|Year : 2016 | Volume
| Issue : 2 | Page : 73-76
Influence of the complete denture treatment on patients speech intelligibility
Surekha R Godbole, Pooja Rangilal Jaiswal, Shreyas S Gotoorkar, Kiran B Kulkarni, Apurva P Madhup
Department of Prosthodontics, Sharad Pawar Dental College, Wardha, Maharashtra, India
|Date of Web Publication||6-Jan-2017|
Pooja Rangilal Jaiswal
Department of Prosthodontics, Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Context: An important aspect of oral rehabilitation that has been neglected all the while is speech efficiency which is also an important part of complete oral rehabilitation of edentulous patients apart from mastication and esthetics.
Aim: Hence, the purpose of this study was to evaluate the influence of the complete denture treatment on patient's speech intelligibility using automatic speech recognition system.
Settings and Design: Twenty completely edentulous patients were analyzed for speech intelligibility before and after denture insertion to check for improvement in phonetics after denture fabrication and insertion.
Subjects and Methods: Speech was recorded in twenty edentulous patients 2 weeks before the fabrication of new complete maxillary and mandibular dentures and 1 week thereafter. Speech intelligibility was computed based on the word accuracy by means of an automated speech recognition system, and comparison was done between speech before and after denture insertion.
Statistical Analysis Used: Statistical analysis was done using descriptive and inferential statistics using Student's paired t-test, and software used in the analysis was SPSS 17.0 version and P < 0.05 is considered as level of significance.
Results: Improvement in the speech intelligibility of the patients was noted after fabrication of denture.
Conclusions: It is possible to evaluate the mechanisms and the processes leading to speech difficulties and hence to make required adjustments within the denture which may produce the desired speech change as it is evident from the present study.
Keywords: Automated speech recognition system; speech; speech analysis
|How to cite this article:|
Godbole SR, Jaiswal PR, Gotoorkar SS, Kulkarni KB, Madhup AP. Influence of the complete denture treatment on patients speech intelligibility. Indian J Multidiscip Dent 2016;6:73-6
|How to cite this URL:|
Godbole SR, Jaiswal PR, Gotoorkar SS, Kulkarni KB, Madhup AP. Influence of the complete denture treatment on patients speech intelligibility. Indian J Multidiscip Dent [serial online] 2016 [cited 2017 Nov 17];6:73-6. Available from: http://www.ijmdent.com/text.asp?2016/6/2/73/197747
| Introduction|| |
"Speech is the use of systematized vocalization to express verbal symbols or words." (Sheridan).
Speech is an important part of human communication apart from intelligence which has made human life superior to other forms of life.  It is basically a well-coordinated learned habitual neuromuscular pattern and a sophisticated, autonomous, and unconscious activity. Production of speech needs working of neural, muscular, mechanical, aerodynamic, acoustic, and auditory factors in a well-coordinated and sequential manner.  A method that allows for the objective and independent assessment of speech in such patients has not yet been documented and authenticated and as there is no standardized assessment tool available for speech disorders in adults and children. 
Semi-standardized instruments commonly used for the analysis of speech disorders are well known.  The auditory speech evaluation by speech therapists is state of the art in analyzing speech quality as a phonetic outcome of dental rehabilitation of patients with speech disorders. However, the assessment of speech intelligibility in such patients is performed perceptually and hence lacks reliability because of differences in the speech therapists experience and judgment.  This is accompanied by the problem of reproducibility and documentation of the evaluation results.  For more reliable outcomes, transcription and multiple-choice tasks for several listeners have been found to be appropriate.  However, the use of several listeners is very time consuming and hence is mainly used for research projects. For clinical purposes, a single expert usually evaluates the patient's speech.  There exists much research in prosthetic dentistry that reports on the prominent influence of a maxillary prosthetic rehabilitation with regard to speech. 
| Subjects and Methods|| |
There are two types: Perceptual/acoustic analysis and kinematic methods for movement analysis. An acoustic analysis is based on a broadband spectrogram recorded by a sonograph when the patient is made to utter different phrases containing key phrases. Kinematic analysis includes methods such as ultrasonics, X-ray mapping, cineradiography, optoelectronic articulatory movement tracking, and electropalatography.  Speech analysis in velopharyngeal defect cases may include multiview fluoroscopy and/or nasal endoscopy may contribute to the diagnostic confirmation of the assessment of velar mobility, pattern of velar elevation, size of residual velopharyngeal, and gap lateral pharyngeal wall displacement while the patient is producing a standardized sample of connected speech. It may also contribute to the assessment of the treated patients with velopharyngeal insufficiency.  All of the above-mentioned methods are not aimed for use in routine practice but used after the failure of conventional means to improve an impaired speech production.
