SWALLOWING AND SPEECH

Presented by- Dr. Nilesh Gadiya ( PG I year) Guided by- Dr. Rupal J Shah ( Professor & HOD )
- Dr. Sanjay Lagdive ( Professor)
 Index
1.Definitions
2.Phases of swallowing
3.Oral phase
4.Pharyngeal phase
5.Esophageal phase
6.Clinical significance
 DEFINITIONS
Swallowing, also called Deglutition, the act of passing food from the mouth, by
way of the pharynx (or throat) and esophagus, to the stomach. Three stages are
involved in swallowing food.

THE GLOSSARY OF PROSTHODONTIC TERMS Ninth Edition

deglutition \de΄gloo-t ĭsh΄un\ n (1650): the coordination of voluntary and involuntary muscle contractions at the
initiation of digestion; the act of swallowing

PHASES
• ORAL
• PHARYNGEAL
• ESOPHAGEAL
 ORAL PHASE
• ORAL CAVITY BOUNDARIES
• ANTERIRIOLY – ORAL VESTIBULE
• POSTERIOR- PALATOGLOSAL ARCH
• MUSCLES
• Depressors
• Lateral pterygoid- V3
• Digastric Ant belly – V3
• Mylohyoid – V3
• Geniohyoid – C1
• Elevators – V3
• Masseter
• Temporalis
• Media pterygoid
• SALIVARY GLANDS -
• Intrinsic ( 10%)
• Extrinsic (90%)
• Muscles of tongue
• Intrinsic muscles – central trough CN XII
• Extrinsic muscles – elevates tongue CN XII
 PHARYNGEAL PHASE
Closure of the nasopharynx
• The soft palate is tensed by tensor palatini (Vc), and then elevated by
levator palatini (pharyngeal plexus—IX, X) to close the nasopharynx.
• There is also the simultaneous approximation of the walls of the pharynx
to the posterior free border of the soft palate, which is carried out by the
palatopharyngeus (pharyngeal plexus—IX, X) and the upper part of the
superior constrictor (pharyngeal plexus—IX, X).

The pharynx prepares to receive the bolus

• pharynx is pulled upwards and forwards by the suprahyoid and
longitudinal pharyngeal muscles – stylopharyngeus (IX),
salpingopharyngeus (pharyngeal plexus—IX, X) and palatopharyngeus
(pharyngeal plexus—IX, X) to receive the bolus.
• The palatopharyngeal folds on each side of the pharynx are brought close
together through the superior constrictor muscles, so that only a small
bolus can pass.

Closure of the oropharynx

• The oropharynx is kept closed by palatoglossus (pharyngeal plexus—IX,
X), the intrinsic muscles of tongue (XII) and styloglossus (XII).
Laryngeal closure
• The primary- via the closure of the true vocal folds. The
adduction of the vocal cords is effected by the contraction
of the lateral cricoarytenoids and the oblique and
transverse arytenoids (all recurrent laryngeal nerve of
vagus).
• Retroversion of the epiglottis, while not the primary
mechanism of protecting the airway from laryngeal
penetration and aspiration, acts to anatomically direct the
food bolus laterally towards the piriform fossa.
• Additionally, the larynx is pulled up with the pharynx under
the tongue by stylopharyngeus (IX), salpingopharyngeus
(pharyngeal plexus—IX, X), palatopharyngeus (pharyngeal
plexus—IX, X) and inferior constrictor (pharyngeal plexus—
IX, X). This phase is passively controlled reflexively and
involves cranial nerves V, X (vagus), XI (accessory) and
XII (hypoglossal).
• Hyoid elevation
• The respiratory center of the medulla is directly inhibited by
the swallowing center
• This means that it is briefly impossible to breathe during
this phase of swallowing and the moment where breathing
is prevented is known as deglutition apnea.
Bolus transits pharynx
• peristalsis which takes place by
sequential contraction of the superior,
middle and inferior pharyngeal
constrictor muscles (pharyngeal
plexus—IX, X).
• The lower part of the inferior
constrictor (cricopharyngeus) is
normally closed and only opens for the
advancing bolus.
• 30-40 cm/sec
• it is possible to swallow solid food
even when standing on one’s head.
 ESOPHAGEAL PHASE
• Esophageal peristalsis
Involuntary
The bolus enters the esophagus and is propelled downwards first by striated muscle
(recurrent laryngeal, X) then by the smooth muscle (X) at a rate of 3–5 cm/s.
The upper esophageal sphincter relaxes to let food pass, after which various striated
constrictor muscles of the pharynx as well as peristalsis and relaxation of the
lower esophageal sphincter sequentially push the bolus of food through the esophagus
into the stomach.

