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Classic 5-Part Problem
01.17.08 My client has an inter-dental lisp, possibly a tongue thrust, a high narrow palate and an anterior open bite. He also has difficulty with /r/ in all positions. I only saw him one time and do not want to waste time in therapy. Should I send him to the orthodontist before beginning therapy? Is there anything I can do in terms of exercises to help him?
This client represents most of what I call the 5-Part Problem:
- An anterior open bite with a high arch palate
- A reverse swallow pattern
- A frontal lisp. He may also have
- An oral habit like thumb or finger sucking, and
- An open mouth resting posture.
These five patterns are integrally related to one another and you need to treat all of these problems together. The client needs:
- Orthodontic management to close the bite
- To eliminate the oral habit
- To establish a closed-mouth resting posture with the tongue back
- To establish a normal swallow
- To learn to keep the tongue back while articulating
The problem with R is a separate one. The R is not necessarily effected by the other problems, although the whole oral-motor problem is over-riding his speech. You can treat the R while all the rest is going on.
May I suggest my two texts: Successful R Therapy, and Frontal Lisp, Lateral Lisp. I cover all of this in those two volumes.