Palato ram Assessment of Maxillary
Comp ete Dentures H
Dauid W.FarlT, DDS,John D.Jones, DDS,2 and RobertJ. Cronin DDS,MS3
Phonetics, esthetics, function, and comfort form the foundation of a successful dental
prosthesis.A review of the mechanics of speech as well as common speech problems encountered
with a removable maxillary prosthesis are presented. The use of a palatogramto aid the clinician in
the assessment and resolution of speech problems associated with a maxillary denture is
demonstrated.
J Prosthod 1998;7:84-90. Copyright0 1998 by The American College of Prosthodontists.
INDEX WORDS: palate, speech, phonetics
P HONETICS, ESTEIETICS, functional efficiency,
and comfort are key elements of successhl com-
plete denture treatment. All too often. a thorough
evaluation of phonetics is neglccted as more empha-
sis is placed on the other three components. Optimal
phonetics following denture placement is dependent
on the establishment of physiologicallyaccurate vcrti-
cal dimension of occlusion, occlusal plane, p d a t d
contour, and positioning of the anterior teeth.b7
Background
It has been stated that the primary functional pho-
netic role of a complete denture is to facilitate the
stream of air as it passes through the oral cavity.e
Speech sounds are noises created by a combination of
laryngeal tone and airflow. Rothman lists the follow-
ing essential mechanisms of speech production2:
Initintor-the motor speech area of the brain.
Motor-the lungs and associated musculature.
Vibrator-expired air from the lungs cause vibra-
tions in the vocal cords yielding pitch and tone.
Resonatow-oral, nasal, and phaqiigeal catitics
intensify and enrich the sound.
From the UniniDersitp f Texar Health Scierut Center at San Antonio,
Department ofProsthoduritics, Sun Antonio, TX.
GraduateProsfhodontirResiknt.
2hsociate Pmfasor.
3AssociateProf.or, Director ofportdoctoral Prosthodontics.
Accepted March 12, 1998.
Presented ar a table clinic at the I.996Annual Sesrion of The Ammian
CoUqe a/Pro&?dontists, Kuruar Ci@;X O .
Correspondence to: Rob&.]. Cronin, ODs, CniaersiQof Texas Health
Science Cmtrt at San Antonio, Ilefiartment vf Graduate Pmsthodontics,
7703FZyd Curl DT. San14nlonio. TX 78284-7912
Copyright 0 1998 ly The Amorkan College u/Prosthodontirts
105~-g4rx/98/0702-00~4~~. OOIO
84 Journal ofPosthodonticr, Vol7,N o 2 (June), 1998:pp 84-90
5. Enwciators-the lips, tongue, soft palate, hard
palate, and teeth add distinctncss and articulation
to the speech sounds.
The tongue plays a major role in the formation of
specch. The tongue changes position and shape for
pronunciation of cach of the vowcls, with little or no
contact with other tissues. The tonLgucalso acts as
the principal articulator of the consonants as it
contacts specific areas of the teeth, alveolar ridge,
and hard palate. For this reason, the corisonant
sounds are of greatest intcrcst to the prosthodontist.
Several classifications of speech sounds are presented
in Table I .
This review will focus on those sounds formed by
phonetic contact betwccn the hard palate and the
tongue that can be assessed with a clinical palato-
gram technique. These are known as the@alatolinpal
confonants and consist of the S, T, D, N, and
L sounds. Tanaka studied the relationship between
palatal contour and speech intelligibility. He noted
that in a sagittal section, the natural anterior palate
exhibits a rcvcrse curve. This contour is crucial for
pronunciation of the S and SH sounds. In a
comparison betcvccn the palatal contours of dentate
patients and acrylic resin maxillary dentures, Tanaka
found this prominence either deficient or completely
lacking in the majority of maxillary complete den-
tures.g
An alveolopalatal prominence should also be prc-
sent beginning at the premolar teeth and should
become thicker as it progresses distally to thc molars.
This contour allows the tongue to seal the posterior
palatal denture surface and direct a flow of air
anteriorly. Many dentures feature a concavity on the
palatal surface just below the gingival margin instead
of this posterior palatal prominence. Phonetic alter-
ations occur when an airstrcam escapes over one or
 June 1998, Volume 7,Nurnbn 2 85