Relaxation phase
Finally the larynx and pharynx move down – with hyoid elastic recoil.
Clinical significance

• Elderly- strokes and Alzheimer's disease can interfere with the autonomic nervous system.
• Speech pathologists commonly diagnose and treat this condition since the speech process uses the same
neuromuscular structures as swallowing. Diagnostic procedures commonly performed by a speech pathologist
to evaluate dysphagia include Fiberoptic Endoscopic Evaluation of Swallowing and Modified Barium Swallow
Study.
• Terminally ill patients- a failure of the reflex to swallow leads to a build-up of mucus or saliva in the throat and
airways, producing a noise known as a death rattle
• Oropharyngeal dysphagia.
• Esophageal dysphagia.
• The failure of the lower esophagus sphincter to respond properly to swallowing is called achalasia.
 ECH
S P E
 Index
• INTRODUCTION
• TERMINOLOGIES
• DEVELOPMENT OF SPEECH SKILLS
• SPEECH PRODUCTION
• CLASSIFICATION OF SPEECH SOUNDS
• S SOUNDS
• SPEECH TEST
• SPEECH ANALYSIS
• SPEECH DEFECTS
• CONCLUSION
 INTRODUCTION
THREE MAJOR FACTORS IN COMPLETE DENTURE CONSTRUCTION

Oxford English Dictionary- The expression of or the ability to express thoughts and feelings by articulate sounds
GPT –9
Speech articulation \spech är-tĭk΄ya-la΄shun\: 1. the phonation of sounds in connected discourse; 2. the movement and
placement during speech of the organs that serve to interrupt or modify the voiced or unvoiced air stream into meaningful
sounds; 3. the speech function performed largely through the movements of the lower jaw, lips, tongue, and soft palate.

Merriam-Webster
speech
1a: the communication or expression of thoughts in spoken words
b: exchange of spoken words : CONVERSATION
 TERMINOLOGIES

- PHONETICS- The study of speech sounds, their production and combination and their representation by
written symbols.
- 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.
E.g. : Phoneme |P| includes phonetically differentiated sounds represented by P in pin, spin, tip.
- PHONEMICS- The description and classification of the phonemes of the specific language--
−MORPHEMES- Smallest meaningful units of language. They are formed by collection of various phonemes.
In simple term, they can be called words.
−PROSODY- It’s a term that describes all those variations in time, pitch and loudness that accomplish
emphasis and lend interest to speech.
 DEVELOPMENT OF SPEECH SKILLS
• Speech is an evolution rather than a spontaneous or even a short time
creation with upright posture and development of manual dexterity came
freedom of the mouth from crude grasping and manipulative duties.
 SPEECH PRODUCTION
Kartner and West divided speech
into 5 components
AIR
Respiration.
Phonation.
Resonation.
Articulation.
Neurologic integration CNS and
ARTICULATOR
Added by George Chierici & Lawson
(1973)
−Audition
−Emotional behaviour
• Respiration.
The stream of air is modified in its course from lungs by maxillofacial structures
and gives rise to the symbols which are recognized as speech.

