The Mandibuiar Speech Envelope

in Subjects with and without

Incisai Tooth Wear

C. Andrew Burnett, BDS, FDS RCPS, PhD

Thomas J. Clifford, BDS, FDS RCPS,

Purpose: The purpose of ihis study was to describe a mandibular envelope of motion
during speech for 2 subject groups. One subject group had experienced no tooth wear and
the other had incisai tooth wear. The speech envelope was to be described with regard to
its maximal dimensions in the vertical, anteroposterior, and lateral directions, and its most
superior and anterior positions in relation to intercuspal position. Materials and Methods;
An electromagnetic method of jaw tracking was employed to record mandibular speech
movements for 60 subjects whose teeth exhibited no tooth wear and 30 subjects with
incisai dental attrition. The test speech exercise contained all of the word sounds that
occur in the Engiish language. The test was recorded 3 times, and mean values for
parameters were reported. Results: The speech envelope of the tooth wear group was
significantly smaller (Student's (test, P < 0.01) in all 3 dimensions than that of the normal
group. The tooth wear group speech envelope was also located closer to the intercuspal
position in the vertical dimension {P< O.OI) and was not as anteriorly placed [P< 0.01). In
the normal group, correlations were found between the vertical incisor overlap and the
mosL superior speech position {r- 0.48, P < 0.0001), and between the horizontal incisor
overlapand the most anterior mandibular speaking position ( r = 0.63, P < 0.0001).
Conclusion: The envelope of mandibular movement during speech differed in dimension
and position between the 2 groups investigated. Int J Prosthodont 1999;'!2:514-518.

n the management of dentate and edentulous patients, valuable clinical information such as anterior
tooth position, incisai guidance, and occlusal vertical
dimension may be rendered by an assessment of

mandibular positions assumed during speech.'^ Tooth

wear, the noncarious loss of tooth tissue, often necessitates restorative intervention, and although it seems
to be commonly accepted that the condition is on the
increase, data on its prevalence are limited. It has
been suggested that more than 5% of tootb surfaces,
'Clinical Lecturer, Division of Restorative Dentistry, School of rising to nearly 9% in tbe oldest age group, are unacClinical Dentistry, The Queen's University of Beifast, Northern
ceptably worn.^ When this is considered with the inIreland.
''Senior Lecturer and Consultant, Division of Restorative Dentistry, crease in longevity and tooth retention, concerns are
School of Clinicai Dentistry, The Queen's University of Belfast, raised regarding future restorative needs. Tooth wear
Beifast, Northern Ireland.
bas a multifactorial etiology in which attrition, a physical process whereby tootb substance is removed
through the movement of teetb against one another,
Reprint requests: Dr C. A. Burnett, Division of Restorative
has been shown to be contributory to pathologic wear
Dentistry, School of Clinical Dentistry, The Queen's University of
in 27% of referred cases.^ Attrition usually occurs over
Belfast, The Royai Croup of Hospitais, Grosvenor Road, Belfast
a sufficient period of time to allow physiologic mechBTU 68P, Northern ireland. Fax: + 44-1232-438861. e-mail:
anisms to operate in compensation for loss of occlusal
[email protected]

The international lournai or Proiiliodoolics

514

12, Number 6,1

Burnett/Clilord

Mandibular Speecii Envelope witii and wlihout incisai We

vertical dimension,^-^ This can greatly complicate

dental management with regard to providing space for
restorative materials.
Mandibular movement during oral functions involving occlusal contact is influenced by the form of
the occlusion and may be affected by changes of it,'"
Investigations have also shown that age and changes
in dental condition may affect oral motor function.' '-' ^ Speech movements, although not reliant on
occlusal contact, are nonetheless affected by anomalous aw and occlusal relations.'-"^
The purpose of this study was to describe the 3-dimensional limits of the mandibular envelope of motion during speech and its most superior and anterior
positions. Two subject groups were investigated, a
group without tooth wear and a group with incisai
tooth wear caused by attrition.
Materials and Methods
A total of 90 individuals participated in tbe study. No
subject suffered any speech defect or exhibited any
signs or symptoms of dysfunction of the masticatory
system. The first subject group, the so-called normal
group, comprised 30 female and 30 male dental students. Their mean age was 22 1 years, ranging from
20 to 25 years. All had intact dentitions, and although
some subjects in this group had evidence of loss of
enamel surface characteristics, such as on tbe canine
cusps, for the purposes ofthis investigation this group
was assumed not to have suffered tooth wear. The incisor relationship of each subject was recorded and
classified''^ on the basis of contact of the mandibular
incisors, or a continuation of their axial plane, with the
palatal surface of tbe maxillary incisors when occluding in the intercuspal position (ICP). The composition of this subject group, with regard to relative
numbers ofthe 4 different incisor relationship classes,
was determined to closely reflect an average ofthat
reported for a young British population,'^"'^ which
was taken as tbe accepted standard for the study.
Random allocation, from a total sampling frame of 80
subjects, to each ofthe 4 incisor subgroups supplied
the makeup of the final subject group, with 26 Class
I, 17 Class II division 1,12 Class II division 2, and 5
Class III subjects. There was no statistically significant
proportional difference (Chi-squared) in relation to incisal classification between the subject group and the
accepted standard. The magnitude of incisor overlap
in ICP, in the vertical and horizontal dimensions, was
recorded using a millimeter rule.
The second study group, the so-called tooth wear
group, comprised 30 consecutive consenting subjects who fulfilled tbe selection criteria and were referred for dental management by their general

