Chapter Nine Flashcards by Becky Chesney

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

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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

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Normal Dentition

Deciduous teeth number ___total, __teeth in each arch.

20; 10

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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

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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

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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

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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

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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

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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

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Dental Anomalies

Overjet

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

image

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Underjet (anterior crossbite)—

a reversal of the normal upper to lower incisor relationships; upper incisors are inside lower incisors

image

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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.

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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

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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

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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.

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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

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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

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Dental Anomalies

Missing teeth

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

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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.