This project is ongoing. Presented here is a report of my Pilot study:
The role of palatal rugae in speech of complete denture patients has been debatable. While some authors have questioned their role in the past, a few authors have also said that rugae incorporated on the palatal surface of a denture enhance pronunciations.
I have found that going the extra mile with edentulous patients to give them better speech is worth it as:
- It is our responsibility
- It is often neglected and left for the patient to adjust to.
- Patients often complain that rugae has been replaced by smooth surface resulting in improper articulation.
- Psychological comfort.
What I basially did was derived my own new classification for palatal-vault depths and tried to assess whether the presence or absence of rugae affects the speech in patients with varying depths of the palate.
Objectives of my project:
To compare and evaluate pronunciation of linguo-palatal sounds in
patients with high, medium and low palatal vault depths using trial
record bases with and without palatal rugae.
Inclusion Criteria for my patients:
-Normal speech.
-Normal hearing.
-Good neuromuscular control ;voluntary control of tongue,lips and cheek.
-Read standard paragraph given for recital for speech assessment.
-Normal ridge relationship.
-Ridges without prominent undercuts.
Exclusion criteria for my patients:
-Speech abnormalities.
-Impaired hearing.
-Poor neuromuscular control.
-Inability to read.
-Undercuts which would needed to be blocked prior to fabrication.
-Previous denture wearers who have developed adjusted speech patterns.
-Unwilling/uncooperative patients.
Methodology:
Impressions were made using routine standard procedures.
Record bases were fabricated for each patient using a uniform thickness of autopolymerising acrylic resin.
Jaw relation recording and mounting on a Mean Value articulator was done.
Denture teeth were selected and set up on the rims.
The trial dentures were approved by the patient for their esthetic value.
Following this step the patients were divided in 3 categories (see separate blog for details):
SK1 - Shallow palatal vault
SK2 - Medium depth palatal vault
SK3 - Deep palatal vault.
Each patient underwent speech testing. Initial testing was done using maxillary and mandibular trial dentures with rugae incorporated with wax. Subsequently the rugae were eliminated and speech test was repeated using a smooth palatal contour.
Speech testing : Each patient was made to read a paragraph containing and stressing on 't', 'd', 'n', 'l' sounds.
1 patient was tested of each palatal vault depth.
The Speech Rating Scale used (Developed by Speech language Pathology Dept, AYJNIHH,1984)
0-Normal.
1-Can understand without difficulty. However feels speech is not normal.
2-Can understand with little efforts.
3-Can understand with concentration and effort, especially by a sympathetic listener.
4-Can understand with difficulty and concentration by family, but not by others.
5- Can understand with effort if context is known.
6-Cannot understand at all, even when context is known.
The results of the 3 patients can be summarised as follows
Without dentures Dentures with rugae Dentures without rugae
SK1(Shallow) - 1.6 2 .0 2.3
SK2(Medium) - 1.0 1.3 0.6
SK3 (Deep) - 0.6 1.0 1.3
The shallow and deep palate showed an improvement in phonetics when rugae was incorporated.
More studies and more patients need to be assessed to reach a definite conclusion
The project is ongoing and will be updated when I finish 10 patients in each SK category.
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