^ Volume 12, Number 6,1999

515

dental practitioner to a hospital tooth wear clinic. The

criteria for selection to the tooth wear group was that
each subject retained all of their incisor teeth and that
these teeth had tooth wear, of approximately at least
'/i of the crown height, for which attrition was diagnosed as the major etiologic factor. The group was
made up of 23 men and 7 women, a ratio that reflected the overall attendance pattern at this clinic.
Their mean age was 49 9 years, ranging from 34 to
63 years. All 30 subjects had an edge-to-edge incisai
relationship in ICP.
Jaw movements were recorded using a Sirognathograph (SCG, Siemens!. The SGC was connected to a
computerized system (Bio-Pak, io-Research Associates) that recorded and displayed, to the nearest 0.1
mm, spatial coordinates in 2 planes: frontal (vertical
and lateral dimensions! and sagittal (anteroposterior
and vertical dimensions!. The system has been
shown-" to have linear output for up to about 40 mm
of vertical displacement when lateral movement is
less than 10 mm, and these conditions were fulfilled
in this study.
Mandibular movement was recorded as subjects
read a 106-word test passage of text closely modeled
on that suggested by Kestenberg,^' The passage contains all ofthe phonemes that occur in the English language, and the frequency of their occurrence in the
paragraph is approximately the same as their relative
frequency in conversational English.
How are you Tom Dope? and no oranges are growing in
Mexico and it is nice to see my grandfather swim about
here and George depend on Ruth to bake a big lemon
cake and roses are red and violets are blue and three lashings won't hurt poor old Dick and Tim show Harry where
to wash your clothes tub and Wednesday will be a laugh
for all otusand the sixty five fast trucks leave the zoo each
year and perhaps you need to fire the man in England too
andsweet Peggy Nun caught that fur hat and the children
weren't catching anything.

The speech test was verbally demonstrated for pronunciation and rate and volume of speech. The latter
2 parameters were described as being of normal conversational speech and subjects were given a few
minutes to rehearse the tests. The SCG headset was
mounted and aligned with the subject seated upright
on a plastic chair with the head firmly supported
against the rear chair support. Subjects were instructed
to keep their head as steady as possible during recording. Recording artifacts caused by head movement or
displacement ofthe antenna device may occur when
using the SCG.^^-^^ For this reason, movements ofthe
headset were checked for by inspection and by having subjects start and finish each test at the reference
point, ICP as identified onscreen; discrepancies were

The Internatioril ournsl o Proslhodonlics

Bumett/Clifford

MandibuisrSpeecii Envelope with and wilhout incisai Wear

Table 1 Dimensions ot the Speech Envelope and Its Most Superior and Anterior
Positions for the Normal and Tooth Wear Groups (mm)
Tooth waar group (n = 30)

Normal group (n = 60)

Mean
Speech envelope diimensions
10,9'
5.2'
AnteioposleriOf
3,r
Laterai
Speech position
2,2*
1.9'
Anterior

SD

Range

Mean

SD

2,6

5,8-16,0
2.4-9.8
1,3-S.6

9,r
4,r

1.3

1,0
1.3
1,9

0-7.0
-2.8-11 1

1,0'
0.5'

1 6

Range

2,10,9
1.7

0.1-3,6
-2.3-5.2

Significant aifterence between groups (Student's (test. P i 0,01).

SD = star a ara deviation.

