Page 112 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

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Chapter 4
to a level that is comparable to the ones previously reported.14, 16 In the domain ‘functional limitation’ participants rated the impact of their denture on speech. Over the different stages of the treatment people reported less impact of their denture on speech. This is also in line with previous studies on speech.14, 16
It is worth mentioning that the strength of this study lies in the large sample size, the detailed and professional speech analysis and the longitudinal design. The limitation of this design is the drop-out of the participants during the study due to organizational and logistic issues. It is known that hearing problems can affect speech production. We didn’t perform a hearing test before treatment but we asked the patients if they had any hearing conditions. This subjective manner could have been less precise. It was impossible to assess the speech profile of the participants in normal conditions because they presented already with complaints about their dental situation at the start of the study. In an ideal situation we know about possible speech problems in normal conditions, so we can detect what speech problems are due to the treatment and what problems already existed. A last limitation is the fact that only one speech therapist was blinded for time points measured when examining the videos. It is possible that the expectation of the therapist influenced the rating. Still there was a good inter-rater reliability.
It is to highlight that despite the speech problems, assessed by the speech therapists, people are in the end very satisfied with their speech and oral situation. Therefore it is very important to ask patients opinion about their speech and oral situation and the impact of it on their quality of life before pointing out possible problems you notice as a professional. When people give a rating about speech it is possible that besides the sound they produce they also rate the comfort they experience while speaking. This is something speech therapists can’t assess. Hypothetically the comfort of speaking is for non-professional speakers more important than the way they sound. It is important to inform patients before treatment about the possible difficulties they may encounter during treatment. In the future research should focus on the possibility to deal with patients with remaining speech problems. To avoid speech problems it is necessary to check if the retention of de denture is sufficient and if the coverage of the palate isn’t obstructing good speech production. The shape of the denture should get as close as possible to the shape of a normal oral cave. The technique of Collaert et al. 2015 applied on