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A Chair-side correction of a speech problem due to a complete denture

Article  in  Dental Update · September 2014

DOI: 10.12968/denu.2014.41.7.657

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Technique Tips – A Chair-side Correction of a Speech
Problem Due to a Complete Denture
With an increasing elderly population there
is an increased prevalence of edentulism and
a need for complete dentures.1,2 Traditionally,
complete loss of teeth is restored with a
conventional complete denture. Several
problems are reported to be associated
with the use of complete dentures.3-5 These
problems include discomfort, looseness of
dentures, adaptation difficulty and phonetics.
These complications are not uncommon
and dental practitioners need to be able to
diagnose and manage such complications.
In this clinical tip, a 62-year-old male patient
presented to the Dublin Dental University
Hospital (DDUH) complaining of a loose
upper complete denture and requesting a
new one to be made. Clinical examination
revealed a completely edentulous upper
jaw and Kennedy Class I lower arch. The
upper edentulous jaw was restored with a
conventional complete denture while the
lower jaw was not restored. Both arches
had good alveolar ridges with a Class II
skeletal relationship. The patient’s denture
stability and retention were poor and it was
approximately 10 years old. After discussing
treatment options with patient, the following
treatment was carried out: upper complete
denture and lower chrome cobalt removable
partial denture using the RPI system. A new
upper complete denture was made along
with a lower chrome cobalt removable partial
denture. On review, the patient reported
difficulties in speech and making a whistle
sound when pronouncing words with sibilants;
in particular when he pronounced ‘flowers’,
which was heard as ‘flowersh’.
A subsequent examination
revealed an increase in the closest speaking
space. Further clinical examination was carried
out to study the cause of the existing speech
problem. The clinical examination revealed
that the incisor relationship between the
upper artificial and lower natural teeth, in the
normal occlusal vertical dimension (OVD),
was about 5 mm and a large space between
the incisal edges of the lower anterior teeth
Aslam Fadel Alkadhimi, Fifth Year Dental Science Student, Rose McCann, Fifth Year Dental Science Student, Nazatul Husna
Kamaruzaman, Fifth Year Dental Science Student, Mohamed Hania, Fourth Year Dental Science Student and Abdulhadi Warreth, BDS,
MDentSc, PhD, MFDS RCS, Restorative and Periodontology Division, Dublin Dental University Hospital, Dublin, Ireland.
September 2014 DentalUpdate 657
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TechniqueTips
and the palatal surface of the denture could Dent 1994; 71: 41–112.
be seen. This relationship was dictated by 2. Müller F, Naharro M, Carlsson GE. What are
the skeletal relationship as the patient had a the prevalence and incidence of tooth loss in
Class II skeletal relationship. Furthermore, the the adult and elderly population in Europe?
incisal edge of the upper two central incisors Clin Oral Implan Res 2007: 18 (Suppl 3): 2–14.
was placed almost at an equal level incisally 3. Petrovic A. Speech sound distortions
with those of the lateral incisors (Figure 1). caused by changes in complete denture
Any of these findings may have caused the morphology. J Oral Rehab 1985; 12: 69–79.
speech problem. Therefore, Red beading wax® 4. Seifert E, Runte C, Riebandt M, Lamprecht-
(Associated Dental Products Ltd, Kemdent Dinnesen A, Bollmann F. Can dental
Works, Swindon, UK) was added to the palatal prostheses influence vocal parameters?
surface of the upper anterior teeth in order J Prosthet Dent 1999; 81: 579–585.
to reduce the horizontal overlap. A little 5. McCord JF, Firestone HJ, Grant AA. Phonetic
improvement was observed but the patient determinants of tooth placement in complete
still had speech difficulties. The length of the dentures. Quintessence Int 1994; 25: 341–345.
four incisors was then increased by about
2 mm. Speech returned to normal and the
patient was able to create intelligible speech.
The patient was involved in a conversation and
different sibilant sounds were pronounced.
Accordingly, the options were to reset the
upper four incisors in the laboratory and to
retry the denture in wax again. This is a lengthy
clinical and laboratory procedure which leaves
the patient without his denture for some
time. The second option was to replace the
beading wax with an acrylic resin which has Figure 1. An anterior view of the upper com-
the same shade as the teeth. However, the plete and lower RPD immediately after denture
acrylic is liable to discoloration and needs to delivery. Note the incisal edges of the upper two
be frequently changed. As the patient declined central incisors are set almost on the same level
to leave the clinic without the denture, the with the two lateral incisors, which were then
corrected.
second option was carried out. Therefore,
the wax was replaced by auto-polymerizing
acrylic (Snap® Parkell, Inc, NY, USA) (Figure 2).
An acrylic resin of the same shade as the teeth
was added to the teeth and the palatal surface
of the denture in order to regain the normal
phonetics. The acrylic was adjusted until the
patient was able to create intelligible speech.
One week later, the patient was
satisfied with the result. This method is fast
and can be carried out in clinic, but should be
considered as a provisional measure only.
References Figure 2. A palatal view of the polished surface
of the denture after adding auto-polymerizing
1. Glossary of Prosthodontic Terms. The
acrylic (Snap® Parkell, Inc, NY, USA).
Academy of Prosthodontics. J Prosthet