Hooked on Phonetics
Esthetic positioning of maxillary incisal edges may create a phonetic concern depending on the adaptability of the patient to the new position. Anytime you make significant changes in anterior tooth position, patients can react very strongly to those changes, causing things such as speech impediments, or they can have little to no reaction and adapt immediately.
Patients who are already fitted with dentures or overdentures may adapt very quickly, whereas patients with natural teeth may take up to a month to get used to the changes and can develop some of the following phonetic issues during the process.
“F and V” sounds. These sounds evaluate the incisal edge of the upper incisors to the lower lip. In most cases, the incisal edge should touch the “wet-dry’ line of the lower lip without causing any phonetic issues. If your patient continues to have difficulties with these sounds for more than a month after the treatment, this may be an indicator that the incisors you placed are a little too long.
“S” sounds. This is mainly a function of upper incisor position, lower incisor position and the tongue. When you think about how your patients make the “s” sound, some will come edge-to-edge and others will stay at the lingual. Patients who stay at the lingual rarely ever have lisping problems, but for those patients that do the former usually end up having too much contact with their teeth and will develop a lisp. If your patient is still producing a lisp for more than a month after treatment, removal of the contacts should fix this speech problem.
“Th” sounds. This sound evaluates the cingulum in relation to the tongue. When patients struggle making this sound, it’s necessary to go back and evaluate the original shape of the patients teeth. This will show you how much you need to reshape the cingulum in order to get rid of the interferences that are causing their speech issues.
Now, there are several things that can cause changes in speech. In most cases the tongue will start to adapt to changes over time, but if your patient continues to have improper speech, you need to go back to the first step of your treatment process and solve their adaptability issues before you treat them again. The most important thing to remember is to be patient in the adaptability process so your patient has time to adjust in the changes you’ve made.
Esthetics is much more than cosmetic changes made to alter appearance and there are both highly objective and highly subjective criteria applied to the creation of esthetics. View the free lesson: Looking at Faces From an Esthetic Viewpoint.