Here, doctor, is a strategy that positions you to market and advertise your diversity.
Barbara Levine-Offenbacher, MS, CCC-SLP
The speech clinician can be a valuable asset to your practice by enhancing patient relations and professional image. Broadening your diagnostic scope allows you to reach out to a greater population in your community, and can dramatically expand your target market. This can offer a unique opportunity for patient expansion.
Your expansion can be twofold: increasing your client base; and increasing the number of times you see patients for follow-ups. According to the American Speech Language Foundation, passage of Public Law 99-457 focuses on the prevention of speech pathology, at the earliest time of onset, with an "impetus to develop increased outreach." This is especially important to you since children are "at risk" for speech and swallowing disorders, creating a greater push toward community involvement.
Since you, the dentist, are usually the first person to see and observe the oral mechanism, you are the best qualified person to identify associated oral problems.
Between the ages of 2 and 7, children "at risk" demonstrate the following most-common problems: tongue thrusting, articulation errors and motor- control deficits. Many of these problems have a direct impact on dental alignment and various classes of malocclusions. Children who are "at risk" need to be monitored at a minimum of two times per year in order for you to decide:
- Is this a chronic problem?
- Is orthodontic intervention necessary?
- Should you call in your community speech clinician as a "team member" to begin myofunctional therapy?
Very often you can set up an early intervention, myofunctional therapy program, with the speech clinician, in order to begin strengthening motor control. At the same time, you can begin to discuss the possibility of orthodontics for those patients at risk.
Barton H. Tayer, DMD, MScD, clinical director of orthodontics at Harvard University School of Dental Medicine, cites two types of treatments that you might want to discuss with parents in advance. One is aesthetic brackets, and the other, lingual braces. In addition, you may be able to give parents some important insight as to how their children`s tongue mobility has an overall effect on speech production, swallowing and dental alignment.
The Swallowing Function
Swallowing is a function for three basic human needs: The reduction of saliva collection, the passage of liquids during drinking and the passage of solids during eating. The actual act of swallowing significantly affects the structure of the oral cavity, particularly the teeth. This is due to the pressure the tongue exerts, if it`s pushing on the central incisors. The general swallowing pattern reflects a common set of motions. How- ever, these motions can be quite unique for each individual child and adult. Individually identifying these patterns, when not normal, is a valuable challenge for the dentist. By incorporating these observations with the speech clinician as part of your exam, makes you the "key" provider to help restore normal function.
Speech and Reading
Tongue positioning has a direct impact on speech. Low and extended tongue postures may present not only interdental lisps, but lingua-dental production of the "t,d,l and n" sounds, as well. These four sounds, "t,d,l,n," should normally be produced by lingua-alveolar tongue placement, requiring the tongue to be elevated to the alveolar ridge, and retracted into the mouth. Children with poor motor control for tongue-tip/alveolar ridge placement, or those who demonstrate chronic mouth breathing, may lack the muscle control and strength to accomplish this placement.
Speech errors have an impact on reading, as well. The typical interdental lisp, which often causes malalignment of the central incisors, distorts the `s` sound, as in (soup) to sound like (thoup). This s/th sound substitution has the potential to confuse early phonic skills, letter and sound identification. This sound confusion can have an impact on pre-reading, as early as 4 years old, when many children in the United States begin pre-kindergarten programs. This is only one example of sound substitutions that may cause reading interference.
The Patient As Consumer
More so than ever, patients are active consumers. Dental care often is not covered under traditional insurance plans. Orthodontic treatment can be long and expensive. By working with the speech clinician to provide muscle retraining and swallowing techniques, you might be able to reduce the amount of time necessary for dental correction. This is a very desirable feature in today`s high cost of medical and dental treatment.
Consumers are not only looking for skill, but the "human element" of trust and interest that goes beyond the professional`s traditional scope. If you have a pediatric or young-adult population, your interest in speech production, as well as your alliance with the speech clinician, is even more valuable. Building and marketing these bridges will build your reputation and expertise, by demonstrating your sincere interest, not only in the medical aspect of dentistry, but in oro-motor functioning and development, as well. Your community learns that you run an interdisciplinary practice. This creates additional opportunities for consultation visits, in order for parents to gain your professional input, another strong marketing expansion tool.
By addressing all these issues: risk, swallowing function, speech and reading and 1990 consumerism, you have a marketing strategy that places you a cut above your colleagues. You also have the opportunity to market your diversity, while building bridges with the Speech Clinician-Your For- gotten Ally.
The author is a New York state licensed speech and language pathologist. She lectures, presents seminars, has written two curriculum guides and has a book submitted for publication. For additional information, call: The American Speech Language and Hearing Association Consumer Hotline at (800) 638-8255 or Ms. Offenbacher at (718) 646-4482.