• Phonation.
• When air leaves the lungs it passes through the vocal folds or vocal cords • Average length
modify the stream. The true vocal folds opposing each other with different • Males – 15 mm 
degrees of tension and space create a slit like aperture of varying size and Deeper pitch
contour. The folds by creating resistance to stream of air, set up a sequence • Females – 11 mm
of laryngeal sound waves with characteristic pitch and intensity. These
laryngeal sounds provide the basis for organization of speech

• Resonation .
• air sinuses, organ surfaces and cavities such as the pharynx, oral
cavity, nasal cavity and chest wall
Articulation.
SPEECH PRODUCTION
• NEUROLOGICAL INTEGRATION
• Corticobulbar pathway- conscious
control precise movement required.
Important in relearning.
• Extra pyramidal pathway- controls
muscle tone , regulation and inhibition
of muscles, coordination of depth of
breathing, the tension of vocal cords,
the lips, the cheeks, the tongue, and
the pharyngeal walls.
• Cerebellar pathway- route of
automatic coordination.
VARIATIONS
 CLASSIFICATION OF SPEECH SOUNDS
Phonemes of English language can be divided
into four groups,
1.VOWELS: voiced sounds ACCORDING TO LARYNGEAL ACTION
2.DIPTHONGS: blends of two vowels ex: boy, main,
tone, dine. Voiceless Voiced
3.CONSONANTS: may be either voiced or produced
ptk bdg
with out vocal cord vibration, in which case they
are called breathed sounds. eg: p, b, m, s, t, r, z sf zv
etc…
ts dz
4.COMBINATION: Is blend of a consonant and vowel,
articulated in quick succession that they are
identified as single phonemes
The consonants are divided into groups depending on their characteristic production and use of different articulators and
valves. They are as follows :
1.Plosives- These sounds are produced when overpressure of the air has been built up by consonants between the soft palate
and pharyngeal wall and released in an explosive way. Ex: P (pay), B (bay), T (to), D (dot)
2.Fricatives- are also called sibilants and are characterized by their sharp and whistling sound quality created when air is
squeezed through the nearly obstructed articulators.
Ex: S (so), Z (zoo)
3. Affricative consonants: are a mix between plosive and fricative ones. Ex: Ch (chin), J (jar)
4. Nasal consonants :are produced with out oral exit of air. Production involves the coupling of nasal cavity as resonators.When
nasal cavities are blocked,the nasal sounds are produced hyponasally, the resulting in speech-we describe as talking with
“stuffy nose”….Ex: M (man), N (name), NG (bang)
5. Liquid consonants(semi vowels) : are , as the name implies , produced with out friction. Ex: R (rose),L(lily)
6. Glides: that is sounds characterized by a gradually changing articulator shape Ex: W (witch), Y (you)
 BILABIAL SOUNDS
Lip closure Lip rounding

|p|, |b| & |m| |w|

I/O breath pressure is impounded behind closed lips Moves to appropriate position

To determine the anteroposterior positioning of the anterior teeth and thickness of the denture
flange:.

To determine the vertical dimension.

LABIODENTAL CONSONANTS
• Fricatives f & v
• Forcing breath stream through contact made by upper incisors with
lower lip.
CLINICAL SIGNIFICANCE:

• To determine the superoinferior position of anterior

maxillary teeth
• To determine correct occlusal plane.
• To determine anteroposterior positioning of the
incisors.
LINGUODENTAL SOUNDS

• Linguodentals - are formed by the tongue and

the teeth. They are also called interdental
sounds
• Ex: Th (fricative) this, that, these, those.
• CLINICAL SIGNIFICANCE:
• To determine the labiolingual position of anterior
teeth.
• Tip of tongue extending slightly between upper
and lower anterior teeth.
• Sounds are made closer to alveolus
LINGUOALVEOLAR SOUNDS
• Linguoalveolar sounds are made with the valve formed by
contact of the tip of the tongue with the most anterior part
of the palate (alveolus) or lingual side of anterior teeth
• Ex: T,D (plosives) ,S,Z (fricatives),N (nasals)

