Ch. 9

Question 0

Dental Anomalies

Children with cleft or craniofacial anomalies commonly have anomalies of the _____ and _____.
Dental and occlusal anomalies can cause obligatory _____ distortion compensatory _____ productions.
Speech-language pathologist must correct the functional modifications in speech that occur as a result of these anomalies.

Answer 0

Children with cleft or craniofacial anomalies commonly have anomalies of the teeth and jaws.
Dental and occlusal anomalies can cause obligatory speech distortion compensatory articulation productions.
Speech-language pathologist must correct the _____ modifications in speech that occur as a result of these _____.

The term occlusion means how the upper and lower set of teeth align with each other.

Question 1

Chapter 9Dental Anomalies

Answer 1

*

Question 2

Normal Dentition

_____ (permanent) teeth number _____ total, ____ teeth in each arch.
_____ and lateral incisors are in _____.
_____ and lateral incisor border the _____ sutures.

Answer 2

Succedaneous (permanent) teeth number 32 total, 16 teeth in each arch.
Central and lateral incisors are in premaxilla.
Canine and lateral incisor border the incisive sutures.

Question 3

Normal Dentition

_____ teeth number _____ total, _____ teeth in each arch.

Answer 3

Deciduous teeth number 20 total, 10 teeth in each arch.

Question 4

Normal Dentition

Number of permanent teeth per arch:
Central incisors: \_\_\_\_\_ 
Lateral incisors: \_\_\_\_\_ 
Canines: \_\_\_\_\_\_ 
Bicuspids: \_\_\_\_\_ 
Molars: \_\_\_\_\_ 
3rd molars/wisdom teeth: \_\_\_\_\_

Answer 4

Number of permanent teeth per arch:
Central incisors: 2 
Lateral incisors: 2 
Canines: 2 
Bicuspids: 4 
Molars: 4 
3rd molars/wisdom teeth: 2

Question 5

Normal Dentition

Normal relationship of the incisors:
_____ (_____)—______ (or anterior-posterior) relationship between the incisors
______—______ overlap of the upper and lower incisors

Answer 5

Normal relationship of the incisors:
Overjet (Labioversion)—horizontal (or anterior-posterior) relationship between the incisors
Overbite—vertical overlap of the upper and lower incisors

Question 6

Normal Occlusion

_____ occlusion—manner in which the teeth fit together
Normal relationship of the _____ to the ______ teeth is called a Class _____ occlusion.
Normal occlusion is important for:
______
______ and ______
_____

Answer 6

Dental occlusion—manner in which the teeth fit together
Normal relationship of the upper to the lower teeth is called a Class I occlusion.
Normal occlusion is important for:
Aesthetics
Biting and chewing
Speech

Question 7

Normal Occlusion and Speech

_____ incisors overlap _____ teeth.
Tongue rests in mandible, just under _____ _____.
Tongue tip is able to move up and down during speech without dental interference.
_____ and _____ lips are _____ for _____ and _____ sounds.

Answer 7

Maxillary incisors overlap mandibular teeth.
Tongue rests in mandible, just under alveolar ridge.
Tongue tip is able to move up and down during speech without dental interference.
Upper and lower lips are approximated for bilabial and labiodental sounds.

Question 8

Normal Occlusion and Speech

____ (teeth sounds) are not really produced by the teeth.
Closing the teeth is done to elevate the mandible, which positions the tongue tip under the alveolar ridge.
Sibilants are produced by _____ between the _____ ____ and the _____ _____.
Teeth are really not necessary for normal speech.

Answer 8

Sibilants (teeth sounds) are not really produced by the teeth.
Closing the teeth is done to elevate the mandible, which positions the tongue tip under the alveolar ridge.
Sibilants are produced by airstream between the tongue tip and the alveolar ridge.
Teeth are really not necessary for normal speech.

Question 9

Dental Anomalies and Speech

Teeth may cause speech problems by interfering with ____ and _____ movement, affecting _____ or _____ sounds.

Abnormal structure can cause:
_____ _____—articulation placement is normal, but ____ abnormalities interfere with the sound, causing speech distortion
____ ____—articulation is altered to compensate for structural abnormalities, causing a _____ error

Answer 9

Teeth may cause speech problems by interfering with lip and tongue movement, affecting bilabial or lingual sounds.
Abnormal structure can cause:
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

Question 10

Dental Anomalies

_____—abnormal when the horizontal relationship between the incisors exceeds ___ mm

Answer 10

Overjet—abnormal when the horizontal relationship between the incisors exceeds 2 mm

Question 11

Dental Anomalies

_____ (anterior crossbite)—a reversal of the normal upper to lower incisor relationships; _____ incisors are _____ lower incisors

Answer 11

Underjet (anterior crossbite)—a reversal of the normal upper to lower incisor relationships; upper incisors are inside lower incisors

Question 12

Dental Anomalies and Speech

Severe overjet may affect bilabial ____ and bilabial ____.
Underjet (anterior crossbite) may cause ____ teeth to interfere with tongue _____ placement for ____.

