Prosthodontics & Occlusion · patient case question
She cannot produce clear “f” and “v” sounds. What adjustment is indicated?
Patient case: Three Weeks Into New Complete Dentures
Patient: 62-year-old female
Chief Complaint: “My palate burns, and I whistle when I talk.”
Background: Edentulous for 6 years. New maxillary and mandibular complete dentures delivered 3 weeks ago. She wears them 24 hours a day and has not been removing them at night. Type 2 diabetes, well controlled.
Medications: Metformin 1000 mg twice daily
Vital Signs: BP 128/76 mmHg · HR 74 bpm · RR 16 · T 98.4°F
Findings: Diffuse bright erythema of the palatal mucosa conforming precisely to the outline of the maxillary denture base, with sharp demarcation at the denture border. Maxillary anterior teeth appear prominent; she cannot produce clear “f” and “v” sounds. Small, firm, smooth, immobile sessile nodules on the lingual aspect of the mandibular alveolus bilaterally, covered by normal-appearing mucosa, which she reports have been present “for as long as I can remember.”
Show answer and explanation
Correct answer: D. Reposition the maxillary anterior teeth more posteriorly
- A. Incorrect. Excessive vertical dimension produces clicking teeth during speech, difficulty with the “s” sound, and a strained facial appearance. Increasing it would not correct a labiodental problem.
- B. Incorrect. Reduced vertical dimension causes an aged appearance, angular cheilitis, and cheek biting. It does not cause fricative distortion.
- C. Incorrect. The posterior palatal seal governs retention of the maxillary denture. Reducing it would loosen the prosthesis without any effect on speech articulation.
- D. Correct. The labiodental fricatives “f” and “v” are produced when the incisal edges of the maxillary anterior teeth contact the wet-dry line of the lower lip. When the teeth are set too far anteriorly, that contact cannot be made properly and the sounds are distorted. Moving them posteriorly restores the relationship.
Note: Speech sound checklist: “f” and “v” test anteroposterior position of the maxillary anteriors. “s” tests vertical dimension and the anterior palatal contour. “th” tests the anteroposterior position of the anterior teeth as a group.
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