Objective and independent diagnostic tools for the assessment of speech quality concerned with dental parameters have only been used for single parameter of speech. However, this does not allow for deriving a global measure of speech quality as a fundamental attribute of real-life communication.  Integration of an interdisciplinary team to increase the efficacy of rehabilitation and the quality of life of patients with maxillofacial defects should also include speech therapist, surgical correction for cleft lip and palate, and prosthetic construction of appliances such as pharyngeal obturators for defects in the palate and hypernasality, palatograms can be used to shape the rugae for improving speech. Orthodontic treatment for aligning teeth for improving speech.  A computer-based technique for the objective evaluation of speech intelligibility has been introduced long back as a diagnostic tool in adult patients who suffer from neurologic diseases or who stutter, in laryngectomees with tracheoesophageal speech, and in children with cleft lip and palate.  A method has been recently evaluated for the automated analysis of edentulous patients and patients with complete dentures or partial dentures.  A validation of this system demonstrated very strong correlations between expert ratings of intelligibility and automatic assessment of word accuracy (WA) for each of the different investigations. 
To evaluate the influence of complete denture on the production of speech and speech intelligibility, according to WA of edentulous patients with and without complete denture, this study was done where analysis with automated speech recognition system was done, and a comparison was made. Institutional Ethical Committee approval was obtained.
Patients and control group
The study group consisted of twenty edentulous patients with complete dentures. All the patients were natives of Wardha district using a local dialect. None of the patient had any speech disorders between the age group of 50-60 years and was literate. Single denture patients, medically compromised patients, patients with existing speech difficulty, and old denture wearers were excluded from the study. All the patients were made to provide written consent for their participation in the present investigation after explaining the complete procedure. All complete dentures were constructed according to the standard guidelines.
Speech recording and assessment
A standardized reference text was used for all the patients in the local dialect; it was presented to the patient on a computer screen in large visible letters to be better understood and to be read easily. The patients were made to read the text once a week before the treatment was started, i.e., without denture and then with dentures inserted in place and were recorded, respectively. The recording was performed using a close-talking microphone at a frequency of 16 kHz and 16-bit quantization, and assessment was done for WA for all the patients.
| Results|| |
Student's paired 't' test
Statistical analysis was done by using descriptive and inferential statistical using Student's paired 't' test and software used in the analysis was SPSS 17.0 version and P<0.05 is considered as level of significance.
Word accuracy was significantly lower when not wearing a complete denture with mean value of 9.10 compared to after denture insertion of 14.20 with a standard deviation of 1.86 and 1.39 respectively ( table no. 1 and graph 1) [Additional file 1]. p value found to be was 0.0001. A significant improvement in the speech was noted in all the patients.
WA was significantly lower as shown in Graph 1 and [Table 1] when not wearing a complete denture with a mean value of 9.1 compared to after denture insertion of 14.2. P value found to be was 0.0001. A significant improvement in the speech was noted in all the patients in the graph.
|Table 1: Comparison of word accuracy in edentulous patients before and after denture insertion |
Click here to view
| Discussion|| |
Speech mechanism is very susceptible to degenerative diseases, and the loss of teeth and supporting structures along with affecting masticatory efficiency alters the speech articulatory mechanism, can cause speech disorder by affecting the speech pattern, greatly reducing the intelligibility of speech in such patients through its impact on articulation. ,, Teeth loss affects a number of parameters including facial appearance, masticatory ability, nutrition, and speech articulation, as well as psychosocial parameters such as quality of life and socializing ability of an individual.  More so, speech intelligibility is significantly reduced after complete loss of teeth. 
Phonetics, esthetics, function, and comfort are the main foundation determining the success of a prosthodontic treatment done. Complete dental rehabilitation of edentulous patients with complete dentures includes not only esthetics and mastication of food but also speech quality. Maxillary anterior teeth, in particular, play an important role for adequate speech intelligibility and articulation, their rehabilitation improves articulation ability significantly.  It is the responsibility of the dentist to fabricate a denture that is functionally acceptable by the patient and is perfectly esthetic. One prime oral function that has always been overlooked for years is speech intelligibility. It has always been presumed that speech will eventually follow by mere replacement of teeth and that it is patient's duty to fine tune speech with practice over the period of time or it is perfectly alright to have some kind of discrepancy in speech intelligibility. 