Answer 12

Severe overjet may affect bilabial competence and bilabial sounds.
Underjet (anterior crossbite) may cause maxillary teeth to interfere with tongue tip placement for sibilant.

Question 13

Dental Anomalies

_____—too much overlap of the upper incisors over the lower incisors
_____ (deep bite)—a _____ overlap of the ____ incisors _____ the _____ incisors

Answer 13

Overbite—too much overlap of the upper incisors over the lower incisors
Underbite (deep bite)—a vertical overlap of the lower incisors over the upper incisors

Question 14

Dental Anomalies and Speech

Both _____ and _____ can shorten _____ dimension of oral cavity during occlusion.
Dental anomalies cause oral cavity _____.
They can affect _____-_____ and ____ sounds.

Answer 14

Both overbite and underbite can shorten vertical dimension of oral cavity during occlusion.
Dental anomalies cause oral cavity crowding.
They can affect lingual-alveolar and sibilant sounds.

Question 15

Dental Anomalies

____ teeth are common in those with cleft lip and alveolus.
Central incisors and lateral incisors (if present) are often rotated _____ the cleft.

Answer 15

Rotated teeth are common in those with cleft lip and alveolus.
Central incisors and lateral incisors (if present) are often rotated toward the cleft.

Question 16

Dental Anomalies

_____ teeth (extra teeth) and _____ teeth (normal teeth that erupt in abnormal positions) often erupt in _____ in line of the cleft.

Answer 16

Supernumerary teeth (extra teeth) and ectopic teeth (normal teeth that erupt in abnormal positions) often erupt in palate in line of the cleft.

Question 17

Dental Anomalies and Speech

Rotated, supernumerary, or ectopic teeth may interfere with tongue ____ movement during speech.
Teeth can divert the airstream _____, causing an obligatory _____ distortion.
Pulling the _____ _____ for compensation also causes lateral distortion.

Answer 17

Rotated, supernumerary, or ectopic teeth may interfere with tongue tip movement during speech.
Teeth can divert the airstream laterally, causing an obligatory lateral distortion.
Pulling the tongue back for compensation also causes lateral distortion.

Question 18

Dental Anomalies

_____ teeth—lateral incisor and/or canine often missing because they border the line of the cleft

Answer 18

Missing teeth—lateral incisor and/or canine often missing because they border the line of the cleft

Question 19

Dental Anomalies

_____ _____—when one or more maxillary teeth fail to occlude with the opposing mandibular teeth. Causes include
_____ teeth
Poor ____ due to _____ or _____ sucking habits
_____ discrepancies

Answer 19

Open bite—when one or more maxillary teeth fail to occlude with the opposing mandibular teeth. Causes include
Missing teeth
Poor occlusion due to digit or pacifier sucking habits
Skeletal discrepancies

Question 20

Dental Anomalies and Speech

Missing teeth or open bite only affect speech if there is oral cavity ____.
Tongue may _____ through an ____ opening, causing _____ of _____ or _____-____ sounds.
Tongue may protrude through a _____ opening (due to missing teeth in line of the cleft), causing a _____ distortion.

Answer 20

Missing teeth or open bite only affect speech if there is oral cavity crowding.
Tongue may protrude through an anterior opening, causing fronting of sibilants or lingual-alveolar sounds.
Tongue may protrude through a lateral opening (due to missing teeth in line of the cleft), causing a lateral distortion.

Question 21

Dental Anomalies

_____—_____ teeth are _____ the +++++ teeth; common with history of cleft
_____ crossbite—____ incisors positioned _____ the _____ incisors; typical with Class _____ malocclusion and midface _____

Answer 21

Crossbite—upper teeth are inside the lower teeth; common with history of cleft
Anterior crossbite—maxillary incisors positioned inside the mandibular incisors; typical with Class III malocclusion and midface retrusion

Question 22

Dental Anomalies and Speech

Anterior crossbite can cause maxillary teeth to articulate ____ tongue during occlusion. This, in turn, can cause:
_____ of _____ (obligatory distortion)
_____ distortion of ____ (compensatory error) if the tongue is brought back to compensate

Answer 22

Anterior crossbite can cause maxillary teeth to articulate against tongue during occlusion. This, in turn, can cause:
Fronting of sibilants (obligatory distortion)
Lateral distortion of sibilants (compensatory error) if the tongue is brought back to compensate

Question 23

Dental Anomalies

____ (posterior) ____—affects teeth distal (posterior) to the canines; can be unilateral or bilateral; usually occurs because the _____ is too _____

Answer 23

Lateral (posterior) crossbite—affects teeth distal (posterior) to the canines; can be unilateral or bilateral; usually occurs because the maxilla is too narrow

Question 24

Dental Anomalies _____ _____—entire _____ arch is inside _____ arch

Answer 24

Complete crossbite—entire maxillary arch is inside mandibular arch

Question 25

Dental Anomalies and Speech _____ (posterior) _____ and complete crossbite can restrict oral cavity size. Dental anomalies cause distorted _____ due to oral cavity _____.

