By Pam Marshalla
Q: My 12-year-old client is bright but has a lateral lisp. He has a gap between his side teeth. How can I tell if the dental gap is causing the lateral lisp, and how should I precede? I stuck cotton between the side teeth but it didn’t help. The dental problem may have contributed to the lisp, OR the lisp may have contributed to the dental problem. This is a chicken-and-egg situation that usually has no clear answer. But it doesn’t…
By Pam Marshalla
Q: My client lets air come out the side of his mouth when he makes Th. It’s not a big deal, but it is noticeable and distracting. This could be classified as a minor lateral lisp. The client is lacking the firm push of the side of his tongue against his side teeth that would prevent the airstream from staying midline. I would use a straw. Place one end of the straw outside the central incisors and tell him the…
By Pam Marshalla
Q: My client makes a whistling sound when he says S. Do you have advice? A high-pitched “whistled S” is the result of an airway space in the mouth that simply is too narrow causing whistling instead of true frication. All you have to do is get him in front of a mirror and have him start experimenting with how much air he is letting out. He may need to pull the tip of his tongue back a little, or…
By Pam Marshalla
Q: Do you have any treatment for incisor grinding? I wrote about this recently regarding clients who are lower-functioning, but in general — Changing any oral habit is a matter of engaging in the following points: Identify the problem. Help the client become aware of the problem: What can he do to track how often he does this? Get more info about it: E.g., what does the orthodontist/dental say about it and what methods do they recommend. Identifying specifics about…
By Pam Marshalla
Q: Do you have any treatment for incisor grinding in a client with low cognition? Oral habits are difficult to change when cognition is low. The standard rule of thumb is to recognize that he child is benefitting in some way from the habit. Most people postulate that the grinding relieves boredom and/or it gives tactile stimulation that feels good. Many children with low cognition also have low oral-tactile awareness and discrimination, therefore oral habits feel good. If grinding is…
By Pam Marshalla
Sooooooooo many questions about teaching S come in that I want to take this opportunity to write out the simplest most direct method that therapists have been using since early in the 20th century. This method is reported in just about every articulation therapy textbook ever written. The oldest reference I have seen for it is Scripture (1912). Scripture’s book is one that Van Riper recommended. There are dozens of ways to do this, but this is the basic procedure––…
By Pam Marshalla
Q: I have a student with a frontal lisp and an anterior open bite. Can you suggest compensatory strategies to help him? If he is going to get his teeth fixed I might wait to do anything until after he teeth are fixed. If he is not going to get his teeth fixed, then the compensation simply involves getting him to produce the best sibilants he can given his dental structure. He needs to stabilize the tongue at the back-lateral…
By Pam Marshalla
Q: My client is 4;0 with a frontal lisp with a very small mandible (underbite) and chronic upper respiratory problems––congestion, nasal drip, mouth breathing, snoring, etc. He cannot breath through his nose. Do you think he is capable of learning to keep his tongue in for the sibilants given his underbite? Yours is a very common question for which we have no clear answers. In all likelihood both the under-bite and the upper respiratory problems are contributing to his speech…
By Pam Marshalla
Q: My 2-year-old daughter has to get her four front teeth extracted because of decay. The doctor told me that there could be speech disorders. She doesn’t speak as much as other kids of her age and she started walking a little late. After these teeth are extracted I am worried that she is going to stop trying to talk and become even more timid. What can I do? You have two things going on that have different impacts on…
By Pam Marshalla
Q: I have a new referral from a dentist for a client with a “gummy smile.” Haven’t seen him yet. What do you think this means? I would assume that the term “gummy smile” means that the upper lip is retracted and the upper gums are exposed. Assuming that this is the case, the client needs to learn normal oral rest posture. Normal oral rest consists of the lips resting gently together, the teeth resting a few millimeters apart, and…
