ISSN No: 2582-0559

Volume No: 9, Issue No: 1

ORGINAL ARTICLE

EVALUATION OF CORRELATION BETWEEN HABITS AND

DYSLALIAS- AN OBSERVATIONAL STUDY

Dr AKR Santhosh Priya, Dr. Deepak Prabhu* ,

Department of Pedodontics and Preventive Dentistry, Sathyabama Dental College and Hospital, Chennai, Tamilnadu,

India

*Department of Orthodontics, Tagore Dental college and Hospital, Rathinamangalam Chennai, Tamilnadu, India

DOI:

10.37841/jidam_2022_V9_I1_01

Address for Correspondence

Dr AKR Santhosh Priya, MDS,

Senior Lecturer

Department of Pedodontics and Preventive dentistry

Sathyabama dental college and Hospital, Chennai

Email id: santhosh.appiya@gmail.

Received : 06.02.2022 Accepted : 09.03.2022

First Published: 14.03.2022 Published : 30.03.2022

ABSTRACT

AIM

: The aim of the present study is to evaluate the

correlation between habits and dyslalias in school going
children between age of 8-13 years.

MATERIALS AND METHODS:

A group of 500

children, between age group of 8-13 years were included in
this study of which 229 were boys and 271 were girls from
various schools in south Chennai. Presence of habits were
noted, dental and soft tissue changes were noted. Speech
sounds were evaluated using charts presenting with pictures
(combining consonants and vowels in english language).
Sounds evaluated are sibilants, linguoalveolar stops,
labiodental fricatives, linguodental fricatives.

RESULTS:

Out of the 500 participants evaluated 159

children met the inclusion criteria. Out of which 34 children
had habits associated with speech difficulty. (phonemes /s//
z// th// sh/).

CONCLUSION:

Not all habits caused dyslalias, early

identification of dyslalias and its association with any
underlying habits is important to aid in correction of habit
and speech improvement.

KEWORDS:

Habits, Malocclusion, Dyslalias,

ISSN No: 2582-0559

Priya et al: Evaluation Of Correlation Between Habits And Dyslalias- An Observational Study

Volume No: 9, Issue No: 1

INTRODUCTION

The literature says that malocclusion may affect oral
functions

. This is particularly true for malocclusions and

speech difficulties (dyslalias). In presence of certain
malocclusions, it can be difficult or impossible to produce
certain words (sounds), this may require effective speech
therapy and preliminary orthodontic treatment for
correction of speech difficulties. Several studies report that
occlusal alterations may cause disorders in the production
of alveolar fricative consonants, in normal morphological
and/or functional conditions

Dyslalias is a change that occurs during the emission of
certain vowels and consonant sounds, which is caused by
alterations in fonoarticuladores organs (lips, palate, cheeks,
tongue, and respiratory organs)

. This can be due to

abnormal growth and development or may be due to
different etiological factors. The concept of dyslalia
corresponds to a disorder in the articulation of phonemes,
either by altering or omitting some specific sounds or by
replacing sounds incorrectly. It is an inability to properly
pronounce or form certain phonemes or groups of
phonemes. Based on its causes, dyslalias may be classified
as evolutionary, functional, audiogenic, and organic.

Functional dyslalias may be classified as Substitution
dyslalias, which define an error in speech articulation where
a sound is replaced by another; Omission dyslalias occur
when the proper articulation of the phoneme is unknown
and is not replaced by another phoneme; Insertion dyslalias
refer to the replacement of a sound by another sound that
does not correspond to the specific word; Distortion
dyslalias occur when a phoneme is articulated incorrectly
but is not replaced by a specific phoneme, or the
articulation is similar, not exact, to the correct form. This is
usually the result of a defective position of the articulation
organs.

