Chapter Nine Flashcards
Dental Anomalies
Children with cleft or craniofacial anomalies commonly have anomalies of the ______.
Dental and occlusal anomalies can cause _______and ________productions.
Speech-language pathologist must correct the _______ in speech that occur as a result of these anomalies.
teeth and jaws
obligatory speech distortion and compensatory articulation
functional modifications
Normal Dentition
________(permanent) teeth number ___total, __teeth in each arch.
____ and _____are in premaxilla.
Canine and lateral incisor border the ______.
Succedaneous; 32; 16
Central and lateral incisors
incisive sutures
IMAGE
Normal Dentition
Deciduous teeth number ___total, __teeth in each arch.
20; 10
Normal Dentition
Number of permanent teeth per arch:
Central incisors:
Lateral incisors:
Canines:
Bicuspids:
Molars:
3rd molars/wisdom teeth:
Central incisors: 2
Lateral incisors: 2
Canines: 2
Bicuspids: 4
Molars: 4
3rd molars/wisdom teeth: 2
Normal Dentition
Normal relationship of the incisors:
________-horizontal (or anterior-posterior) relationship between the incisors
______—vertical overlap of the upper and lower incisors
Overjet (Labioversion)—
Overbite
Normal Occlusion
Dental occlusion—
Normal relationship of the upper to the lower teeth is called a ______
Normal occlusion is important for:
1.
2.
3.
manner in which the teeth fit together
Class I occlusion.
- Aesthetics
- Biting and chewing
- Speech
Normal Occlusion and Speech
____incisors overlap _____teeth.
Tongue rests in ____, just under ______.
Tongue tip is able to move up and down during speech without ______.
Upper and lower lips are approximated for ______and ______sounds.
Maxillary; mandibular
mandible; alveolar ridge
dental interference
bilabial AND labiodental
Normal Occlusion and Speech
_____(teeth sounds) are not really produced by the teeth.
_______is done to elevate the mandible, which positions the ______under the alveolar ridge.
Sibilants are produced by …
Teeth are really not necessary for _____.
Sibilants
Closing the teeth; tongue tip
airstream between the tongue tip and the alveolar ridge.
normal speech
Dental Anomalies and Speech
Teeth may cause speech problems by interfering with lip and tongue movement, affecting _____or ____sounds.
Abnormal structure can cause:
1.
2.
bilabial OR lingual
Obligatory distortion—articulation placement is normal, but structural abnormalities interfere with the sound, causing speech distortion
Compensatory error—articulation is altered to compensate for structural abnormalities, causing a substitution error
Dental Anomalies
Overjet
Overjet—abnormal when the horizontal relationship between the incisors exceeds 2 mm
image
Underjet (anterior crossbite)—
a reversal of the normal upper to lower incisor relationships; upper incisors are inside lower incisors
image
Dental Anomalies and Speech
Severe overjet may affect ______ and ____sounds.
Underjet (anterior crossbite) may cause ….
bilabial competence and bilabial
maxillary teeth to interfere with tongue tip placement for sibilant.
Overbite—
Underbite (deep bite)—
too much overlap of the upper incisors over the lower incisors
a vertical overlap of the lower incisors over the upper incisors
Dental Anomalies and Speech
Both overbite and underbite can ________of oral cavity during occlusion.
Dental anomalies cause _______
They can affect ____ and _____sounds.
shorten vertical dimension
oral cavity crowding.
lingual-alveolar and sibilant
Dental Anomalies
______are common in those with cleft lip and alveolus.
Central incisors and lateral incisors (if present) are often _______
Rotated teeth
rotated toward the cleft.
Dental Anomalies
______(extra teeth) and ectopic teeth (normal teeth that erupt in abnormal positions) often erupt in _____in line of the cleft.
Supernumerary teeth; palate
IMAGE
Dental Anomalies and Speech
Rotated, supernumerary, or ectopic teeth may interfere with _________
Teeth can _____the airstream laterally, causing an ______
Pulling the tongue back for compensation also causes ______.
tongue tip movement during speech.
divert; obligatory lateral distortion.
lateral distortion
Dental Anomalies
Missing teeth
lateral incisor and/or canine often missing because they border the line of the cleft
Dental Anomalies
Open bite—
Causes include:
1.
2.
3.
when one or more maxillary teeth fail to occlude with the opposing mandibular teeth.
- Missing teeth
- Poor occlusion due to digit or pacifier sucking habits
- Skeletal discrepancies
Dental Anomalies and Speech
Missing teeth or open bite only affect speech if there is _____
Tongue may ______through an anterior opening, causing _____of sibilants or lingual-alveolar sounds.
Tongue may protrude through a lateral opening (due to missing teeth in line of the cleft), causing a ______
oral cavity crowding.
protrude; fronting
lateral distortion.
Dental Anomalies
Crossbite—
Anterior crossbite—
upper teeth are inside the lower teeth; common with history of cleft
maxillary incisors positioned inside the mandibular incisors; typical with Class III malocclusion and midface retrusion
Dental Anomalies and Speech
Anterior crossbite can cause _____teeth to articulate against _____during occlusion. This, in turn, can cause:
maxillary; tongue
- Fronting of sibilants (obligatory distortion)
- Lateral distortion of sibilants (compensatory error) if the tongue is brought back to compensate
Dental Anomalies
Lateral (posterior) crossbite—
affects teeth distal (posterior) to the canines; can be unilateral or bilateral; usually occurs because the maxilla is too narrow
IMAGE
Dental Anomalies
Complete crossbite—
entire maxillary arch is inside mandibular arch
image
Dental Anomalies and Speech
Lateral (posterior) crossbite and complete crossbite can _______
Dental anomalies cause ______due to oral cavity crowding.
restrict oral cavity size.
distorted speech
Dental Anomalies
_______is sometimes a problem with bilateral complete cleft lip and palate.
Protruding premaxilla
Dental Anomalies and Speech
A protruding premaxilla can affect _______at rest and also during speech.
