Orthodontics – speech therapy – ENT interrelationship
Dr A.kheroua
I. Orthodontics – speech therapy interrelationship
The muscles of the orofacial sphere play a role in the articulation of sounds, in mimicry, but also in the morphogenesis of the dental arches, hence the close relationship between phonation and dentofacial orthopedics.
1.Definition of phonation:
Phonation is a function for the purpose of communication, it is a function of relationship, phonation is a complex function which involves the lungs, the pharynx, the larynx, the supraglottic cavities, the nasal cavities and the oral cavity (tongue, teeth, cheeks, lips)
2. Physiology of phonation:
Phonemes are classified into vowels and consonants, and it is the latter that interest us.
The consonants:
Consonants can be classified according to their point of articulation, which is the location of the obstacle or narrowing that prevents the passage of air.
Normally, in adults, and in the French language, the tongue never relies on the upper incisors for the pronunciation of phonemes.
- The palatals (D, L, N, T):
They are also called dentals, they must be pronounced tip of the tongue touching the palatine papillae
- Sibilants (S, Z) and sibilants (CH, J):
The lateral edges of the tongue should be in contact with the molars and its tip should either remain free or be in contact with the retro-incisive mucosa or with the palatine papillae
- Fricatives or labiodentals (F, V)
They are pronounced with the inner surface of the lower lip pressing against the upper incisors.
- Bilabials (B, P, M):
Pronunciation is done by pressing the upper lip on the lower lip, the two lips coming into contact with each other.
3. Speech disorders:
- The palatals D, T, N, L:
Instead of making contact with the palatine papilla, the tip of the tongue rests on the palatal surface of the upper incisors or on the lower incisors or is interposed between the teeth. Sometimes the edges of the tongue are interposed between the molars.
- The sibilants S, Z:
The tip of the tongue is interposed between the incisors or raised behind the upper incisors. Sometimes the edges of the tongue are interposed between the molars.
Orthodontics – speech therapy – ENT interrelationship
- Labiodentals F, V:
The lower lip is placed between the incisors.
It should be noted that most of these motor disorders are associated with abnormalities in swallowing praxis.
Articulation disorders related to atypical swallowing are: tdn sz ch-j. The points of articulation are anteriorized.
- tdn are interdental
- Sz are interdental (interdental sigmatism), rarely schlinted (lateral sigmatism)
- Ch-j are replaced by sz (lisp), rarely schlinted
The relationship between articulatory disorders and morphological disorders was summarized by DAHAN
| Incisor gap | Interdental sigmatism – anterior interdentality |
| Overbite | lateral sigmatism – hissing |
| Proalveolism | lingual thrust on the incisors during palatal pronunciation |
| Anterior gape | interdental sigmatism |
| Lateral gape | hissing |
The conclusion on the relationship between articulatory disorders and morphogenesis is not unanimous; for some, malocclusions lead to phonation disorders, and for others these dysmorphoses are the consequence of phonation disorders.
For some authors such as CAUHEPE, the action of articulatory disorders on morphogenesis is minimal because the action exerted by the tongue during the articulation of a consonant lasts only a tenth of a second; however, we know that phonation disorders and swallowing disorders are closely linked, and consequently, that the presence of an articulatory anomaly is more than an isolated symptom; it is rather the revealing sign of a disturbance of oral functions; this is why rehabilitation of all these disorders will be necessary.
Orthodontics – speech therapy – ENT interrelationship
4.Therapeutic:
Indications for phonetic articulation education
- Education of the articulation of anterior palatal consonants must always be associated with education of swallowing.
- It may be the only treatment if the articulation disorder is of low amplitude or in the incisor infra-alveoli.
- It can follow mechanical treatment if the articulation disorder is more significant.
Contraindications:
- Unmotivated child
- In the case of a child with significant educational delay or following another education for dyslexia or dysorthography
- The same goes for a child with a below average IQ.
- Child Sucking Finger
5. Speech therapy and orthodontics:
The speech therapist collaborates with or precedes orthodontic treatment; the treatment is called myofunctional therapy.