Table 1. Classiticatioiis o f Speech Sounds

Vuicelers Spcech Sound (meuted by air u h e )
Air is forced by the tongue through a narrow apertiire and s, sh, th, f
is associated withf ~ c t i o n
Plosives &x@losioe release of air p, t, k
Affricatives A combination of the fiction and e x t i h i ~ t eelcnients ch
Voice Speech Sounds (created by laryngeally produced noise)
Vowels Formed from continuour oocul cord oibrutiom; tongue and lip a, e, i, o, u
positions impart structural overtones
Voiccd Consonants A combinarioii of air-producedsounds and laryngeal tone b, d, g, j, I, m, n, q, r, v, w, x, x
Classification 4ccording to Anatomic Sound Formation
Palatolingual
Tongue and hard palate The tonguc is positioned just behind the maxillary incisor s
teeth with the sides of the tongue in contact with the
maxillary posterior teeth and alveolar ridges
Tongue and hard palate The tongue is placed firmly against the anterior hard 1, d, n, 1
palate
Tongue and soft palate Thc posterior dorsal tongue is raised to occlude with the k, g, ng
soft palate
Linpoden t a1 The tip o f The tongue is placcd between the maxillary and th
mandibiilar incisal edges
Labiodental Formed by the lower lip contacting 1 he iricisal cdges of the f, v
maxillary incisor teeth
Bilabial These sounds are formcd between the lips b, p, 171

both sides of the tongue when the tongue tip is in
contact with the anterior denture palatc or when the
tongue tip cannot compress the airstream between
the tongue and palatal denturc surface. Allen statcd
that the most widely used procedure to improvc
denture phonetics is thc random thinning of the
entire maxillary liiigual surface to create more space
for the tongue.1 Such arbitrary removal of acrylic
resin fiom the palatal surfacc ignores the critical
importance of correct palatal contours in the propcr
formation of sounds.
A patient receiving a new maxillary dcnture may
noticc subtle changes in the palatal contours. Such
changes can be manifestcd as phonetic alterations of
the palatolingual consonants, especially the S sound.
Typical alterations are a whistling S or a shift to an
Sh sound.? The S sound is Cornled by a stream of
air escaping from the medial groovc of the tongue
behind the alveolus. The sides of the tongue are in
contact with the maxillary posterior teeth and palatal
denture base.* The tip of the ton<pe forms the
medial groove and does not contact the anterior
teeth or palate. The grooving of the tongue and
laterally sealed airflow arc essential in the proper
formation of the S sound. If the medial groove
opening is too small, a whistle will result. If the space
is too broad, the S sound will develop as an Sh.
Table 2 reviews various causes, diagnostic proce-
durcs, and treatments of aberrant S sounds.13The
vcrtical dimension of occlusion should always be
verified for correct and comfortable formation of the
S sound before making changes in the maxillary
denture base?
Other palatolingual consonants can also be af-
fected by changes in palatal contours. To form the
sounds T, D, N,and L, the tongue is placed
firmly against the anterior hard palate.2 Excessive
denture base thickness in the antcrior palate can
prove detrimental if premature contact is made.
Prcmature contact can result in the T sounding
like a D. The conccpt of replicating rugae in the
anterior palate of a prosthesis is controversial in the
literature. Landas stated that rugae are useless or
detrimental because of the additional denturc base
thickness. Slaughterz preferred the use of r i p e in
thc dcnture base for tactile oricntation in the fotma-
tion of sounds. Other authors believe that rugae are
critical for the formation of palatolingual s0unds.2:~:~
Allen recommended thickening the denture base in
the area of the incisive papilla to prevent the jet of air
emitted from the median sulcus when pronouncing
S from escaping toward the vault.1
Apalatogram is a record of contact made betwccn
the tonguc and the hard palate and tecth cvhen
86 Palatogram Rrsessrncnl Farlgy,Jones, and Cronzn

Table 2. Common Palatolingual h e e c h Problems

~

Possible Cuuw Iliupnostic Procedure Treatment

1. Whistle on s sounds
Median tongue groove too deep
Air escape space in denture base too
deep
Maxillary teeth set too far labial
Insufficient denture basc material on
lingual of maxillary anterior teeth
Posterior leeth set too far lingual
cramping the tongue space
Denture base material too prominent
causing median ,qoove to deepen
Palatogram assessment Replace wax with acrylic resin if
Add wax to anterior palate to restore whistle is corrected
normal palatal s c u n ~
Add a wax incisive papilla (1 to 3-mm
height X 3 to 4-mm diameter)
Palatogram assessment
Add wax to thicken center of palate
Relieve posterior denture base
Add wax to anterior palate
~ ~ ~ ~ ~

