Brasil
Revista CEFAC
Sumário Anterior Atual Seguinte
Sumário
ORIGINAL ARTICLES • Rev. CEFAC 28 (2) • 2026 • https://doi.org/10.1590/1982-0216/20262829325 linkcopy

Open-access Instruction material on the implications of the stomatognathic system in speech sound production: Development, content validation, and appearance

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:  to develop an instructional material on the implications of the stomatognathic system in speech sound production, identify evidence of content validity, and evaluate the appearance of the material in a virtual environment.

Methods:  a descriptive study conducted in three phases: 1) Planning and development of the material based on a literature review; 2) Content validation by four expert speech-language therapists using the Likert scale and Content Validation Index, with revisions according to feedback; 3) Implementation of the material in a Virtual Learning Environment and evaluation of its appearance by the same specialists.

Results:  the material consisted of 9 modules covering typical and altered sound production, types of phonetic disorders, and the impact of stomatognathic system alterations. After two rounds of evaluation, all 19 final topics reached a Content Validation Index of 1.0. The virtual material’s appearance was rated as satisfactory or excellent by at least 75% of the evaluators in most categories.

Conclusion:  the developed material presents evidence of content and appearance validity. Its availability in a virtual environment facilitates remote access and represents a promising resource for the training of undergraduate students of Speech-Language Pathology.

Keywords:
Speech; Speech Disorders; Speech Perception; Teaching Materials

RESUMO

Objetivo:  desenvolver um material didático sobre as implicações do sistema estomatognático na produção dos sons da fala, identificar as evidências de validade baseadas no conteúdo e avaliar a aparência do material em ambiente virtual.

Métodos:  estudo descritivo realizado em três fases: 1) Planejamento e desenvolvimento do material com base em revisão bibliográfica; 2) Validação do conteúdo por quatro fonoaudiólogas especialistas, utilizando escala Likert e Índice de Validação de Conteúdo, com revisões conforme sugestões; 3) Inserção do material em Ambiente Virtual de Aprendizagem e avaliação de sua aparência pelas mesmas especialistas.

Resultados:  o material foi composto por 9 módulos abordando produção típica e alterada dos sons, tipos de distúrbios fonéticos e impactos das alterações do sistema estomatognático. Após duas rodadas de avaliação, todos os 19 tópicos finais atingiram Índice de Validação de Conteúdo de 1,0. A aparência do material virtual foi considerada satisfatória ou excelente por pelo menos 75% das avaliadoras na maioria dos quesitos.

Conclusão:  o material desenvolvido apresenta evidências de validade de conteúdo e de aparência, sua disponibilização em ambiente virtual facilita o acesso remoto e representa um recurso promissor para a formação de alunos de graduação em Fonoaudiologia.

Descritores:
Fala; Distúrbios da Fala; Percepção da Fala; Materiais de Ensino

INTRODUCTION

Alterations in speech sound production can occur due to various conditions, including malocclusion and bite type, altered tooth positioning or missing teeth, use of poorly fitting dentures, temporomandibular joint dysfunction, structural alterations in the face and lingual frenulum, hypertrophic tonsils, and even the amount of saliva1. These alterations are commonly referred to as phonetic deviations 2. Knowledge of the various factors that may be associated with alterations in speech sound production, as well as the characteristics of these alterations, is essential for speech-language pathologists and audiologists, especially those specializing in Orofacial Myofunctional Therapy (OMT).

Clinically, speech sound production is assessed through perceptual analysis1,3-6, which can be combined with acoustic analysis7. In the presence of alterations, the evaluator must identify, visually and audibly, the movements of the articulators involved in the production of the target phoneme. It is also essential to locate the auditory result of articulatory adjustments during their production1,3,4. Taken together, this information can facilitate accurate diagnoses and guide rehabilitation1. However, for untrained evaluators, the auditory and/or visual perceptual identification of the alteration and its characterization can be challenging.

The susceptibility to deviations in speech sound production across different life cycles, resulting from anatomical and functional alterations of the stomatognathic system, points to the need for in-training student to consolidate this knowledge before their clinical practice, which involves evaluative and/or therapeutic procedures. Findings from a previous study8 suggest that students in the Speech-Language Pathology and Audiology course have difficulty identifying, visually and/or auditorily, adjustments in speech production resulting from anatomical and functional alterations of the stomatognathic system structures. In this context, teaching materials are considered important tools for training health professionals9 and, when offered in a Virtual Learning Environment (VLE), such materials can represent a resource that facilitates the initial learning process related to specific topics in Speech-Language Pathology and Audiology, including for laypeople10.

In the OMT field, especially regarding speech sound production, there are no descriptions of teaching materials developed and with content validated by speech-language pathology and audiology therapists focusing on speech disorders related to alterations in the stomatognathic system. The importance of content validation for proposed materials in the field of Speech-Language Pathology and Audiology has been widely highlighted in previous studies9,11-14. Furthermore, there are reports of success in developing content in VLE focused on Speech-Language Pathology and Audiology topics, such as voice15, as well as satisfactory results from the use of VLE platforms, such as Moodle, in undergraduate Speech-Language Pathology and Audiology courses that address specific content, such as dysphagia16. However, no descriptions of teaching materials, in VLE format, that address alterations in speech sound production related to the stomatognathic system were found.

The present study aimed to develop a teaching material on the implications of the stomatognathic system in speech sound production, intended for undergraduate students in Speech-Language Pathology and Audiology. The study also sought to identify evidence of validity based on the content of the material, as well as to assess its appearance in a virtual learning environment through the analysis of speech-language pathologists and audiologists. This material is expected to contribute to the training of Speech-Language Pathology and Audiology students, providing resources for the assimilation of knowledge that favors the evaluation and rehabilitation of changes in speech sound production.

METHODS

This is a descriptive study that involved the development of a teaching material on the implications of the stomatognathic system in speech sound production. Furthermore, the evidence of validity based on the content of the developed material was identified, and the material’s appearance in a VLE was evaluated. This study is part of a broader research, approved by the Research Ethics Committee on Human Beings of the Faculty of Philosophy and Sciences, Marilia campus, UNESP, SP, Brazil, under number 6.121.851 and CAAE: 70456323.3.0000.5406. The research was developed in three phases: 1) planning and development of the material; 2) validation of its content; and 3) construction of the VLE and evaluation of its appearance.