It is not always possible to correct articulation disorders, but if swallowing is corrected, the resting position is correct and the lip/cheek muscle tone is good, any remaining articulation disorders have no influence on the teeth; the pressure is minimal and short-lived; otherwise all English speakers would have their teeth protruding.
II. Interrelation between orthodontics and ENT
The complete orthodontic examination should include examination of the entire dentition, lingual examination, and examination of the upper airways in order to objectify the fundamental etiological factors.
1. Physiology: nasal ventilation
Nasal ventilation is a vital orofacial function. It is a reflex activity whose purpose is to oxygenate the cells of the body; only nasal ventilation is physiological and functional.
The nasal cavities are specifically dedicated by their anatomy to prepare the air before it reaches the lungs for the process of humidification, warming, and purification of tiny particles.
In addition, nasal ventilation contributes to the optimal development of the nasomaxillary complex and the stomatognathic system.
But this function is only effective if the tongue rests jointly on the palate and on the alveolo-dental arches, thus stressing the midpalatine suture by spreading the maxillae.
2. Dysfunction: Oral or mouth ventilation
Mouth breathing is an abnormality of respiratory function behavior; it can be used when the upper airways are obstructed, or during intensive effort, but always associated with a tongue in poor position.
Etiology:
The upper airway may be obstructed if the patient has:
- A deviated nasal septum
- Polyps
- Allergic rhinitis
- Adenoid or tonsillar hypertrophy
A “negative” ENT assessment does not eliminate:
- narrow nasal passages
Consequences :
The so-called “adenoid” facies includes:
- A pinched nose
- A lip gap
- A thick, shortened upper lip
- Dry lips
- A low and forward position of the tongue
- Facial hyperdivergence
- Generalized hypotonicity
- An increase in the lower level of the face
- An opening of the goniac angle
- Cephalovertebral static disorders with spinal deformation
Ventilation review:
The ventilation examination begins as soon as the patient enters the office, we look at his general appearance and posture.
Examination
Parents are asked:
- If the child always has his mouth open
- If he sleeps with his mouth open and needs to drink when he wakes up
- If he snores
- If he has an ENT pathology
- If he has had an adenoidectomy or tonsillectomy
- If he has trouble sleeping, is tired or has difficulty at school
Clinical examination:
We look for the different clinical signs of mouth breathing .
Tests:
- Mirror test: nasal patency
- Rosenthal test: + or –
- Gudin test: nostril reflex
X-ray
In the event of disorders, a complete assessment must be carried out by an ENT specialist, who performs a rhinoscopy or fibroscopy to observe the upper airways, and if necessary, an allergist.
Additional functional explorations – in particular rhinomanometry which measures nasal resistance or an examination using an aerophonoscope which determines and compares airflows of nasal and oral origin – can be carried out.
3.Ventilation therapy
From a therapeutic point of view, it is necessary to insist, in children, on the at least partial reversibility of morphofunctional adaptations, after removal of the obstacle responsible for oral ventilation.
This reversibility justifies diagnosis and treatment as early as possible, in order to create the conditions for better nasal ventilation.
If the anatomical cause is removed, the persistence of oral ventilation can be explained by:
- rhinopathy, narrow nasal passages
- “habit” or non-learning of the neuromotor praxis of normal ventilation and lingual function
Need for ventilatory rehabilitation
Breathing rehabilitation:
It is based on:
- learning to blow your nose
- The work of opening the nostril wings
- Alternate ventilation exercises
- Automation of abdominodiaphragmatic ventilation
Orthopedic therapy:
Maxillary expansion remains the treatment of choice, acting simultaneously on the nasal fossae and the maxillae .
Rapid maxillary disjunction, used for the correction of transverse deficits of the maxillaries, allows, according to many studies, to improve nasal ventilation. This latter effect would be linked to the modifications of the transverse dimensions of the nasal cavities of which the maxillary bones form a significant part of the walls.
Conclusion :
To benefit from the essential otolaryngological contribution, it is appropriate to approach the problem in a multidisciplinary medical manner and to understand that the normalization of the upper airways comes before any attempt at orthopedic therapy.
Moreover, orthopedic techniques, which are illusory in effect without effective nasal function, take on new meaning when it is restored.