2. s sounds like sh
Median tongue groove too shallow Palatogram assessment Relieve anterior palatal denture base
and air escapes at lateral borders of
tonguc
Excessive denture base lingual to
anterior teeth
Anterior teeth set too far lingual
Air escaping at lateral tongue borders Palatogram assessment Replace wax with acrylic denture
due to insuficient denture basc Build up linLpaltissue roll adjacent to resin
eminence lingual to posterior teeth posterior teeth in wax
(stigmatismus lateralis)
Note. Adapted h n l Kuehker WA Denture Problems: Causes, Diagnostic Procedures, and Clinical Treatment.n W . Gagging Problems
and Speech Problems. Quint Int 1984;12:1231-1238. Quintessence Publishing Go, Inc Copyright holder.

certain sounds are pronounccd. The palatogram is
useful at the wax try-in appointment to assess proper
lingual contact with the record base. It can also be
used as a guide for the assessment of phonetic
alterations after placement of a maxillary prosthesis.
A palatogram assessment or denture palatal con-
tours can be beneficial when used with implant-
supported maxillary dentures. Deviation from ideal
palatal contours are often encountered with maxil-
lary implant-supported dentures. This can bc caused
by implant anplation problems, diminished restor-
ative space, and bulky attachment mechanisms. The
palatogram can be an extremely useful technique,
alloming the clinician to determine the phonetic
impact of the implant-affected contours.
Another indication for use of the palatogram
technique is in the cvaluation of maxillary denture
placcment in the sensory- or muscularly impaired
patient. An analysis of the space of Donder in
patients suffering from a loss of motor function can
be simplified by the use of a palatogram. A careful
evaluation of speech patterns and food bolus manage-
ment in the orally disabled or geriatric patient may
include palatal contour assessment. The usc of the
palatogram grcatly aids the communication between
the prosthodontist and the speech pathologist or oral
physiotherapist in evaluating the problematic pa-
ticnt.
Clinical Techniques
To demonstratc the use of a palatogram, a patients
maxillary denture was duplicatcd. Two different
maxillary dentures were fabricated with modified
palatal contours representing an undercontoured
and an overcontoured palate. The patients denture
was uscd to represent a well-contoured palate. The
patient was then instructed to pronouncc certain
palatolingual sounds with each of the three maxillary
prostheses, and the contacting surfaces were re-
corded.
According to the protocol set forth by Allen, all
consonants used in making the palatograms were
combincd with thc vowel 0. Thc 0sound was
found to be the only vowel that consistently had no
palatal contact when pronounced. Because pronuncia-
tion of the consonant sounds alone involves two or
more sounds, and therefore two or more tongue
positions, this prevented unwanted additional palatal
contacts. For example, when pronouncing the T
 June 1998, Volume 7. Numbt-, 2
Figure 1. Complete denture sprayed with grecn Occludc
marker.
sound, the vowel sound ee is also made. Having the
patient say ~octo register the Tsound creates a
more accurate reproduction of the desircd contact
areas.
Palatograms were made using green Occlude
aerosol (Pascal Company, Inc, Bellewe, WA) as a
marking media. All ingredients in the Occlude prod-
uct are listed as safe for ingestion. The green Oc-
clude material provided a distinctive contrast against
Figure 2. S unciercontoured palate. Light ctintaci is
seen adjacent to the posterior teeth as the tongue has wet
the surface of the marking material.
87
Figure 3. Snormal-contoured palate. In a more anatomi-
cally correct dcnture palate, some of the marking material
has been wipcd away from the palatal surface by the
tongue, in addition to wetting t h e wrfa~:e.This is indicative
of an increase in contact prcssure.
the pink denture base and did not transfer to the
patients tongue or intraoral tissues. The polished
palatal and alveolar areas of the dentures werc
carefully sprayed with the Occlude marking media.
The patient was asked to repeat only the desired
sound two consecutive times. The denture was then
promptly removed and assessed for contact. Ex-
Figure 4. S overcontoured palate. Tissue contact has
increased further as indicated by the extent ofwetting both
anteriorly and into the palatal vault area.
88 Palatogram .4~te1\rnpnt a Far&, Jiints, and Cronzn
Figure 5. T undcrcontoured palate. Light contact be-
tween the tongue and the acrylic resin palate is seen both
adjacent to the posterior teeth and in the antcrior palate
area.
amples of palatograms for the S and T sounds
are demonstrated in Figs 1 through 7. These photo-
graphs reveal progressively increasing contact with
the palate when comparing the undercontoured den-
Figure 6. Tnormal-contoured palate. A broader area of
contact is seen in the anterior palatal area when compared
with the undercontoured palatal surface. Also, some niark-
ing material has been wiped away from the palatal surfaces
adjaccnt to thc posterior teeth.
~i~~~~7. yoL,rrc:ontouredpalate. H~~~ (:ontact in the
anterior palatal regiDn is indicated by an irlcrease in thr
amount ,,fwetting o)rlllesprayed denture base.
ture base with the normal and overcontoured palates
for all sounds tested. This is indicated both by
increased wetting of the marking material by the
tongue and the removal of the niarking material in
certain areas caused hy greater contact pressures.
Additional line drawings are shown to demonstrate
repi-cscntativc palatograms for the T and S
sounds (Figs 8 and 9). Each individual will produce a
similar palatogram for a given sound, but there will
be unique characteristics for that particular pcrsoii.
This is because individuals have anatomic variations
in the shape and size ofthe tongue, palatal vault, and
arch form.
If it is dctermincd that some areas of palatal
contour are deficient, an assessment as to the extent
of deficiency can be made. The palatal and alveolar
areas of the maxillary denture are lightly coated with
an alginate adhesive. i\ mix of alginate is then
prepared usingvery cold water to retard the set ofthe
matcrial. A thin wash of alginate is uniformly spread
over the palatal area of the denture and smoothed
with a wet, gloved finger. The denture is quickly
placed into the patients mouth and the patient is
allowed to speak using various sound stimulus sen-
tences. Table 3 lists various sound stimulus sentences
useful for this purpose.9 After the alginate has set, a
periodontal probe can be inserted through thc algi-
nate to the acrylic denture base as seen in Fig 10. The
 June 1998, Volume 7, Number 2 89