The oral function is mainly carried out by the tongue and its
movements, the shape of the palate and the dental arches,
the teeth and the lips, and the movements of the jaw, under
the directives of the ATM (Temperomandibular
articulation) and the skeletal muscles, which cause the
alteration of the phonemes, modifying the spatial
trajectories during the functions. Concerning occlusal
problems, it emerges that a big overjet can play a role in
predisposing to dyslalia. The identification of dyslalia is
based on the auditory and visual analysis of tongue
movements. Children with an overjet > 4mm have a greater
prevalence of speech diseases than children without it (p =
0.0117), and with a unilateral crossbite[4]. Frequently there
are distortions of the phonemes /s/ e /z/. It has also been
demonstrated the association between the presence of an
anterior open bite (AOB) or head-to-head bite and the
phonemic /s/z/t/d/l/ alteration of pronunciation. The AOB is
the more common malocclusion in patients with dyslalia,
because it causes the alteration of the emission of
phonemes

5,6,7

Apart from skeletal changes the presence of abnormal oral
habits is related to underlying malocclusions which are
correlated with dyslalias. Longstanding habits cause both
dental and skeletal alteration which also lead to improper
tongue positioning. The common habits associated with
dyslalias are sucking habits (fingers, lips, pacifiers, etc),
mouth breathing, altered tongue position (tongue
trusting)

This article aims to evaluate correlation between habits and
dyslalias in school children between 8-13 years.

MATERIALS AND METHODS

A group of 500 children, aged 8-13 years, 229 boys and 271
girls were included in the study conducted in the various
schools in South Chennai.

The inclusion criteria were the following:

1. Growing patients with habits
2. No evidence of significant hearing loss;
3. Adequate cooperation;
4. No history of orthodontic treatment.

The exclusion criteria were:

1. History of hearing loss;
2. Previous orthodontic treatment;
3. Informed consent not granted;
4. Nasal or laryngeal disorder;
5. Congenital anomalies.

Presence of habits like thumb sucking, tongue thrusting,
mouth breathing, nail-biting were noted. Dental and soft
tissue changes due to habits like anterior open bite, anterior
protrusion, improper tongue positioning, lip incompetency
was noted.

Speech sounds were evaluated by a chart containing
pictures that refer to words combining all consonants and
vowels in the English language. The child is asked to name
the pictures or repeat their name. The examiner enters the
answers on the prescribed form.

Speech sounds evaluated are sibilants, linguoalveolar
stops, labiodental fricatives, and linguodental
fricatives(table 1)

. Evaluation: notes on the evaluation

form refer to the method of articulating phonemes,
whether their pronunciation was correct, or they were
substituted, omitted, distorted or if misarticulation
occurred (at the beginning or middle of a word, in a
consonantal group). It is necessary to highlight whether
the data refer to spontaneous articulation or to word
repetition. This is a very quick test; however, the analysis
of the responses must go more into detail to provide a
more complete overview of the patient’s articulating
process.

ISSN No: 2582-0559

Priya et al: Evaluation Of Correlation Between Habits And Dyslalias- An Observational Study

Volume No: 9, Issue No: 1

Table 1: Speech difficulties related to malocclusion

Speech sound

Problem

Related

malocclusion

/s/, /z/ (sibilants)

Lisp

Anterior open
bite, large gap
between incisors

/t/, /d/
(linguoalveolarstops)

Difficulty in
production

Irregular
incisors,
especially
lingual position
of maxillary
incisor

/t/, /v/ (labiodental
fricatives)

Distortion

Skeletal class III

Th, sh, ch(linguodental
fricatives )

Distortion

Anterior open
bite

RESULTS:

500 patients were considered and 159 children met the
inclusion criteria.

34 children with oral habits were associated with speech
defect.

On evaluation of articulation, speech difficulties were
associated with the phonemes /s/ /z/ /th/ /sh/.

Common functional dyslalias associated with habits was
Distortion.

DISCUSSION:

In this present study presence of speech difficulty
associated with habits was evaluated in 500 children in
which 34 children with habits presented speech difficulty.

DORLAND( 1957) defined habit as a fixed or constant
practice established by frequent repetition. Oral habits could
be partitioned into 2 primary gatherings: Procured oral
habits: Incorporate those practices which are learned and
could be halted effectively and when the youngster grows
up, the person can surrender that conduct and start another
(Finn, 1998) Impulsive oral habits: Comprises of practices
which are fixed in kid and when passionate pressing factors
are excruciating for the kid, the individual in question can

feel security with this propensity, and keeping the kid from
these habits make the person in question restless and
stressed.