Phonetics has been known as the complex phenomenon of emission of voice, i.e., by the combination of phonemes at different frequencies. The sound of every individuals voice is unique and is basically determined by the size of the resonator system (oral cavity, larynx, pharynx, vocal folds, and nasal sinus), which vibrates at different frequencies, producing various types of sounds. It is claimed and has been studied upon that a prosthesis can modify phonetics of the patient, even if it is functionally and esthetically well designed, especially the maxillary anterior teeth. Certain authors consider phonetics an important satisfaction factor for patients.  Schlosser and Gehl have said that "correction of speech defects due to the partial or complete loss of natural teeth in the patients in compliance with phonetic requirements" was the third major and important objective for the fabrication of a denture prosthesis. 
In the present study, an assessment of the effect of dentures on speech intelligibility was carried out, and for this purpose, the speech data of two groups were studied before and after the fabrication of dentures. Twenty patients were made to get their speech recorded with and without their dentures in situ after the fabrication of new dentures. Speech intelligibility was measured using an automated speech recognition system that calculated WA for each patient.
Without a dental prosthesis inserted, it showed that speech intelligibility was significantly lower compared to the measurement data with denture inserted. In agreement with the present study, with dentures inserted, an improvement in the speech intelligibility of patients with an edentulous mouth was stated in studies that used a perceptual rating of speech intelligibility or spectral analysis to assess single distorted sounds. In these studies, the articulation of fricative sounds or consonants, in particular, posed a problem for edentulous speakers, which may explain reduced speech intelligibility.
The impact of maxillary teeth and palatal coverage and contour on speech production was noted and found to be improved. The maxillary incisors and their positions were found crucial for speech production, and there are various studies concerning the effects of the size and surface of the denture base on speech production.
The study needs to be done on a larger number of population.
| Conclusions|| |
Analysis of speech production in prosthetic dentistry must be based on complete understanding of nature of speech sounds, how they are produced in an individual, and anatomic and physiologic structures involved. It is possible to diagnose the mechanisms and the processes that may lead to speech problems and hence to make necessary adjustments which may help in producing the desired speech change. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Karthik BK. Speech in prosthodontics. JIADS 2011;2:79.
Knipfer C, Bocklet T, Noeth E, Schuster M, Sokol B, Eitner S, et al.
Speech intelligibility enhancement through maxillary dental rehabilitation with telescopic prostheses and complete dentures: A prospective study using automatic, computer-based speech analysis. Int J Prosthodont 2012;25:24-32.
Stelzle F, Ugrinovic B, Knipfer C, Bocklet T, Nöth E, Schuster M, et al.
Automatic, computer-based speech assessment on edentulous patients with and without complete dentures-preliminary results. J Oral Rehabil 2010;37:209-16.
Knipfer C, Riemann M, Bocklet T, Noeth E, Schuster M, Sokol B, et al.
Speech intelligibility enhancement after maxillary denture treatment and its impact on quality of life. Int J Prosthodont 2014;27:61-9.
Kalra A, Kinra M, Fahim R. Speech considerations with complete denture. Indian J Dent Sci 2010;2:6-39.
Cholan R, Dilip Kumar M, Vidyashree NV. Evaluation of speech for a patient with an extensive soft palate defect, before and after fabrication of obturator. J Sci Dent 2014;4:34.
Dhakshaini MR, Pushpavathi M, Garhnayak M, Dhal A. Prosthodontic management in conjunction with speech therapy in cleft lip and palate: A review and case report. J Int Oral Health 2015;7 Suppl 2:106-11.
Jain AR, Venkat Prasad MK, Ariga P. Palatogram revisited. Contemp Clin Dent 2014;5:138-41.
Giovannetti M, Casucci A, Casucci D, Mazzitelli C, Borracchini A. Phonetic analysis and maxillary anterior tooth position: A pilot study on preliminary outcome. Int Dent SA 2009;11:5.
Palmer JM. Analysis of speech in prosthodontic practice. J Prosthet Dent 1974;31:605-14.