• CLINICAL SIGNIFICANCE:
• To determine the horizontal and vertical relations of the
anterior teeth:
• To determine the labiolingual position of anterior teeth:
• To determine the thickness of denture base:
• To determine the vertical dimension of the occlusion
• 10 sounds : divided into 5 types depending on distinct
place and manner of production
• A) t &d ; n
• B) Fricatives s & z
• Formation of a midline groove (10 mm sq. ) of the tongue.
• C) Fricatives- sh & zh
• Broader groove compared to s & z.
• Can be discussed as linguopalatal.
• D) ts & dz linguoalveolar or palatal affricatives
• Tongue placed as in plosives and air is exploded through constriction.
• E) Lateral L
• Tip of the tongue is in contact with the alveolus.
• Lowered lateral margins- facilitates air flow.
LINGUOPALATAL SOUNDS
• Linguopalatals- are formed by the tongue and hard palate. The tongue
may contact portion of the hard palate just posterior to the area
which is contacted while pronuncing linguoalveolar sounds I.e
alveolus.
• Ex- Sh (fricatives) , Ch, J (affricatives), R (rose) , Y (glides)
• Clinical significance:
• To determine the thickness of denture.
• To determine the anteroposterior position of the maxillary incisors .
• |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.
|j| - Linguopalatal glide
Tongue raised toward the front of hard palate but in
the course it moves to a position appropriate for
articulation of following phoneme.
LINGUOVELAR SOUNDS
• Linguovelar sounds- are by tongue and soft palate. In these sounds
the air blast is checked by the base of the tongue being raised
upwards and backwards to make contact with the soft palate.
• CLINICAL SIGNIFICANCE:
• To determine the thickness and posterior extension of denture.
• k, g, ng.
• Contact of the middle of the tongue with soft palate
S SOUNDS AND THEIR PROSTHODONTIC
CONSIDERATION
• The S sound is the most interesting one because its articulation is
mainly influenced by the teeth and palatal part of maxillary
prosthesis.
• S formation needs particularly fine adjustments of the tongue
and depends on special neuromuscular and psychoaudative
abilities.
• The inability to produce sibilant sound correctly is referred to as
STIGMATISM.
CHARACTERISTICS OF /S/ SOUND
• ARTICULATORY CHARACTERISTICS:
• The tip of the tongue is placed forward, coming close to but never touching
the upper front incisors.
• A sagittal groove is made in the upper front part of the tongue, with a small
cross-sectional area.
• The tongue dorsum is flat.
• Normally, the mandible will move forward and upward, with the teeth almost
in contact.
• ACOUSTIC CHARACTERISTICS:
• The comparatively strong sound energy is concentrated to a high
frequency range, with a steep energy cutoff at about 3 to 4 Hz.
• AUDITORY CHARACTERISTICS:
• The sound is fairly loud, with a light, sibilant (sharp) quality.
HOW ARE “S” SOUND PRODUCED ?
• S sounds are also called SIBILANTS, whch are a type of fricative,
linguoalveolar sounds. Ex: S, Z, Sh.
• The S sounds are produced equally well with two differnet tongue
positions, but there can be some variation even behind the alveolus.
• Most people make S sound with the tip of the tongue against the
alveolus in the area of rugae, but with a small space for air to escape
between the tongue and alveolus. The tongue’s anterior dorsum forms a
narrow groove near the midline , with a cross section of about 10mm.sq.
• Part of the sibilant sound is generated when the teeth are being hit by a
concentrated air jet.
• Opening too small- Whistle
• Happens when the posterior dental arch form of the denture is
narrow.
• Too broad and thin- ‘sh’ Lisp
• When the tip of tongue contacts with upper front teeth in dentures.
• About 1/3rd of patients, make S sound with the tip of tongue contacting the
lingual side of anterior part of the lower denture and arching against anterior
palate to form the desired shape and size of the airway.
• CLINICAL SIGNIFICANCE :
• If lower anterior teeth are too far back, the tongue will be forced to arch itself up to a
higher position, and the airway will be too small.
• If the lingual flange of the mandibular denture is too thick in anterior region, the result
will be faulty S sound.
 CLINICAL SIGNIFICANCE
• To determine the thickness of denture.
• To determine the vertical dimension of occlusion (Silverman’s closest
speaking space)
• To determine anteroposterior positioning of teeth.
• To determine the width of dental arch.
• To determine the relationship of upper teeth to the lower anterior teeth by S-
position
SPECIAL CONSIDERATION IN IMPLANT
PROSTHODONTICS
• MAXILLARY IMMEDIATE LOADED IMPLANTS SUPPORTED PROSTHESIS-
3-6 months speech adaptation period
• Overdenture with or without palate – more intelligible speech than
fixed prostheses.
SPEECH TESTS
S,Sh Six, sixty, ships, sailed Mississippi, Sixty six ships sailed
sure ,sign, sun, shine Mississippi. Sure sign of sun
shine