Bilabial sounds may be produced with a _______
bilabial competence
labiodental placement.
Occlusion and Skeletal Relationships
Occlusion—
Angle Classification
System—
Skeletal relationship—
the way the maxillary and mandibular teeth fit together when the jaws are closed
describes normal occlusion and three types of malocclusion
the way the jaws (not just the teeth) come together during biting
Occlusion and Skeletal Relationships
Malocclusion—
The mandible (and thus the tongue) can be positioned ….
This can affect the relationship of _____to ____ or relationship between the upper and lower ___.
an abnormal dental or skeletal relationship between the maxillary and mandibular teeth in which the arches do not close together normally during biting
too far behind or in front of the maxilla.
tongue tip to alveolar ridge
lip
Angle’s Classification of Occlusion**
Chart
Class I Occlusion:
The mesiobuccal (front outside) cusp of the first maxillary molar fits in the ______of the first mandibular molar
occlusion—maxillary and mandibular arch relationship is normal, although the teeth may be misaligned
buccal (outside) groove
Class II Malocclusion and Speech
If severe, Class II causes the tongue to …..
This can cause obligatory distortion of ____and ______ phonemes.
The individual may compensate by ______
be under the palatal arch, rather than the alveolar ridge.
sibilants and lingual-alveolar
backing tongue-tip sounds.
Class III Malocclusion:
The mesiobuccal (front outside) cusp of the first _____is posterior to the buccal (outside) groove of the first mandibular molar.
It is often associated with _____and ______
maxillary arch is too far behind the mandibular arch; causes midface retrusion; common with CLP
maxillary molar
anterior crossbite and mandibular prognathism.
Class III Malocclusion and Speech
Difficulty with ____and ______because the tongue tip is in front of the maxilla and alveolar ridge
Can cause _____(obligatory distortion)
Can cause _______, resulting in lateral distortion (compensatory error)
Difficulty with ______due to lip discrepancy
Can cause________for labiodental and bilabial sounds
sibilants and lingual-alveolars
fronting
dorsal production
labial sounds
reverse labiodental production
Stages of Dental Development
Essay Question***
Infant stage: 0 to 12 months
Primary dentition: 1 to 6 years
Early mixed dentition: 6 to 9 years
Late mixed dentition: 9 to 12 years
Adolescent dentition: 12 to 18 years
Infant Stage (______) Treatment
Premaxillary orthopedics (for _______)
Done in ____period
_______manipulation of the premaxilla and lateral segments
Makes _____easier with better results
___and/or ____repair
0 to 12 months
bilateral complete clefts
newborn
Nonsurgical
lip repair
Lip and or palate
Primary Dentition (______) Treatment
______ expansion
May be started at ______of age
Goal is to create __________ and to_______
Can be done within a _____
Retention done with _______
1 to 6 Years
Maxillary
4 to 5 years
adequate width of the maxilla and to correct position of erupting permanent incisors
few months
lingual fixed appliance
Maxillary expansion
May result in _______or _____a new fistula
Fistula can be______ if necessary
Fistula is usually closed later with ______
widening a preexisting fistula or opening
temporarily obturated
a bone graft
Early Mixed Dentition (_______) Treatment
________(or face mask)—a nonsurgical option for correction of maxillary retrusion
6 to 9 Years
Reverse pull headgear
Early Mixed Dentition (6 to 9 Years) Treatment
_________ graft
Done at site of cleft in _____ before _____ of lateral incisor and canine in cleft area
_______ is usually used for the graft
Helps to _______ and give _______for incisors to erupt through
Alveolar bone
alveolar ridge; eruption
Iliac crest bone
stabilize maxillary arch; bony structure
Late Mixed Dentition (______) Treatment
Orthodontics to …
Replacement of …
9 to 12 Years
improve dental relationships
missing teeth with denture plate
Adolescent Dentition(______)
Full ….
May make occlusion …
12 to 18 Years
orthodontic treatment to align the teeth in the arches
worse until the orthognathic surgery is done
Adolescent Dentition (12 to 18 Years)
Orthognathic surgery or …
Done after _______ (girls: _____; boys: ______)
_______of missing teeth
distraction to align the jaws
facial growth is complete
girls: age 14-15
boys: age 18-19
Permanent replacement
Summary of Stages of Treatment
Premaxillary orthopedics:
Lip repair:
Palate repair:
Maxillary expansion:
Alveolar bone graft:
Orthodontics:
Orthognathic surgery or distraction
Premaxillary orthopedics: infant stage
Lip repair: about 3 months
Palate repair: about 10 months
Maxillary expansion: 6 to 9 years
Alveolar bone graft: 6 to 9 years
Orthodontics: 12 to 18 years
Orthognathic surgery or distraction
Role of Speech Therapy
Speech therapy to correct compensatory errors is best.
It’s always best to correct after structure is fixed.
Speech therapy does not correct obligatory errors.
Summary
Children with clefts or other craniofacial anomalies are at risk for dental and occlusal abnormalities.
Most consonants are produced in the anterior portion of the oral cavity.
Abnormalities of the anterior dental arch and of jaw relationships can interfere with movement of the tongue tip and lips.
It’s important for dental professionals and speech-language pathologists to work closely together to coordinate care.
