By Marlene Salas-Provance, Ph.D. CCC-SLP, Vice Dean, Professor-A.T. Still University, Speech-Language Pathologist

Photos by Dr. Mary Adrianne Dominique “Nikki” Toledo, DDM

Dentists and speech pathologists work as an interprofessional team to meet the needs of children with cleft lip and cleft palate. Children with cleft palate may have openings (fistulas) of various sizes on the palate, which may be located anywhere along the palate, front to back or side to side. In most cases, the fistula will effect the production of speech sounds that require oral pressure, for example the sounds, p, t, d, s, z, k and g. Another side effect of a fistula, is that food and liquid may leak from this fistula through the nose during drinking and eating. The three team members will work together to plan the need and size of a dental obturator to close the space. Although this may help significantly to decrease the food and liquid coming through the nose, it may only have minimal improvement on speech production as air continues to flow around the sides of the obturator through the nose. There are several patients in the Cebu City, Philippines mission who will receive dental obturators for cleft palate fistulas.

Another dental prosthetic that is used is called a speech bulb. It is used for children and adults with velopharyngeal incompetence (VPI). VPI is the consequence of a soft palate that is too short and does not meet the back wall of the throat during speech. The lateral pharyngeal walls also may not move appropriately to close this space. Thus, air flows through this opening into the nose, resulting in hypernasal speech. The orthodontist, dentist and speech pathologist will work closely together to build a speech bulb that results in tight closure of this velopharyngeal area for good oral-nasal balance during speech. The speech pathologist can assist the dental professionals by assessing speech sound production while the speech bulb is being built in order to determine the appropriate size. If available, the speech pathologist can also use nasendoscopy to view the velopharyngeal area with the speech bulb in place. In this mission, the dental team will work with the Rotaplast speech pathologist and a local speech pathologist to build a speech bulb for a patient.

The dentists working with Rotaplast are Dr. Mary Adrianne Dominique “Nikki” Toledo, DDM, and Dr. Shaira Boiser, DMD.

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