Patient Visit 4

Clinical Procedures

Confirm the Mold, Shade and Arrangement of the Artificial Teeth

1. Check the size, form, shade and arrangement of the teeth. Harmony and a pleasing natural appearance are the goals. The teeth should be observed from several angles to evaluate their mesiodistal inclinations and labiolingual inclinations. The midline and the occlusal plane must also be evaluated at this time. The dentures should be observed when the patient is standing, sitting, talking and at rest.

2. When the functional and esthetic factors are correct, phonetics seldom presents a problem. It is helpful to attempt to engage the patient in a meaningful conversation in which the patient expresses himself or herself in a natural way. During the conversation certain sounds should be observed carefully:
a. "F" and "V" sounds are produced when the highest part of the lower lip is barely in contact with the incisal edges of the upper teeth. Difficulty in producing the "F" and "V" sounds is due to placing the maxillary anterior teeth too far lingually or placing the occlusal plane too high.
b. "S" sounds are produced by air as it escapes behind the maxillary incisors near the center of the mouth between the tongue and palate. Lisping can be caused by excessive thickness lingual to the maxillary central incisors. A deep channel located lingual to the maxillary central incisors causes whistling. An "S" sound that sounds like the "sh" may be caused by too broad a channel lingual to the maxillary central incisors preventing contact between the tongue and the denture base in the premolar and molar region.
c. "Th" sounds are produced by slightly protruding the jaw and bringing the tip of the tongue in contact with the incisal edges of the upper and lower incisors. Difficulty in producing this sound is due to too much horizontal overlap or a deep and/or board channel between the tongue and the area of the denture base lingual to the upper incisors. The "S, "Sh" and "Th" sounds are closely related to one another. Remember all patients will have some difficulty with new dentures and require an adaptation period. Don't be too demanding of phonetics at this stage. Use phonetics to verify the position of the teeth.