Phase 1: Planning and Development of the Material

Filatro and Piconez's proposal17 on the development of instructional design, encompassing planning and development, was used to prepare the material. During the planning phase, the theme, objectives, and target audience were established, along with the beginning of the review of literature relevant to the area. The development of the teaching material involved two stages: a bibliographic survey for the theoretical basis of the material and the construction of the material itself.

The descriptive content of the material was based on information from national books and book chapters focused on the OMT specialty. The guiding question that led to the search in these materials was: "What are the speech alterations related to alterations in the stomatognathic system?" For this purpose, the following search terms were used: speech, speech sound production, speech disorder, speech sound production disorder, speech assessment, malocclusion, teeth, dental prosthesis, temporomandibular dysfunction, lingual frenulum, and mouth breather. The selection of the terms “malocclusion”, “teeth”, “dental prosthesis”, “temporomandibular dysfunction”, “lingual frenulum”, and “mouth breather” was made following previous descriptions1.

The inclusion criteria adopted were: books or book chapters published from 2004 onwards that described typical and altered speech sound production in the context of OMT, alterations in the components of the stomatognathic system and their relationship to speech sound production, as well as evaluative procedures for speech sound production within the specialty. Chapters that did not address or explain alterations in speech sound production and their possible relationships with alterations in the stomatognathic system were excluded.

Considering the breadth of the subject covered in the study and the profile of the target audience (students in training), it was decided to condense information derived primarily from books and chapters in the OMT specialty for the development of the teaching material. In total, 15 books with 41 chapters encompassing the field of Speech-Language Pathology and Audiology or the OMT specialty were analyzed to provide a basis for the construction of the descriptive content. Additionally, a book chapter from the field of Linguistics was included, as it presents detailed descriptions of typical speech sound production, including those that are commonly altered due to alterations in the stomatognathic system.

The selected material was read by two independent researchers and classified into 14 topics: speech sound production; typical speech sound production; altered speech sound production; types of speech disorders, malocclusion, bites, teeth, facial alterations, prostheses, temporomandibular dysfunction, altered lingual frenulum, mouth breathing, saliva, and speech assessment. The relationship between the accessed material (books and their chapters) and the respective topics is shown in Chart 1. The number and percentage of chapters used are presented in Table 1.

Thumbnail
Chart 1
Summary of the accessed material and the 14 topics initially proposed

Thumbnail
Table 1
Number of book chapters and percentage used in each topic

Of the 14 topics initially defined, three of them (“Malocclusion”, “Bites”, and “Teeth”) needed to be subdivided to facilitate understanding of the content. Thus, the topic “Malocclusion” was divided into Malocclusion II / Facial Pattern II and Malocclusion III / Facial Pattern III. The topic “Bites” was divided into Anterior Open Bite, Crossbite, Deep Bite, and Edge-to-Edge Bite. The topic “Teeth” gave rise to Tooth Inclination/Crowding and Missing Teeth/Large Interdental Space. With these subdivisions, the number of topics increased to 19. In addition, a new topic, entitled “Summary of Information”, was included to summarize the types of speech disorders and their relationship to alterations in the stomatognathic system, thus facilitating the assimilation of this content by undergraduate students in Speech-Language Pathology and Audiology. At the end, the material covered 20 topics, which were later reorganized into modules.

The audiovisual resources material consisted of images available on the web, from educational institution websites and other sources accessed through the Google Images search engine, as well as photos and videos of the lower third of the face of the first author of the study (B.C.G.), with authorization. These resources were used to complement the descriptive information presented in the material. The selection of images was carried out by the first author, based on the criteria of representativeness of the aspects addressed in the descriptive content (for example, open bite) and the sharpness of the images. All included images were duly referenced, with indication of the access address, in accordance with the criteria established by the Copyright Law (Law 9.610/98, Art. 46).

The photos and videos of the lower third of the face were captured by the author herself using a Redmi Note 9 mobile phone and edited using the free InShot application. Still photos of the researcher's lower third of the face were only included when it was not possible to obtain records of the aspect of interest in images available on the web. By statically recording the image through photos, the aim was to highlight the aspect of interest (for example, saliva at the corners of the mouth), which could hinder the speech sound production. Video recordings were added to exemplify the types of alterations in the speech sound production that could be simulated by the author. The selected visual resources were analyzed by a second evaluator, and only images and/or videos with consensual analyses were incorporated into the material. Based on the final organization of the material, previously established by the researchers, the content of the material was submitted to the validation process.

The 20 topics that comprised the material and their respective images were reorganized and presented in a didactic way in 9 modules, to facilitate the presentation of the content to the judges and, subsequently, its insertion into the Moodle Platform. Based on the final organization of the material, made by the researchers, the content of the material was submitted for validation.

Phase 2: Validation of the Material's Content

The content validation process was carried out in two stages. Speech-language pathologists and audiologists who met the following inclusion criteria: being specialists in the assessment and treatment of speech disorders related to the field of OMT, participated as judges. All judges completed an online questionnaire.

Data Collection Instrument

A questionnaire was created using the Google Forms management application, covering questions related to the judges' academic and professional background, as well as their perceptions regarding the 20 topics covered in the material, organized into 9 modules. The relevance of the content was evaluated using a 4-point Likert scale: unsatisfactory, regular, satisfactory, and excellent. At the end of the form, a space was provided for the judges to offer justifications and suggestions related to their selected answers, aiming to contribute to the improvement of the material.

Data collection procedure

Invitations to join the study's research team were sent via email to speech-language pathologists and audiologists with a Ph.D. and specialists in the field of OMT. After accepting, participants also received, via email, instructions for analyzing the content and a link to access the electronic form on Google Forms. This form contained the first version of the teaching material for reading, as well as questions regarding the evaluation of the material's content (description and images). The professionals were given 20 days to complete their first individual evaluation of the material.