Answer 25

Lateral (posterior) crossbite and complete crossbite can restrict oral cavity size. Dental anomalies cause distorted speech due to oral cavity crowding.

Question 26

Dental Anomalies _____ _____ is sometimes a problem with _____ complete cleft lip and palate.

Answer 26

Protruding premaxilla is sometimes a problem with bilateral complete cleft lip and palate.

Question 27

Dental Anomalies and Speech A _____ _____ can affect _____ competence at ____ and also during __. Bilabial sounds may be produced with a _____ placement.

Answer 27

A protruding premaxilla can affect bilabial competence at rest and also during speech. Bilabial sounds may be produced with a labiodental placement.

Question 28

Occlusion and Skeletal Relationships ____—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

Answer 28

Occlusion—the way the maxillary and mandibular teeth fit together when the jaws are closed Angle Classification System—describes normal occlusion and three types of malocclusion Skeletal relationship—the way the jaws (not just the teeth) come together during biting

Question 29

Occlusion and Skeletal Relationships ``` ____—an abnormal dental or skeletal relationship between the maxillary and mandibular teeth in which the ____ do not _____ together normally during biting The mandible (and thus the tongue) can be positioned too far _____ or in ____ of the ____. This can affect the relationship of tongue tip to ____ ____ or relationship between the ____ and ____ lip. ```

Answer 29

``` Malocclusion—an abnormal dental or skeletal relationship between the maxillary and mandibular teeth in which the arches do not close together normally during biting The mandible (and thus the tongue) can be positioned too far behind or in front of the maxilla. This can affect the relationship of tongue tip to alveolar ridge or relationship between the upper and lower lip. ```

Question 30

Angle's Classification of Occulisons

Answer 30

See Ch. 9 PPT and Slide 31

Question 31

Class I Occlusion ``` Class ____ occlusion—maxillary and mandibular arch relationship is _____, although the teeth may be ____ The _____ (front outside) _____ of the first maxillary molar fits in the _____ (outside) groove of the first mandibular molar ```

Answer 31

``` Class I occlusion—maxillary and mandibular arch relationship is normal, although the teeth may be misaligned The mesiobuccal (front outside) cusp of the first maxillary molar fits in the buccal (outside) groove of the first mandibular molar ```

Question 32

Class II Malocclusion Class ____ malocclusion—_____ arch is too far in _____ of the _____ arch The _____ (front outside) cusp of the first maxillary molar is anterior to the _____ (outside) groove of the first mandibular molar. Class II malocclusion is often associated with _____.

Answer 32

Class II malocclusion—maxillary arch is too far in front of the mandibular arch The mesiobuccal (front outside) cusp of the first maxillary molar is anterior to the buccal (outside) groove of the first mandibular molar. Class II malocclusion is often associated with micrognathia.

Question 33

Class II Malocclusion and Speech If severe, Class II causes the _____ to be ____ the _____ arch, rather than the alveolar ridge. This can cause obligatory distortion of ____ and _____-_____ phonemes. The individual may compensate by backing ____-____ sounds.

Answer 33

If severe, Class II causes the tongue to be under the palatal arch, rather than the alveolar ridge. This can cause obligatory distortion of sibilants and lingual-alveolar phonemes. The individual may compensate by backing tongue-tip sounds.

Question 34

Class III Malocclusion Class ____ malocclusion—maxillary arch is too far ____ the mandibular arch; causes midface _____; common with CLP The mesiobuccal (front outside) cusp of the first maxillary molar is posterior to the buccal (outside) groove of the first mandibular molar. It is often associated with _____ _____ and _____ _____.

Answer 34

Class III malocclusion—maxillary arch is too far behind the mandibular arch; causes midface retrusion; common with CLP The mesiobuccal (front outside) cusp of the first maxillary molar is posterior to the buccal (outside) groove of the first mandibular molar. It is often associated with anterior crossbite and mandibular prognathism.