Table 2 Dimensions of the Speech Envelope and Its Most Superior and Anterior
Positions for the 4 Incisai Subgroups of ttie Normal Group (mm)

Mean
Speech envelope dimensions
V rtica i
11,3
Anteroposterior
52
3.4
Laterai
Speech position
2,2
Superior
1,8
Anterior

Class III
(n = 5)

Class II div 1
(n = 17)

Ciass li div2
(n = 12)

Mean

SD

Mean

SD

Mean

SD

2.5
1.5
1,0

11 7
57
3,4

2,3
1,7
0,9

9,9
4.8
2.6

2,8
2.0
0,8

8,8
4,5
2,5

2,1
1,0
0,9

1,1
0,8

2,3
3,3'

0,7
2,5

2,3
0,7

1.3

0.90.5

0,7
C.7

Class I
(n - 26)
SD

1.6

'Signiticant diftererice among groups (ANOVA, P< (),0t,

SD = standard deviation.

Results

seldom found, bul when they were, the recording

was repealed. The influence of recording and subject
variability has been previously investigated-"'with regard to speech movements, and these were shown to
be reproducible after a &-month time intervai. The
same method was employed in this investigation. For
each subject, 3 recordings of jaw movement were
made and mean values were calculated for each parameter. The mandibular envelope of motion during
speech was described as the maximum range of movement in the vertical, anteroposterior, and lateral dimensions recorded during recitation ofthe test. It was
further described in relation to its most superior and
anterior positions. The mandibular position that came
closest to ICP in the vertical dimension during the exercise was taken to represent the superior speaking position. The most anterior mandibular position assumed
in relation to ICP was taken to represent the anterior
speaking position. Those positions in the anteroposterior dimension that were posterior to ICP were labeled with a negative value.

There was a difference in the size of the speech envelope between tbe normal and the tooth wear groups
(Table 1), with that of the latter being significantly
smaller in all 3 dimensions (P < 0,01), The tooth
wear group also demonstrated a smaller superior
speaking position and anterior speaking position than
the normal group ( P < 0,01) (Table 1), with their
speech envelope located closer to ICP in the vertical
dimension and being more posteriorly placed.
Of the 4 incisai subgroups of the normal group,
there was a trend for the dimensions of the recorded
parameters ofthe Class III incisai group to be smaller,
although this was only supported statistically for
superior speaking position (P< 0,01) (Table 2), The
anterior speaking position of the Class II division 1
subgroup was found to be significantly more anterior
than the other incisai subgroups (P< 0,01),
The correlation ofthe normal group's vertical incisal overlap in ICP with their superior speaking position was significant (r - 0,48, P < 0,0001 ) (Fig 1 ),
There was also a significant linear relationship
demonstrable between this group's horizontal incisai
overlap and their anterior speaking position (r= 0,63,
P<0,0001)(Fig2),

Statistical anaiysis was performed by 2 group unpaired Student's itests and analysis of variance
(ANOVA) multiple comparison tests using the Scheff
criterion, with Pvalues less than 0.01 interpreted as
statistically significant.

The Inlernationai

i of Prosthodontics

516

Volume 12, Number 6,

Burnett/Clifford

Mandibular Speech Envelope willi and without Incisai Wear

8
12
10
6

srior spea king

aking p ositior

f-0.48
4

dng

r= 0 3

6
4

Q.
2

>

-2

10

10

12

Vertical incisor overlap (mm)

fO

Horizontal incisor oveFlap [m m)

Fig 1 Superior speaking position correlated with verfioal incisor

overiap

Fig Z Anterior speaking posifion correlated with horizontai incisor o^ierlap

The norfnal group results were analyzed with respect to gender regarding speech envelope dimension5, superior speaking position, anterior speaking
position, and incisai classification. No statistically significant difference for any of these variables was
found between the male and female subjects.

produce the most superior incisai speaking position,^^

However, the presence of a natural vertical incisai separation greater than the vertical overlap ofthe anterior
teeth during/S/production is not supported by the lack
of a strong correlation between these parameters found
in the current or previous studies,'"*-^'^ The implication for prosthodontics is that by using commonly employed speech techniques^"* in designing the physiologic rest interocclu.sal distance, an excessive space
may be produced. Therefore, we suggest that it is
probably sufficient to ensure only that the anterior
teeth do not contact during speech function.
Comparisons between the 2 subject groups are contentious because of their disparity, and the observed
significant differences hetween them cannot be said to
be solely a result of tooth wear. Some of the factors that
may have had an effect are age, gender, original or habitual dental relationships, dental condition, and
recording variability. The latter parameter was discussed above. Only a few studies have recorded parameters of jaw movement as a measure of oral motor
function specifically in relation to age."''^ These studies, comparing elderly subjects (mean age 8f] y) to
younger subjects (mean age 26 y), concluded that age
rather than the state of the dentition is related to a
reduction in some aspects of oral motor function. In
the current study, the age difference between the 2 subject groups, mean 49 versus 22 years, was not so
marked as in these previous studies, but the effect of

