patients say "S" etc..

 

[2thm8kr]

I'm not a removable guru, but do a fair amount of full arch fixed work changing length of upper interiors. I have the patient count from 60-70 slowly and at their regular cadence. I watch how their lower lip touches the incisal edge and listen for any lisping. Also try and detect if any air is escaping under any pontics. I also ask the patient if everything feels 'normal' or it they are laboring to speak.

I'll also add that I check their profile and lip closure path.
I have found if the teeth are not way to long it only takes very minor adjustments to the length to eliminate a lisp. Fortunately its a lot easier to do with acrylic temps then adjusting a denture wax up.

 

[kcdt]

From University of Iowa, under troubleshooting dentures:

"Speech Problems

It takes patients from 2 – 3 weeks to accustom themselves to dentures, so it is difficult to judge this early on, but some things to think about are:

Patients are adaptable and generally will correct speech difficulties (not directly related to technical error) within 2 or 3 weeks, so most patients can be assured they will get past the difficulty
The pronunciation of the letter "s" is the most common speech problem; the patient may even have involuntary hissing or whistle. This can be caused by:
Rugae area too thick or too thin or the maxillary anterior teeth may be set too far lingually. If the patient has a heavy anterior ridge and the denture is thick, the rugae area should be thinned to allow more space for air to escape. If the anterior ridge is small and thin, likely too much air is escaping and wax on the palatal surface should correct the problem (autopolymerizing resin can then be added if the wax shows this to be an effective correction). If the maxillary anterior teeth are set too lingually, they must be reset or you may try heavy festooning just lingual to the teeth. If these remedies don’t work, sometimes adding a median ridge will help.
Inability to speak clearly may be due to the lack of tongue room posteriorly on the mandibular denture.
Overextension of the upper denture onto the soft palate results in speech difficulties, as the patient has to make a conscious effort to keep the denture in position when talking."

 

[2thm8kr]

Thanks for posting that KC.

 

[kcdt]

There is also a close correlation between the "s" sounds and the mandibular rest position. The reason the clinician has the patient count through the sixties and say things like Mississippi during wax trial is to
determine if VDO is proper. Whistling or air escaping may indicate too much freeway space; clicking or having the "s" sibilant become a "th" ,may indicate the VDO is too open.
I say "may" because a whistling "s" may indicate the maxillary centrals are too labial, and a "sh" or "th" produced during "s" may indicate they are too lingual. If the position is fine, then either the base/rugae are too thin or thick, rspectively.

 

[sas]

Can any of the removable gurus share some tips for some phonetic testing during the try-in stage. What are you looking for when having the patients say "S" etc..

The anterior teeth should have about 1 mm clearance when counting out loud at 60 and going up. If they hit the bite has been opened, close it. If there is a large space the bite has been closed, you need to open the bite accordingly. The vertical dimension of occlusion will always be a measurement inside the S sound measurement. The incisal edges of anteriors should touch the lower lip lightly, just behind the line where women put lipstick, when they are making the f and v sounds. Have the patient lightly wet their lips and swallow and check the occlusion. They can place the tongue as far back as possible and touch the roof of the mouth and close and check the occlusion. Have them sip a little water and when they swallow have them leave their teeth together and check occlusion. Ask them if they feel one side higher than the other when they close lightly. Watch the teeth come together and see if you can detect a side shift when they touch together. if you detect a slight high spot heat the wax on the lower on that side and have them easily tap the teeth together to correct it. Do not have the lower anteriors in tight occlusion in centric because any posterior adjustment will really start banging them harder. Regardless of the class of occlusion you do not want the teeth to touch when speaking.

 

[2thm8kr]

!PMUB

 

[actittle]

Here are a few links to articles that I have found to be helpful

http://www.vita-masterlab.com/resourcesvita/shop/en/en_3056279.pdf

http://www.glidewelldental.com/downloads/dentist/education/articles/ivm14_vertical_dimension.pdf

 

[JohnWilson]

Hey nice info, I had read the Pound info years ago in a book but I had not seen the Vita info, I will enjoy readin it thanks for sharing it

 

[Affinity]

thanks for all the replies, just what I was looking for.. it was also an important topic I hadnt seen discussed here, so I thought Id open it up.

 

[PCDL]

For a quick test, have your patient say "Fifty-" and "Sixty-Six". The "F" sound will show you how the incisal edges play against the lower lip, as well as alert you to any protrusion or retrusion of the anteriors. Air should pass between the lower lip and the teeth. Sixty six will give you the "S" sound, as well as show you the lip's upper position during speech (not as high as a wide smile, but close). This will bring out any lisping if the palate is too thick. After that, you're pretty close to done.

 

[denturist-student]

Counting from sixty to seventy, or repeating 66 is an alternative method of measuring freeway space at the closest speaking distance. We look at the bicuspids and estimate the space present there to verify the measured readings between marks placed on the nose tip and mentum of the chin to establsh freeway space. Typically there are 2-4 mm between resting and occlusion. Fifty five is a fricative as well as V and an important method of determining the positioning of the central incisors......Have now finished my course of Denturist studies and now have to write and do a practical exam for licensing. ....Wish me luck...Take care and keep well.