Question 35

Class III Malocclusion and Speech Difficulty with _____ and _____-_____ because the tongue ____ is in _____ of the _____ and _____ _____ Can cause _____ (obligatory distortion) Can cause ____ production, resulting in _____ distortion (compensatory error) Difficulty with _____ sounds due to _____ discrepancy Can cause reverse labiodental production for labiodental and bilabial sounds

Answer 35

Difficulty with sibilants and lingual-alveolars because the tongue tip is in front of the maxilla and alveolar ridge Can cause fronting (obligatory distortion) Can cause dorsal production, resulting in lateral distortion (compensatory error) Difficulty with labial sounds due to lip discrepancy Can cause reverse labiodental production for labiodental and bilabial sounds

Question 36

Stages of Dental Development ``` ____ stage: ____ to ____ months _____ dentition: ____ to ____ years ____ mixed dentition: ____ to _____ years ____ mixed dentition: ____ to ____ years _____ dentition: ____ to ____ years ```

Answer 36

``` 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 ```

Question 37

Infant Stage (0 to 12 months) Treatment Premaxillary orthopedics (for bilateral complete clefts) Done in ____ period Nonsurgical manipulation of the premaxilla and lateral segments Makes lip repair easier with better results Lip and/or palate repair

Answer 37

Premaxillary orthopedics (for bilateral complete clefts) Done in newborn period Nonsurgical manipulation of the premaxilla and lateral segments Makes lip repair easier with better results Lip and/or palate repair

Question 38

Primary Dentition (1 to 6 Years) Treatment ____ expansion May be started at ____ to ____ years of age Goal is to create adequate ____ of the maxilla and to correct position of erupting permanent incisors Can be done within a few months Retention done with lingual fixed ____

Answer 38

Maxillary expansion May be started at 4 to 5 years of age Goal is to create adequate width of the maxilla and to correct position of erupting permanent incisors Can be done within a few months Retention done with lingual fixed appliance

Question 39

Primary Dentition (1 to 6 Years) Treatment Maxillary expansion May result in ____ a preexisting fistula or ____ a new fistula Fistula can be temporarily obturated if necessary Fistula is usually closed later with a ____ graft

Answer 39

Maxillary expansion May result in widening a preexisting fistula or opening a new fistula Fistula can be temporarily obturated if necessary Fistula is usually closed later with a bone graft

Question 40

Early Mixed Dentition (6 to 9 Years) Treatment ____ pull _____ (or face mask)—a nonsurgical option for correction of ____ ____

Answer 40

Reverse pull headgear (or face mask)—a nonsurgical option for correction of maxillary retrusion

Question 41

Early Mixed Dentition (6 to 9 Years) Treatment ____ bone graft Done at site of cleft in alveolar ridge before eruption of lateral incisor and canine in cleft area Iliac crest bone is usually used for the graft Helps to stabilize ____ arch and give bony structure for incisors to erupt through

Answer 41

Alveolar bone graft Done at site of cleft in alveolar ridge before eruption of lateral incisor and canine in cleft area Iliac crest bone is usually used for the graft Helps to stabilize maxillary arch and give bony structure for incisors to erupt through

Question 42

Late Mixed Dentition (9 to 12 Years) Treatment ____ to improve dental relationships ____ of missing teeth with _____ plate

Answer 42

Orthodontics to improve dental relationships | Replacement of missing teeth with denture plate

Question 43

Adolescent Dentition (12 to 18 Years) Full _____ treatment to ____ the teeth in the arches May make occlusion worse until the orthognathic surgery is done

Answer 43

Full orthodontic treatment to align the teeth in the arches | May make occlusion worse until the orthognathic surgery is done

Question 44

Adolescent Dentition (12 to 18 Years) ____ surgery or distraction to align the ____ Done after facial growth is complete (girls: age _____ to ____; boys: age ____ to ____) ____ replacement of missing teeth

Answer 44

Orthognathic surgery or distraction to align the jaws Done after facial growth is complete (girls: age 14 to 15; boys: age 18 to 19) Permanent replacement of missing teeth

Question 45

Summary of Stages of Treatment ``` _____ orthopedics: infant stage ____ repair: about 3 months _____ repair: about 10 months ____ expansion: 6 to 9 years ____ bone graft: 6 to 9 years _____: 12 to 18 years _____ surgery or distraction ```

Answer 45

``` 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 ```

Question 46

Summary of Stages of Treatment CONT. ``` Premaxillary orthopedics: ____ stage Lip repair: about ____ months Palate repair: about ____ months Maxillary expansion: ____ to ____ years Alveolar bone graft: ____ to ____ years Orthodontics: ____ to ____ years Orthognathic surgery or distraction ```

Answer 46

``` 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 ```

Question 47

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.

Answer 47

Speech therapy to correct ____ ____ is best. It’s always best to correct ____ structure is ____. Speech therapy does ____ correct ____ errors.

Question 48

Summary Children with clefts or other craniofacial anomalies are at risk for ___ and ____ abnormalities. Most ____ are produced in the ____ portion of the oral cavity. Abnormalities of the anterior dental arch and of jaw relationships can interfere with movement of the ____ ____ and ____. It’s important for ____ professionals and speech-language pathologists to work closely together to coordinate care.

Answer 48

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.