T,D,N,L Locator, located, tornado, near, Locator located tornado near

Toledo Toledo

Ch,J Joe, Joyce, joined, George, Joe and Joyce joined George
Charles, church and Charles at church

K Committee, convented, political, The committee convented at

convention, Connecticut the political convention in
connecticut.

F,V Vivacious, Vivian, lived, five, fifty, Vivacious Vivian lived at five
five, fifth, avenue fifty-five fifth avenue
 SPEECH ANALYSIS
• There are basically two methods:
– Perceptual/Acoustic analysis : It is based on
broadband spectrogram recorded by a sonograph
during uttering of different phases containing key
phrases. By doing this objective opinion of certain
sounds maybe achieved.
– Kinematic methods of movement analysis :
• X-ray mapping
• Cineradiography
• Optoelectronic articulatory movement tracking
• Electropalatography
• Electropalatography
 SPEECH DEFECTS
• APHASIA-
Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or
write. Aphasia is always due to injury to the brain-most commonly from a stroke, particularly in older individuals

• DYSATHRIA- Dysarthria is a motor speech disorder in which the muscles that are used to produce
speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control their tongue or voice box
and may slur words.

• DYSLALIA- Dyslalia means difficulties in talking due to structural defects in speech organs, [1]
such as
sigmatism (defective pronunciation of sibilant sounds, for example "S" pronounced as "TH") and rhotacism, in which
the letter "R" pronounced as "I or Y". It does not include speech impairment due to neurological or other factors.

• SPEECH AND LANGUAGE RETARDATION.-

A speech and language delay is when a child isn’t developing speech and language at an expected rate. It’s a
common developmental problem that affects as many as 10% of preschool children
 Evenly sprayed palatal area with green food
colour liquid which immediately dries.

Palatograms for “s” and “T” sounds.

A. Red outlined area shows under- contoured palate while

orange outline shows over-contoured area.

B. Violet outlined area shows under-contoured part of palate

 Partial denture with palatal augmentation
Tongue prosthesis for swallowing. Tongue prosthesis for speech
prosthesis
CONCLUSION
• The specific relationship between dentistry and speech pathology is
still emerging.
• The aim of the well designed prosthesis is not only to restore proper
function and esthetics but also to facilitate acceptable phonetics.
Accurate approximation of palatal contours of maxillary complete
denture to a patient’s tongue can improve speech clarity, if other
factors are satisfactory.
• Because oro-dental morphological features may influence an
individual speech, the dentist should therefore recognize the possible
rate of phonetic treatment on speech activity.
 Questions
1. Phonetic considerations in denture prosthesis
2. Anatomy of tongue and swallowing.