Malocclusion and its relationship to speech sound production: Redefining the effect of malocclusal traits on sound production


      • We compared occlusal features to speech samples in 115 subjects, 8 to 36 years old.
      • Predictable malocclusal traits were associated with speech sound errors.
      • The more handicapping the occlusion, the more likely the speech errors.
      • Open bite was the feature most associated with sound distortions, especially /s/ and /t/.
      • Lingual protrusion (lisp and tongue thrust) was the typical visual inaccuracy.


      The purpose of this study was to identify variables of dental malocclusion with the greatest effect on sound production that can be easily identified during an orthodontic assessment.


      One hundred fifteen patients (8.2-36 years of age) seeking orthodontic evaluation were assessed for speech sound production abnormalities. An orthodontic clinical examination assessed Angle classification, overjet, overbite, crowding, spacing, and crossbites. A standard speech sample was elicited from each subject.


      The results indicated that 71 (62%) of the subjects made a production error, particularly with the /s/ and /t/ sounds. However, auditory distortions occurred in 12 subjects (20%), and 56 (80%) subjects had visual distortions of the sound. An open bite (>2 mm) was the key malocclusal factor underlying speech sound errors. There was statistical significance between the Orthodontic Treatment Priority Index and the sound errors of /s / and /t/ (mean score of 9.54 vs 6.29 for subjects without sound errors).


      Predictive malocclusal traits are associated with speech sound production errors. The more severe or handicapping the malocclusion, the more likely that a speech sound error will occur. Open bites of 2 mm are associated with sound production errors. Visual inaccuracy of the sound occurs with more frequency than auditory inaccuracy and is the most common articulation error noted with occlusal irregularities.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Orthodontics and Dentofacial Orthopedics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • LeBlanc E.M.
        • Cisneros G.J.
        The dynamics of speech and orthodontic management in cleft lip and palate.
        in: Shprintzen R.J. Bardach J. Cleft palate speech management: a multidisciplinary approach. Mosby, St Louis1995: 305-326
        • Subtelny J.D.
        • Mestre J.C.
        • Subtelny J.D.
        Comparative study of normal and defective articulation of /s/ as related to malocclusion and deglutition.
        J Speech Hearing Dis. 1964; 29: 269-285
        • Bloomer H.H.
        Speech defects associated with dental malocclusions and related anomalies.
        in: Travis L.E. Handbook of speech pathology and audiology. Appleton-Century-Crofts, New York1971: 715-765
        • Starr C.D.
        Dental and occlusal hazards to normal speech production.
        in: Bzoch K.R. Communicative disorders related to cleft lip and palate. Little Brown, Boston1979: 313
        • Jensen R.
        Anterior teeth relationship and speech.
        Acta Radiol. 1968; 276: 1-69
        • Rathbone J.S.
        Appraisal of speech defects in dental anomalies.
        Angle Orthod. 1955; 25: 42-48
        • Jesus L.M.
        • Araujo A.
        • Costa I.M.
        Speech production in two occlusal classes.
        Onomázein. 2014; 29: 129-151
        • Johnson C.L.
        • Sandy J.R.
        Tooth position and speech–is there a relationship?.
        Angle Orthod. 1999; 69: 306-310
        • Vallino L.D.
        • Tompson B.
        Perceptual characteristics of consonant errors associated with malocclusion.
        J Oral Maxillofac Surg. 1993; 51: 850-856
        • Benediktsson E.
        Variation in tongue and jaw position in /s/ production in relation to front teeth occlusion.
        Acta Odont Scand. 1958; 15: 275-303
        • Lee A.S.
        • Whitehall T.L.
        • Ciocca V.
        • Samman N.
        Acoustic and perceptual analysis of the sibilant sound /s/ before and after orthognathic surgery.
        J Oral Maxillofac Surg. 2002; 60: 364-372
      1. Araujo A, Jesus L, Costa IM. Clinical analysis in speech language therapy: occlusal class and speech production. Proceedings of the 27th World Congress of the International Association of Logopedics and Phoniatrics, vol 173; Copenhagen, Denmark: Technical University Denmark; 2007.

        • Bernstein M.
        The relation of speech defects and malocclusion.
        Am J Orthod. 1954; 40: 149-150
        • Klechak T.L.
        • Bradley D.P.
        • Warren D.W.
        Anterior open bite and oral port constriction.
        Angle Orthod. 1976; 46: 232-242
        • Laine T.
        Associations between articulatory disorders in speech and occlusal anomalies.
        Eur J Orthod. 1987; 9: 144-150
        • Guay A.H.
        • Maxwell D.L.
        • Beecher R.
        A radiographic study of tongue posture at rest and during the phonation of /s/ in class III malocclusion.
        Angle Orthod. 1978; 48: 10-22
        • Blyth P.
        The relationship between speech, tongue behavior, and occlusal abnormalities.
        Dent Pract. 1959; 10: 1-20
        • Schwartz R.G.
        The phonological system: normal acquisition.
        in: Costello J.M. Holland A.L. Handbook of speech and language disorders. College-Hill Press, San Diego, Calif1986: 25-74
      2. Whitley M.S. Spanish-English contrasts: a course in Spanish linguistics. Georgetown University Press, Washington, DC1986
        • Goldstein B.A.
        Bilingual language development and disorders.
        in: Spanish-English speakers. Paul H. Brookes, Baltimore2004
      3. Gorman B, Stubbe-Kester E. Spanish influenced English: typical phonological patterns in the English language learner. ASHA Biolinguistics Presentation, 2008. Available at: Accessed April 26, 2016.

        • Grainger R.M.
        Orthodontic treatment priority index.
        Vital Health Stat 2. 1967; : 1-49
        • International Clinical Phonetics and Linguistics Association
        Handbook of the International Phonetic Alphabet.
        Cambridge University Press, Cambridge, United Kingdom2002
        • Jakobson R.C.
        • Fant G.M.
        • Halle M.
        Preliminaries to speech analysis: the distinctive features and their correlates.
        MIT Press, Cambridge, Mass1952
        • Leske C.
        Prevalence estimates of communicative disorders in the U.S.: speech disorders.
        ASHA. 1981; 23: 217-225
        • Gardner A.
        Dental, oral, and general causes of speech pathology.
        Oral Surg Oral Med Oral Pathol. 1949; 2: 742-751
        • Lubit E.C.
        The relationship of malocclusion and faulty speech articulation.
        J Oral Med. 1967; 22: 47-55
        • Hartbauer R.E.
        Speech defects associated with orofacial abnormalities.
        Dent Assist. 1972; 41: 15-16
        • Snow K.
        Articulation proficiency in relation to certain dental abnormalities.
        J Speech Hearing Dis. 1961; 26: 209-212
        • Weinberg B.
        A cephalometric study of normal and defective /s/ articulation and variations in incisor dentition.
        J Speech Hearing Res. 1968; 11: 288-300
        • Artese A.
        • Drummond S.
        • Mendes do Nascimento J.
        • Artese F.
        Criteria for diagnosing and treating anterior open bite with stability.
        Dental Press J Orthod. 2011; 16: 136-161