Discussion
A speech envelope has been previously documented,-^ with mean dimensions for 95 subjects reported as 8,3 mm vertical, 4.2 mm anteroposterior, and
1,6 mm lateral. These values are slightly smaller than
those found in the current study. The proportion ofthe
incisai Class III group in the previous study^^ was
20%, compared to 8% in the current study, and as this
group displayed a trend to have a smaller speech envelope, this may be reflected in the former result, A limitation of the current work, however, is the small number of subjects in the Class III group. In complete
denture design it has been advocated'"" that positioning the anterior teeth when pronouncing close
speech sounds, such as the /S/ sound, with a vertical
or "closest speaking" space hetween them of 1 to 2 mm
will achieve a satisfactory functional occlusal vertical
dimension. This technique is based on the assumption
that it reflects the anterior tooth relationship ofthe natural dentition during pronunciation ofthe close speech
sounds. The/S/sound has heen shown to clinically

Volume 12, t^umber 5,1999

5^7

The International fournal of Prosthodontics

Mandibuiar Speech Envelope with and without Incisai Wear

3urnetl/Clif!ord

an age-related diminution of speech movements cannot be dismissed. There were no apparent gender differences with respect to the dimensions and position
ofthe speech envelope within the 2 study groups, and
this is n agreement with a previous study.^^ Although
there was a preponderance of male subjects in the
tooth wear group, which reflects the patient presentation pattern in the hospital clinic from which they
were selected, the reduction in the size of the speech
dimensions of the tooth wear group wai thought not
to be caused by the gender distribution. Although an
effort was made in the method of the investigation to
make the normal group representative with regard to
incisai relationships, this was not possible with the
tooth wear group. An asse^ment of the original incisai
classification could not be made because of the anterior tooth destruction, and all subjects in the tooth
wear group showed a habitual edge-to-edge anterior
tooth relationship n ICP. This was reflected in the dimensions and position ofthe speech envelope, which
resembled that of the Class III normal group. Each
speech sound requires a particular articulator format
that is the result of a specific learned neuromuscular
pattern. However, as the form of a speech sound articulator changes, such as with wear of the anterior
teeth, so compensatory changes in the structural format of other articulators, such as the tongue and
mandibular position, may occur. It is intended that further studies be carried out to compare speech movements in older, age-matched cohorts with heaithy and
worn teeth, and in subjects before and after oral rehabilitation.

5.
6
7.
8.
9.
10.
11.

12

13.

Ekfeldt A, Karlsson S. Changes of masticatory movement characteristics after prosthodontic rehabiiitation of individuals with
extensive tooth wear, i n t j Prosthodont 1996;9:539-546.

14.

Benediktsson E. Variation in tongue and jaw position in "s" sound

production m relation to front teeth occlusion. Acta Odontoi
Scand 1958;15:275-303.
Weinberg B. A cephalometric study of normal and defective/s/
articulation and variations in incisor dentition. | Speech Hear Res
1963;11:288-300.

15.

16.
1 7.

13.

19.
20.

Conclusion
Within the limitations ofthe study design, it was concluded that; (1) the envelope of mandibular movement during speech differed in dimension between
the 2 groups investigated, with that ofthe tooth wear
group being smaller; and ('2Jthe most superior and anterior speech positions of the tooth wear group were
closer to ICP than those of the normal group.

British Standards institute. Publication No BS 4492. British

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Todd ]E. Children's Dental Health in England and Wales in
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Houston Vi/JB,TulieyW]. A Textbook of Orthodontics. Bristoi:
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Balkhi KM, Tallents RH, Goldin B, Catania ]A Error analysis of
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Kestenberg JM. Speech assessment in dentistry. Aust Dent J1983;

28:98-101.

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Lewin A Electrognathographics. Chicago: Quintessence, 1985:

13-21.
Michlef L, Bakke M, Mellei E. Graphic assessment of natural
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