Based on the considerations presented by the judges, modifications were made to the material, initiating the second stage of validation. At this stage, the revised version of the teaching material was sent again by email to the participants, who were instructed to answer questions about the content of the material and, if necessary, submit new suggestions.

Data analysis

The scores obtained for each topic of the material were arranged in spreadsheets and assigned the following values: 1 = unsatisfactory; 2 = regular; 3 = satisfactory; 4 = excellent. The responses were analyzed by calculating the percentage of agreement among the judges18), and content validation was performed using the Content Validation Index (CVI) method18. CVI was calculated by dividing the number of judges who scored 3 or 4 on each topic by the total number of judges. The level of agreement among the judges was considered valid when it showed a result equal to 1. Topics with a level of agreement lower than 1 were adapted by two researchers, following the suggestions presented by the judges, and re-analyzed. The qualitative analysis of the material was based on the comments made by the judges.

Phase 3: Construction and evaluation of the material’s appearance in a virtual learning environment

The developed material, after content validation, was inserted into a VLE on the Moodle platform, specifically created for this study. Version 3.0 of Moodle from the originating institution, with the course category selected as "Virtual Environments for Undergraduate Studies", was used. There was no hiring or co-participation of IT or design professionals, only occasional consultations regarding the aesthetics of the VLE, as in a previous study19. The configuration and insertion of the content on the Moodle platform were carried out by the authors of the study. The Boost theme was used for the layout in Moodle, which allows for the organization of content into modules. In total, 9 modules were organized in Moodle (Figure 1). The homepage provided information about the organization of the material on the platform and details about the 9 modules, as illustrated in Figure 1. All images included in the material contain corresponding links, allowing users to be redirected to the original image source when accessed through the VLE.

thumbnail of Figure 1
Figure 1
Homepage of the material on the Moodle platform

Data Collection Instrument

An electronic form was created using the Google Forms application, adapted from the Emory questionnaire20. The form covered 3 main categories: audience, navigation, and structure, encompassing the following evaluation items: 1) Navigation on the Moodle platform, 2) Presentation of the material, 3) Organization and sequence of modules, 4) Amount of didactic content in each module, 5) Use of images and videos of own authorship as facilitating resources for understanding the content of the material, 6) Arrangement of the images presented in relation to the text, 7) Size and font of the text, 8) Spelling and grammar of the material, 9) Form of presentation of concepts (the reading is clear enough for the information provided to be understood) and 10) Scope of the material (the material covers the needs of speech-language pathology and audiology students).

The judges' responses regarding the material's appearance were obtained using a 4-point Likert scale: unsatisfactory, regular, satisfactory, excellent. At the end of the form, a space was provided for the judges to offer justifications and suggestions related to their selected responses, to contribute to the improvement of the material.

Data collection procedure

The evaluation of the material's appearance in a virtual environment was carried out by four judges, the same speech-language pathologists and audiologists who had previously participated in the content validation phase. Instructions on how to access the Moodle platform, including login, password, and instructions for analyzing the material, were sent by email. Additionally, a link to complete an electronic form created in Google Forms was provided. The evaluations were conducted individually within 15 days.

Data analysis

The scores obtained for each of the questions related to the appearance of the material in Moodle were organized in spreadsheets, assigning: 1 = unsatisfactory; 2 = regular; 3 = satisfactory; 4 = excellent. The responses obtained were analyzed by calculating the percentage of agreement among the judges18. The appearance of the material was considered adequate when at least 50% of the evaluations were concentrated in the satisfactory and excellent categories. The qualitative analysis of the appearance was carried out based on the comments and suggestions made by the judges at the end of the form.

RESULTS

Phase 1: Developed Material

The developed material consisted of 9 modules: 1) speech sound production; 2) Typical speech sound production susceptible to alteration related to the OMT specialty; 3) Altered speech sound production in the context of OMT; 4) The types of phonetic disorders most commonly found in unfavorable conditions of the stomatognathic system; 5) Implication of alterations in oral structures in speech sound production (Part 1); 6) Implication of alterations in oral structures in speech sound production (Part 2); 7) Implication of alterations in oral structures in speech sound production (Part 3); 8) Synthesis of alterations in speech sound production related to different conditions of the stomatognathic system; and 9) Speech Assessment in the context of OMT. The aspects covered in each module are presented in Chart 2.

Thumbnail
Chart 2
Aspects covered in the teaching material

Phase 2: Validation of the Material's Content

Four speech-language pathologists and audiologists who met the inclusion criteria participated in the validation process; all had doctoral-level training and between 12 and 39 years of experience (average = 28 years).

The first stage of the material validation process, composed of 9 modules and initially 20 topics, resulted in values between 0.75 and 1.0, as shown in Table 2. It was observed that, of the 20 topics evaluated, 12 presented a concordance index equal to 1 and were therefore considered valid. The remaining 8 topics obtained a concordance index equal to 0.75, requiring revision based on the judges' suggestions.

Thumbnail
Table 2
Agreement among the judges and content validation index for each topic evaluated

The criticisms and suggestions for modifications regarding the 8 topics that did not reach the expected agreement are summarized in Chart 3.

Thumbnail
Chart 3
Criticism and suggestions for changes in the 8 topics

After adjustments were made to the 8 topics that required revision, resulting in the reformulation of 7 topics and the exclusion of 1 topic (top bite), the modified content was submitted to a new analysis by the judges. Table 3 presents a comparison of the percentage of agreement between the judges and the respective Content Validation Index for each of the 7 topics in the initial and revised versions of the material. It should be noted that all reformulated topics achieved an agreement of 1 in the second stage of evaluation, and were therefore considered valid.

Thumbnail
Table 3
Comparison of agreement between judges and content validation index in the initial and revised versions of the material

In the final version of the material, in addition to the reformulation of the 7 topics, the 12 topics previously considered valid were also revised, aiming to incorporate the judges' suggestions and thus improve the content. The suggestions regarding the 12 topics included: insertion of videos (with patients), addition of more illustrative images of the described alterations, expanded detailing of certain alterations of the stomatognathic system, standardization of the term "phone," and discussion with an orthodontist for a more precise definition of the terminology related to the types of bites. In the final version of the material, the 19 topics included one focused on summarizing the alterations in speech sound production associated with different conditions of the stomatognathic system (Chart 4).