Oral habits,if persist beyond certain developmental age, can
cause great harm to the developing teeth, occlusion, and
surrounding oral tissues. The habits are typical upto 2-4
years old. It turns into developmental abnormality when
proceeded for longer time and most commonly seen in
mixed dentition stage. This is the main sign for child to
show future malocclusion or inconsistency during mixed
dentition. These habits might be non-nutritive sucking
(thumb, finger, pacifier and/or tongue), lip biting and
bruxism events. Non-nutritive habits have been identified to
be associated etiological factors, among which the habits of
lingual thrust and atypical swallowing are interrelated.
These habits are the major risk factors for anterior open bite
in mixed dentition which can result in damage to dento-
alveolar structure like anterior tooth protrusion, lip
incompetency leading to speech difficulties hence, causes
and its management plan is important to every clinician.
Speech sound seems more sensitive to alterations of oral
structures than other causes. This may relate to the order of
difficulty of individual sound production, since the sounds
acquired last are those most often reported as distorted. The
ability to adapt and compensate appears to play a significant
role

10,11

Normal structure +normal function = normal speech
Abnormal structure + adaptive function = normal speech
Abnormal structure + no adaptive function = abnormal
speech
Normal structure + abnormal function = abnormal speech

Hence, children presenting with habits having good
adaptive function do not present with speech difficulty. This
outcome is seen in this present study where 125 children
with habits presented with normal speech.

In our present study, the position of the tongue was
significantly altered with lingual thrust, accompanied by
distortion during speech in most patients with thumb
sucking and tongue thrusting. This result was similar to
study conducted by Pomerantz and Zeller

who concluded

that open bite or edge to edge occlusion was significantly
related to defective speech sounds in particular /s,/z/, /th/
and /l/ and Bernstein

12,13

who examined 437 school children

with speech problem and concluded that speech is not
related to malocclusion generally except in open bites,
where there is a strong relationship with lisping. Another
study done by Rathbone et al

shows speech improvement

following orthodontic corrections.

Speech is a progressive phenomenon which is generally
completed by about 8 years of age. Understanding of speech
development helps in reducing misinterruptions of speech
sound difficulty identified at an early age (table 2). When
speech sounds are not developed beyond 8 years of age
dental malocclusion could be one of the reason. Therefore,
it is important for a dentist to evaluate speech at right time
and provide appropriate dental treatment for required
patient. Hence improvement in speech can be predicted

159 children

noted with

habits

34 with

speech

defect

18 tongue

thrusting

15 thumb

sucking

1 mouth

breathing

habit

125 without

speech

defect

44 nail

biting

37 tongue

thrusting

19 lip

sucking

25 thumb

sucking

ISSN No: 2582-0559

Priya et al: Evaluation Of Correlation Between Habits And Dyslalias- An Observational Study

Volume No: 9, Issue No: 1

with improved structural factors and any residual errors can
be reduced or eliminated by the process of learning with the
speech therapist mostly after orthodontic treatment

Therefore, the dentist’s responsibility to dyslalias is to
identify defective sound and to correlate the dental structure
in relative to the production and articulation of speech
sounds. Secondly Pedodontists and Orthodontists are
responsible to correct the dental structure in normal
functioning position to improve the child speech.

CONCLUSION:

Not all children with habits presence as dyslalias.

Children who are having dyslalias associated with habits
early assessment and intervention is required to aid in
correction of habit which also improves speech.

FINANCIAL SUPPORT AND SPONSORSHIP:

Nil

CONFLICTS OF INTEREST:

There are no conflicts of interest.

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Table 2: Age at which selected consonants are usually

produced correctly by children

Age ( in years)

Consonants

p, m, n, ng, f, h, w

3.5

d, g, k, r

t, s, sh, ch, l, v

th( unvoiced), z

th (voiced), s and r blends (sm, gr and
so forth)