Orthodontia Archives - Page 2 of 2 - Marshalla Speech & Language

Tag: Orthodontia

When to Refer to Orthodontia and ENT

By Pam Marshalla

Q: You mentioned orthodontic referral in one of your lectures on the lisps and R. I am wondering if you also refer to ENTs for issues relating to and resulting from mouth breathing. I follow standard practices in SLP. Therefore I refer clients to orthodontics when there are indications that a dental malocclusion may exist, and when it seems to be interfering with sound production. I refer clients to an ENT when there are indications that there may be upper…

Exit Criteria: Getting Kids Off the School Caseload

By Pam Marshalla

Q: I serve a female client with Down syndrome in school. She is bright and has done quite well in articulation therapy, but she cannot produce CH due to a severe underbite. This is her last articulation error. Her inability to say the sound is not due to poor oral control or cognitive issues. She simply cannot make this phoneme correctly because of the occlusal problem, but she is not going to receive orthodontia or oral surgery. The parents have…

Frontal Lisp and Underbite

By Pam Marshalla

Q: I have a third-grader who has a frontal lisp on /s/ and /z/. He has an underbite and produces these sounds with his tongue contacting the inside of his upper teeth. Should I discontinue therapy until he is seen by an orthodontist or is there something I should be doing in the meantime to help him compensate for his jaw and tongue positioning? I am really not sure if he’s capable of a more retracted tongue position or if…

Oral-Motor is Not a Trivial Topic

By Pam Marshalla

Q: I am going to evaluate a 15-year-old male with an orofacial-myofunctional disorder. He will get braces soon. What general oromotor exercises do you recommend to get us jump-started? What materials should I order? Your question is far too general for me to answer. There are no “oral-motor exercises” I can give you to get you “jump-started.” The study of oral motor is deep and complex, and it contains many levels of understanding and direction. Your questions suggest that you…

R and Orthodontia (Palatal Expander)

By Pam Marshalla

Q: Can I work on R with my client who has a palatal expander? My experience has taught me the following: Typical braces, palatal expanders, and the like should not interfere much with the sound quality of R and we can go ahead and begin treatment. However… Oral appliances can interfere with our work on R and other phonemes if there is oral pain in association with them. Wait a few weeks until the pain subsides or is managed appropriately….

Assessment of a Lisp

By Pam Marshalla

Q: I am scheduled to see a 14-year-old male with a lisp on /s/. He recently got braces and the dentist told his mother that the child had better see a speech language pathologist if the braces are to help at all. Can you help me organize this diagnosis? Focus on the speech first. You must know exactly what phonemes are affected. Look at ALL of them, not just /s/. Look at all the sibilants, and all other phonemes, especially the…

Lateral Lisp, Palatal Expander, and Oral Habits

By Pam Marshalla

Q: I am working with an eight-year-old boy who has a lateral lisp as well as orthodontic problems and oral habits. He has severe lip-licking and nail-biting habits, and he has a narrow palate that will need expansion. I am thinking that he may do better in therapy once the palatal expander is removed. What are your thoughts? One could approach this problem from many angles, but this would be my basic line of thinking: A lateral lisp is a…

Lisps and Missing Front Teeth

By Pam Marshalla

Q: I have heard you say that if kids have problems with sibilants and are missing their front teeth you prefer not to see them until their teeth come in. Could you explain your rationale? Without front teeth true stridency cannot be produced. Stridency is produced as the midline air stream hits the front teeth and then escapes between them. Without front teeth, a client would have to be taught a compensatory movement. He would have to produce his sibilants…

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: An anterior…