Thumbnail
Chart 4
Synthesis of alterations in speech sound production related to different conditions of the stomatognathic system

Phase 3: Evaluation of the material's appearance in a virtual learning environment

Table 4 presents the percentage of agreement among the judges for each of the evaluated questions regarding the material's appearance in VLE.

Thumbnail
Table 4
Agreement among the judges on each question

There was no need to submit the material to further analysis, as all questions showed agreement equal to or greater than 50% in the excellent and satisfactory categories after analysis. Specifically, for two questions (3 and 10), all judges assigned the maximum score, resulting in 100% agreement in the excellent category. For eight questions (1, 2, 4, 6, 7, 8, 9, and 11), 75% of the judges considered the material excellent. Only one question (5) showed an equal distribution between the excellent and satisfactory categories.

The suggestions presented by the judges were analyzed to verify their feasibility of implementation and thus improve the material's appearance on the Moodle platform. Regarding navigation on Moodle (question 1), it was suggested that complete references be included at the end of each item, that text be highlighted, and that multiple access methods be offered, considering students with special needs. Regarding the presentation of the material (question 2), it was recommended to allow students to mark the completion of each module after reading it. No changes were suggested for the organization and sequence of the modules (question 3).

Regarding the amount of didactic content in each module (question 4), it was suggested that headphones be included when mentioning the production of bilabial sounds, as well as the organization of tasks that can be performed during the assessment into topics. Concerning the use of images and videos of the author's own creation as resources to facilitate understanding of the material's content (question 5), it was recommended that the distorted headphones be included in the video captions, in addition to the suggestion of, if possible, including videos of patients with real speech disorders. No suggestions regarding the arrangement of images in relation to the text (question 6) were presented.

As for the size and font of the text (question 7), it was suggested that accessibility for students with special educational needs be verified. No suggestions regarding the spelling and grammar of the material (question 8), the way concepts are presented (question 9), or the scope of the material's content (question 10) were made. Regarding the time allotted for accessing the material (15 days - question 11), it was suggested that this time be extended, especially for beginning students.

All suggestions submitted by the judges were analyzed and, where possible, incorporated into the Moodle platform. Exceptions refer to those that depend on specific resources not currently available, such as accessibility for students with special educational needs, inclusion of videos of patients with real speech impairments, and insertion of automatic highlighting.

Figure 1 illustrates the general appearance of the teaching material on the Moodle platform, including the presentation and organization of the modules. Figure 2 presents a summary of the alterations in speech production related to different conditions of the stomatognathic system, as made available in the virtual environment.

thumbnail of Figure 2
Figure 2
Synthesis of speech production alterations related to different conditions of the stomatognathic system presented in Moodle

DISCUSSION

The present study aimed to develop a teaching material on the implications of the stomatognathic system in speech sound production, identify the content-based validity evidence of the material, and also evaluate its appearance in a VLE by speech-language pathologists and audiologists. The motivation for conducting this study stemmed from previous findings that highlighted difficulties among speech-language pathology and audiology students in training in identifying adjustments in speech sound production under both favorable and unfavorable conditions of the stomatognathic system8. These difficulties reinforce the importance of preparing students to identify possible alterations in the speech sound production, considering the anatomical and functional aspects involved.

The teaching material developed in this study included information on the typical and altered speech sound production in the context of OMT, based on content extracted from 15 books, totaling 41 chapters covering the area of Speech-Language Pathology and Audiology or, specifically, the OMT specialty1,2,21-33. Additionally, a chapter from a book in the field of Linguistics34, which presented descriptions of typical speech sound production, was included.

Of the 14 topics initially covered in the material, the topic "types of speech disorders" was the most frequently addressed in the consulted literature, appearing in 52% of the accessed chapters involving the OMT specialty. This finding suggests the relevance of describing the different types of alterations in speech sound production, frequently observed in individuals with structural and/or muscular alterations. Knowledge of these variations is essential for clinicians to be able to accurately identify speech deviations and, based on this, establish appropriate therapeutic plans1. On the other hand, the topics "facial alterations" and "saliva" were the least addressed, being mentioned in only 12% and 10% of the chapters, respectively. These data suggest that the potential interferences of these variables in speech sound production are poorly explored. A single topic (“typical speech sound production”) had its information extracted from only 5% of the total chapters34, specifically from the area of Linguistics. The inclusion of this content is justified by the need to provide a detailed conceptual basis for typical sound production that may be affected in the context of OMT.

The topic "Malocclusion" was identified in 19% of the chapters consulted, from 5 books1,2,23,29,32. However, the literature did not clearly specify the nature of this alteration, whether dental and/or skeletal, which made the initial interpretation of the information difficult during the data extraction phase. This limitation is also commonly observed in scientific articles involving populations with a wide age range3,4, in which speech alterations are generally attributed to dental and/or skeletal alterations. Similarly, studies investigating speech alterations related to malocclusions in children 5,6,35 also do not classify the nature of the occlusal condition, probably due to possible modifications resulting from orthodontic intervention during craniofacial growth. Therefore, in developing the material, the topic "Malocclusion" was subdivided into Malocclusion II / Facial Pattern II and Malocclusion III / Facial Pattern III, with the aim of better detailing the possible speech alterations based on the accessed content. Other subdivided topics were "Bite" (anterior open bite, crossbite, deep bite, and edge-to-edge bite) and "Teeth" (inclination/crowding of teeth and absence of teeth/pronounced interdental space). The subdivision of the initial 14 topics into 20 topics aimed to present, in more detail, the interferences of structural alterations in speech sound production.

In the present study, the topics developed were complemented with audiovisual resources, aiming to optimize the understanding of the descriptive content of the teaching material. Previous studies have also used visual resources to optimize the learning process on the presented theme9,14. One of the challenges of the study was the selection of images that best represented alterations of the stomatognathic system with potential impact on speech sound production, from educational websites. In addition, the creation of videos simulating alterations in speech sound production, commonly observed in the context of OMT, required attention.

