Classic 5-Part Problem (anterior open bite, high arch palate, reverse swallow pattern, frontal lisp, an oral habit like sucking)

By Pam Marshalla

Q: My client has an inter-dental lisp, possibly a tongue thrust, a high narrow palate and an anterior open bite. He also has difficulty with /r/ in all positions. I only saw him one time and do not want to waste time in therapy. Should I send him to the orthodontist before beginning therapy? Is there anything I can do in terms of exercises to help him?

This client represents most of what I call the 5-Part Problem:

  1. An anterior open bite with a high arch palate
  2. A reverse swallow pattern
  3. A frontal lisp. He may also have
  4. An oral habit like thumb or finger sucking, and
  5. An open mouth resting posture.

These five patterns are integrally related to one another and you need to treat all of these problems together. The client needs:

  1. Orthodontic management to close the bite
  2. To eliminate the oral habit
  3. To establish a closed-mouth resting posture with the tongue back
  4. To establish a normal swallow
  5. To learn to keep the tongue back while articulating

The problem with R is a separate one. The R is not necessarily effected by the other problems, although the whole oral-motor problem is over-riding his speech. You can treat the R while all the rest is going on.

May I suggest my two texts: Successful R Therapy, and Frontal Lisp, Lateral Lisp. I cover all of this in those two volumes.

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