Figure 8. Palatogram representative of the S sound. Figure 9. Palatogram representative of the T, D,

N, 3,and Ch sounds.

depth of the alginate can serve as a guidc for accurate

palatal contouring. To prevent excessive thickness of
the alginate, the phonetic displacement of the mate-
rial should commence immediately after insertion of
the denture.

Conclusions
1. Palatograms are helpful in the evaluation of pho-
netics of the complcte denture patient.
2. Thc grecn marking spray Occlude is a safe,
effective, and highly visible marking media for a
palatogram.
3. The use of alginate as a palatal disclosing media is
usefd when detcrrnining the extent or a spacial
dcficicncy.
Figure 10. Demonstration of measuring a palatogram
made with irreversible hydrocolloid.
Table 3. Sound Stimulus Sentences
Sound Sentence
References
ch Chuck is watching Butch.
j Jane enjoyed the fudge. I. Terrell 14: Fundamentals important to good complete den-
sh She is warhing the dkh. tine construction. J Prosthet Dent 1958;8:710-753
zh hlearurc the garage. 2. Rothman R Phonetic considerations in denture prosthesis. J
S Sue is mining one piece. Prosthet Dent 1961:11:214-223
z Zelma is b i q . 3. Martone iv..BlackJV: An approach to prosthodontics through
I Tom waded a bite. speech science: Part V. Speech science research of prosthodon-
n Ned won many prixes. tic significance.J Prosthet Dent 1962;12:629-636
d Did W y lead? 1. Palmer ,JM Analysis of speech in prosthodontic practice. J
1 Lee will allow it. Prosthet Dent 1974:31:605-614
Note. From Tanaka H . Speech Patterns of Edentulous Patients 5. Palmer JM: Structural changes fnr speech improvement in
and Morphology of the Palate in Relation to Phonetics. J Prosthet complete upper denture fabrication. J Prosthet Dent 1979141:
Dent 1 973;29:16-28. 507-510
90 Palatogram ilssessnzent
6. Weir FS: Relating tooth positions in full dentures to the oral
vestibulc to obtain axuracy of speech, esthetics, and anatomic
I;rnction.JAm Dent Assoc 1932;19:1706-1712
7. Zarb GA: Rouchers Prosthodontic Treatment for Edentulous
Patients. St. Louis, MO, C.V. Mosby (20, 1990
8. Lands JS: Practical Full Denture Prosthesis. London, Dental
Items of Interest Publishing Co, 19.54
9. Tanaka H: Speech patterns of edentulous paticnts and mor-
phology of the palate in relation to phonetics. J Prosthet Dent
197329:16-28
Farly,Jones, and Cronin
10. M e n L K Improved phonetics in denture construction. J
Prosthet Dent 1958;8:753-63
1I. Sears VH: Principles and Techniques for Complete Denture
Construction. St. Louis. MO, CV Mosby Co, 1949
12. Slaughter MD: Speech correction in full denture prosthesis.
Dental Digest 1945;51:242-246
13. Kuebker F$A Denture Problems: Causes, Diagtgnostic Proce-
dures, and Clinical Treatment. IIm.Gagging problems and
Speech Problems. Quint Int 1984;15:1231-1238