The decision to simulate these alterations, instead of using real patient records, was made, considering the difficulty in controlling the articulatory adjustments made by individuals with speech disorders, who may make multiple simultaneous deviations. This factor could compromise the isolated identification of certain speech patterns by students in training. The literature indicates that specific simulations can be useful precisely because they allow highlighting isolated aspects of speech production36. Additionally, the use of images or videos of real patients would imply the possibility of personal identification, which was avoided, especially due to the subsequent insertion of the material in a VLE (Moodle).

The validation of educational materials, such as manuals, courses, and blogs available in virtual environments, has been widely discussed in the literature9,14 and is justified by the importance of disseminating reliable and scientifically based content14. In this study, the content of the teaching material, composed of 20 topics, was analyzed by four expert judges, all speech-language pathologists and audiologists with doctoral degrees and clinical and academic experience in the field of OMT, with an average professional experience of 28.5 years. Although all the judges had solid experience in their respective fields, care was taken to consider different professional profiles to guarantee a rigorous analysis of the material. One of the professionals worked predominantly in clinical practice and in offering training courses; another was a postgraduate professor with prior experience in clinical and undergraduate teaching, and had already developed validated protocols; a third worked as technical support in undergraduate teaching; and the fourth was a faculty member at an international institution, with extensive clinical and academic experience at the national level. The selection of these professionals aimed for rigorous analysis to meet the objectives of the study.

The identification of validity evidence, based on the content of the teaching material developed in the study, aimed to assess the relevance and representativeness of its component elements. To this end, the responses obtained for each topic in the material were analyzed by calculating the percentage of agreement among the judges, and content validation was performed based on CVI18. Previous studies have also proposed content validation using a methodology similar to that of the present study9,11-14, reinforcing the importance of this process to ensure the quality and suitability of the materials produced.

In validating the content of the developed teaching material, the goal was to obtain a CVI of 1 for all evaluated topics. In the first version of the material, this index was achieved in 12 of the 20 topics, according to quantitative analysis. However, the analysis based on the judges' comments revealed aspects that could be improved, even in the topics where the desired agreement had already been achieved. This finding reinforces the importance of integrating quantitative and qualitative analyses37 in the development of materials, as highlighted in a previous study14. Eight topics presented a validity index lower than 1.0 and, therefore, required revision. Of these, seven were reformulated to facilitate the understanding of the content by undergraduate students in Speech-Language Pathology and Audiology, the target audience of the material, and one was excluded (edge-to-edge bite) because it did not present a direct relationship with alterations in speech sound production. As a result, the final version of the material consisted of 19 topics.

Of the 7 topics reviewed, three (general aspects of speech sound production, typical sound production, and evaluation procedures) received suggestions related to detailing the content, including more specific information from the field of Dentistry, clarifying the use of terms (such as atypical productions), and reorganizing the presentation of one of the topics (saliva), as it did not directly involve a structural alteration. Considering the relevance of these suggestions, all were accepted, since they contributed significantly to improving the final version of the material.

Suggestions related to three other topics deserve highlighting, as they raise concerns about the terminology used to describe speech alterations associated with interferences of the stomatognathic system. In the topic hypertrophic tonsils/mouth breathing, for example, the need to revise the terms used (lisp and distortion) was pointed out. In the topic altered speech sound production, the importance of including alterations involving the sounds [l] and [r] was highlighted, in addition to incorporating the concepts of compensation and adaptation. Finally, in the topic types of speech alterations, the inclusion of the terminology unilateral lisp, mention of possible distortions in [l] and [r], description of the auditory effects of air escape in lisps, explanation of articulatory point modifications, and detailing of the reduction in articulatory amplitude were suggested.

The need to revise these topics suggests a possible difficulty in interpreting terms (“lisp”, “distortion”, for example) used in the book chapters that served as the basis for the material's development, especially in classifying the types of alterations in sound production related to specific conditions of the stomatognathic system. Despite the large number of book chapters from the accessed books1,2,22,25,32, a non-standardized use of terminology was observed among the different authors. This lack of consensus may have hindered the initial descriptions in the material, making validation difficult, as evidenced by the agreement index of 0.75 obtained in the first version of the material's topics.

Based on further reflections on the descriptions found in the consulted literature, as well as on the suggestions and questions presented by the judges, the term "auditory-perceived distortion" was adopted in the final version of the teaching material to refer to the auditory effect resulting from a modification in the articulatory point during the speech sound production. This alteration may be present in bilabial [p], [b], and [m], labiodental [f] and [v], alveolar [s], [z], [t], [d], [n], [l], and [ɾ], and compound consonant clusters with [ɾ] and/or [l]. However, in the specific case of fricative sounds, the term distortion was reserved to refer to the auditory effect resulting from articulatory adjustments that do not involve tongue interposition between the dental arches (in the anterior or lateral region). For these latter conditions, the term lisp (anterior or lateral) was maintained, according to the predominant terminology in the specialized literature used as a reference1,2,22,25,32.

As established in the final version of the material, the term anterior lisp was used to describe the anterior interdental position of the tongue in the [s] and [z] sounds, characterized by the interposition of the tongue between the dental arches in the anterior region, generally associated with a low tongue position. This configuration results in an auditorily perceptible distortion, especially in the [s] sound. In some cases, anterior lisp may manifest unilaterally.

Lateral lisp, in turn, corresponds to the lateral interdental position of the tongue, generating a perceptible auditory distortion (distortion) that can affect the phonemes [s], [z], [ʃ], and [ʒ], with the possibility of air escape during emission. This term can also be used when the mid-posterior part of the tongue remains close to the hard palate, decreasing the space for air to escape. The term "modification of the articulatory point" was reserved, in the final version of the material, to refer to variations in the movements of the articulators that are visually perceptible, which may represent adaptations or compensations in the production of sounds and may result in auditorily perceptible distortion or imprecision in speech. Such variations depend directly on the structural alterations present in the stomatognathic system. The adoption of these nomenclatures aimed to encompass the terms that can most appropriately reflect the speech alterations related to the specific structural conditions of the stomatognathic system, as summarized and referenced in the synthesis section of the material (Chart 4).

In a previous study, researchers³ differentiated between the terms "distortion" and "lisp" to characterize speech alterations related to distinct structural conditions of the stomatognathic system. The authors attributed the term distortion to adjustments or compensations used for the production of a phoneme or a group of phones, while the term lisp was attributed to the incorrect production of the linguo-alveolar fricative sounds [s] and [z], as observed in specific structural conditions. Specifically, the term anterior lisp was attributed when the expiratory airflow was emitted centrally, but the tongue was poorly positioned in the vertical and anteroposterior planes, resulting in the production of the sounds between the anterior teeth. The term lateral lisp was attributed when the expiratory airflow was divided laterally, with lateral escape of air through the oral cavity during the production of the linguo-dental fricatives. According to the authors, although lisping is part of the group of distortions, this type of speech alteration was considered separately in the study to identify possible specific correlations with occlusion and dentition. In the final version of the developed teaching material, the terms distortion and lisp were also differentiated, being used according to the alterations found in the stomatognathic system.

In international literature38, the use of the term lisp is recommended for difficulties in the correct positioning of the tongue during the production of [s] and [z], with the categorization of 4 types of lisp: anterior interdental lisp, dentalized lisp, lateral lisp, and palatal lisp. The nomenclature used in the developed material is aligned with these recommendations, except for the term palatal lisp, which was not explicitly included. However, the descriptions associated with this type of lisp, such as the use of the mid-posterior part of the tongue close to the hard palate, reducing the space for air to escape, were included in the developed material under the definition of lateral lisp1.

Additionally, some researchers use the term distortions to refer to alterations in the production of alveolar sounds, including [s]. These distortions can be dentalized (when the tongue is visibly positioned more anteriorly) or interdental (when the tongue visually interposes between the anterior teeth). Auditory distortions are particularly referenced to auditorily perceived alterations in these sounds.7 Other scholars also highlight that lingual adjustments can result in visual inaccuracies (normal acoustic properties, but with visual distortion), articulatory distortions (altered acoustic properties, auditory alterations), or a combination of both.4 In these approaches, priority is given to the description of the visual and/or auditory effects resulting from lingual adjustments, without the specific use of the term lisp.

The lack of consensus in the use of the terminology in books and articles represents a challenge for academics and professionals seeking specific information on speech disorders in the context of OMT. In developing the teaching material proposed in this study, we sought to minimize this difficulty by defining terminology that helps students understand the types of speech production disorders related to various alterations of the stomatognathic system. It is worth noting that the operational definitions in the final version of the material were developed exclusively from chapters in books in the field, and were subsequently revised and improved based on suggestions offered by four specialists participating in the validation phase of the study.

In its final version, the descriptive content of the material clearly presents the proposed objectives, since the application of CVI reached the maximum index for all 19 topics analyzed. Specifically, a percentage of agreement was observed among the judges for the 12 topics considered valid in the first phase of validation, with responses classified in the categories excellent (3 topics) or excellent and satisfactory (9 topics). For the 7 topics that required modifications after the first round of content validation, an increase in the percentage of agreement was observed after revision, with the following results: 100% agreement for the excellent category for the topic speech assessment; 75% agreement for the excellent category and 25% satisfactory for the topics saliva, hypertrophic tonsils/mouth breathing, and speech sound production; and 50% agreement for the excellent category and 50% satisfactory for the topics typical sound production, altered speech sound production, and types of speech disorders. Therefore, it is observed that even the topics that needed adjustments after the first round of evaluation achieved the expected agreement after the material review. Taken together, the study data demonstrate that all 19 validated topics (first and second rounds) presented responses that encompassed the excellent and satisfactory categories, suggesting the relevance and adequacy of the information presented.

It is worth noting that not all recommendations presented by the judges were accepted, mainly due to the incompatibility of these suggestions with a later phase of the study, which involved incorporating the developed material into the Moodle platform. In a previous study, other authors also chose to discard suggestions because they did not conform to the objective of the materials developed14.

The final stage of the study involved creating a VLE encompassing the content of the already validated teaching material, using the MOODLE platform. In the field of Speech-Language Pathology and Audiology, there are reports of success in developing content on this platform15, as well as evidence of favorable results with the use of Moodle in undergraduate Speech-Language Pathology and Audiology courses16. It is known that, through Moodle, it is possible to complement the teaching process, since it offers tools for managing academic content, in addition to resources for interaction and communication between teachers and students.

In the present study, we sought to evaluate the appearance of the material after its insertion into the Moodle platform, through the evaluation of expert judges, the same speech-language pathologists and audiologists who previously validated the content. Previous studies have also used evaluations conducted by experts in the field and by lay audiences regarding the presentation format of the materials15,39. Evaluation by experts represents an initial step in the analysis of the presentation format, and subsequent evaluations with the target audience are recommended40.

The findings from the evaluation of the material's appearance, conducted by the participating speech-language pathologists and audiologists, demonstrated that VLE was positively evaluated by all judges. This assessment is reflected by the percentage of agreement obtained in the 11 questions of the applied questionnaire. 100% agreement was observed in the "excellent" category in two questions (organization and sequence of modules, and comprehensiveness of the material for the needs of speech-language pathology and audiology students). In 8 questions, 75% agreement was obtained in the excellent category and 25% in the satisfactory category. These questions refer to: navigation in Moodle, presentation of the material in Moodle, amount of informative content in each module, arrangement of images presented in relation to the text, size and font of the texts, spelling and grammar of the material, clarity in the presentation of concepts, and estimated time to access the material. Only one question obtained an equal distribution of responses between the excellent (50%) and satisfactory (50%) categories from the judges, namely the use of images and videos of own authorship as resources to facilitate understanding of the material's content.

In the qualitative evaluation, there was consensus among the judges that the material available on Moodle will contribute to the training of students, facilitating the understanding of alterations in speech sound production related to the OMT specialty. Not all suggestions were accepted because they were not consistent with the objectives of the study, especially regarding access for students with special educational needs. The insertion of elements such as text highlighting, for example, was not feasible due to the limitations of the Moodle configuration used in this study. Some authors have pointed out that it is not always possible to meet the suggestions of judges.14 However, the reflections arising from the comments received may contribute, in future studies, to the improvement of the material on the Moodle platform, with a view to expanding access and meeting the needs of all undergraduate students in Speech-Language Pathology and Audiology, including those with special needs.

It is important to highlight the need to continue this study, aiming to validate the material with the target audience (students of the Speech-Language Pathology and Audiology course). Considering that VLE has potential as a tool for training, capacity building, and health education, it is understood that the teaching material on the implications of the stomatognathic system in speech sound production, available on the Moodle platform, could be a complementary resource in teaching during the training of speech-language pathology and audiology therapists.

CONCLUSION

The content of a teaching material on the implications of the stomatognathic system in speech sound production was developed and validated by speech-language pathologists with clinical and research experience in the field of OMT. The validation of the material by these speech-language pathologists made it possible to gather specialized theoretical content, illustrated through images and simulations, geared towards the needs of students in academic training. The inclusion of the material on the Moodle platform enabled students in academic training to have easy and remote access to a condensed and visually enriched teaching resource. It is hoped that this material will contribute to pedagogical practices aimed at optimizing the learning of students in training in the area of OMT.

REFERENCES

  • 1 Marchesan IQ, Martinelli RLC. Avaliação da fala: aspectos da motricidade orofacial. In: Giacheti CM, editor. Avaliação da fala e da linguagem: perspectivas interdisciplinares em Fonoaudiologia. Marília: Oficina Universitária; São Paulo: Cultura Acadêmica; 2020. p. 397-406.
  • 2 Silva HJ, Tessitore A, Motta AR, Cunha DA, Berretin-Felix G, Marchesan IQ. Tratado de Motricidade Orofacial. 1st ed. São Paulo: Pulso Editorial - Especial; 2019.
  • 3 Martinelli RL de C, Fornaro ÉF, Oliveira CJM de, Ferreira LMDB, Rehder MIBC. Correlações entre alterações de fala, respiração oral, dentição e oclusão. Rev. CEFAC. 2011;13(1):17-26. https://doi.org/10.1590/S1516-18462010005000127
    » https://doi.org/10.1590/S1516-18462010005000127
  • 4 Leavy KM, Cisneros GJ, LeBlanc EM. Malocclusion and its relationship to speech sound production: Redefining the effect of malocclusal traits on sound production. Am J Orthod Dentofacial Orthop. 2016;150(1):116-23. https://doi.org/10.1016/j.ajodo.2015.12.015
    » https://doi.org/10.1016/j.ajodo.2015.12.015
  • 5 Assaf D do C, Knorst JK, Busanello-Stella AR, Ferrazzo VA, Berwig LC, Ardenghi TM et al. Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: An epidemiological study. J Appl Oral Sci. 2021;29:e20201005. https://doi.org/10.1590/1678-7757-2020-1005 PMID: 34406316.
    » https://doi.org/10.1590/1678-7757-2020-1005
  • 6 Freitas HV, Alves CMC, Silva LFG e, Pereira ALP, Hugo FN, Thomaz EBAF. Alterations of oral functions and dental malocclusions in adolescents: A cross-sectional population-based study. Cienc Saude Colet. 2021;26(suppl 3):5261-72. https://doi.org/10.1590/1413-812320212611.3.07992020 PMID: 34787217.
    » https://doi.org/10.1590/1413-812320212611.3.07992020
  • 7 Keyser MMB, Lathrop H, Jhingree S, Giduz N, Bocklage C, Couldwell S et al. Impacts of skeletal anterior open bite malocclusion on speech. FACE (Thousand Oaks). 2022;3(2):339-49. https://doi.org/10.1177/27325016221082229 PMID: 35903399.
    » https://doi.org/10.1177/27325016221082229
  • 8 Geremias BC, Abreu ACV, Gurgel J de A, Genaro KF, Chagas EFB, Marino VC de C. Perceptual analysis of the tongue position in the production of [s] by SLP students. Distúrb. Comun. 2023;34(4):e58031. https://doi.org/10.23925/2176-2724.2022v34i4e58031
    » https://doi.org/10.23925/2176-2724.2022v34i4e58031
  • 9 Martins A, Souza TC de, Corrêa C de C, Maximino LP. Development of a virtual learning environment on children's language for pediatricians. Distúrb. Comun. 2021;33(4):741-50. https://doi.org/10.23925/2176-2724.2021v33i4p741-750
    » https://doi.org/10.23925/2176-2724.2021v33i4p741-750
  • 10 Oliveira LF de, Corrêa C de C, Vieira MMRM, Blasca WQ, Brasolotto AG. Intervention via teleducation about vocal mutation and vocal habits. Audiol., Commun. Res. 2018;23:e1899. https://doi.org/10.1590/2317-6431-2017-1899
    » https://doi.org/10.1590/2317-6431-2017-1899
  • 11 Graziani AF, Fukushiro AP, Marchesan IQ, Berretin-Félix G, Genaro KF. Extension and validation of the protocol of orofacial myofunctional assessment for individuals with cleft lip and palate. CoDAS. 2019;31(1):e20180109. https://doi.org/10.1590/2317-1782/20182018109 PMID: 30843925.
    » https://doi.org/10.1590/2317-1782/20182018109
  • 12 Lopes LD, Pereira IG, Severo GAP, Picinato-Pirola M, Corrêa CC. Desenvolvimento de aplicativo para promoção de saúde em sono para crianças. RCEAM [journal on the internet]. 2022 [accessed on 2025 aug 25]; 16(1). Available at: https://periodicos.unemat.br/index.php/revistamedicina/article/view/5939
    » https://periodicos.unemat.br/index.php/revistamedicina/article/view/5939
  • 13 Nunes EL, Cardoso MCA. Validação de conteúdo de um instrumento de triagem em motricidade orofacial. Res Soc Dev. 2023;12(1):e19212139785.
  • 14 Cagnoni NA, Jorge TM. Construction and validation of an informative handbook on speech-language-hearing therapy in primary health care. Rev. CEFAC. 2023;25(3):e2422. https://doi.org/10.1590/1982-0216/20232532422
    » https://doi.org/10.1590/1982-0216/20232532422
  • 15 Oliveira AG, Fabbron EMG. Parental support tool for guidance on children's vocal health: The development of a course in a virtual learning environment. Distúrb. Comun. 2021;33(3):571-82. https://doi.org/10.23925/2176-2724.2021v33i3p571-582
    » https://doi.org/10.23925/2176-2724.2021v33i3p571-582
  • 16 Catalani B, Luccas GR, Berretin-Felix G. Technology-mediated education in oropharyngeal dysphagia: Undergraduate teaching proposal. Rev Grad USP. 2020;4(1):71-83. https://doi.org/10.11606/issn.2525-376X.v4i1p71-83
    » https://doi.org/10.11606/issn.2525-376X.v4i1p71-83
  • 17 Piconez SCB, Filatro A. Design instrucional contextualizado: planejamento, elaboração e avaliação de materiais didáticos para educação a distância [journal on the internet] abril/2004 [accessed on 2025 aug 25]; 1-9. Available at: https://www.abed.org.br/hotsite/11-ciaed/por/htm/049-TC-B2.htm
    » https://www.abed.org.br/hotsite/11-ciaed/por/htm/049-TC-B2.htm
  • 18 Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc saúde coletiva. 2011;16(7):3061-8. https://doi.org/10.1590/S1413-81232011000800006
    » https://doi.org/10.1590/S1413-81232011000800006
  • 19 Carvalho RP, Oliveira JRM de, Mondelli MFCG, Matos IL de. Development of an educational tool on tinnitus in a website format. Rev. CEFAC. 2020;22(6):e4720. https://doi.org/10.1590/1982-0216/20202264720
    » https://doi.org/10.1590/1982-0216/20202264720
  • 20 Breckons M, Jones R, Morris J, Richardson J. What do evaluation instruments tell us about the quality of complementary medicine information on the internet? J Med Internet Res. 2008;10(1):e3. https://doi.org/10.2196/jmir.961 PMID: 18244894.
    » https://doi.org/10.2196/jmir.961
  • 21 Feitosa HJ, Ferreira AL, Depolli GT, Silva G. Mapas conceituais em fonoaudiologia: motricidade orofacial. São Paulo: Book Toy; 2022.
  • 22 Felício CM. Motricidade orofacial: teoria, avaliação e estratégias terapêuticas. 1ª ed. São Paulo: Manole; 2020.
  • 23 Berretin-Felix G, Tessitore A, Jordão do Amaral AKF, Alves GAS, Silva HJ, Marchesan IQ et al. A fala nos diversos contextos da motricidade orofacial. 1st ed. São Paulo: Pulso; 2015.
  • 24 Rehder MI, Cazumbá LF, Cazumbá M. Identificação de falantes: uma introdução à fonoaudiologia forense. 1st ed. Rio de Janeiro: Revinter; 2015.
  • 25 Marchesan IQ, Silva HJ, Tomé MC, Tratado das Especialidades em Fonoaudiologia. 1st ed. São Paulo: Roca; 2014.
  • 26 Rahal A, Motta AR, Fernandes CG, Cunha DA, Migliorucci RR, Berretin-Felix G. Manual de Motricidade Orofacial. 1st ed. São Paulo: Booktoy; 2014.
  • 27 Klein D, Justino H, Marchesan I, Andrede I, Brasil L, Pinto M et al. Avaliação em motricidade orofacial. 1st ed. São José dos Campos: ABRAMO; 2013.
  • 28 Marchesan IQ, Silva HJ, Berretin-Felix G, Terapia Fonoaudiológica em Motricidade Orofacial. 1st ed. São Paulo: Pulso; 2012.
  • 29 Pernambuco LA, Silva HJ, Souza LBR, Magalhães HV, Cavalcanti RVA. Atualidades em Motricidade Orofacial. 1st ed. Rio de Janeiro: Thieme Revinter; 2011.
  • 30 Felício CM, Trawitzki LVV. Interfaces da Medicina, Odontologia e Fonoaudiologia no Complexo Cérvico-Craniofacial. 1st ed. São Paulo: Pró-Fono; 2009.
  • 31 Britto AT. Livro de fonoaudiologia. 1st ed. São Paulo: Pulso Edit; 2005.
  • 32 Ferreira LP, Befi-Lopes DM, Limongi SC. Tratado de Fonoaudiologia. 1st ed. São Paulo: Roca; 2004.
  • 33 Marchesan IQ. Motricidade orofacial: como atuam os especialistas. 1st ed. São Paulo: Booktoy; 2004.
  • 34 Silva TC. Fonética e fonologia do português: roteiro de estudos e guia de exercícios. 11th ed. São Paulo: Contexto; 2019.
  • 35 Amr-Rey O, Sánchez-Delgado P, Salvador-Palmer R, Cibrián R, Paredes-Gallardo V. Association between malocclusion and articulation of phonemes in early childhood. Angle Orthod. 2022;92(4):505-11. https://doi.org/10.2319/043021-342.1 PMID: 35275982.
    » https://doi.org/10.2319/043021-342.1
  • 36 Tardif M, Berti LC, Marino VCC, Pardo J, Bressmann T. Hypernasal speech is perceived as more monotonous than typical speech. Folia Phoniatr Logop. 2018;70(3-4):183-90. https://doi.org/10.1159/000492385 PMID: 30184539.
    » https://doi.org/10.1159/000492385
  • 37 Silva REG da, Silva RPM, Avelar AFM. Validation of an exercise booklet for children with acute lymphoblastic leukemia. Fisioter mov. 2021;34:e34101. https://doi.org/10.1590/fm.2021.34101
    » https://doi.org/10.1590/fm.2021.34101
  • 38 Bowen C. Lisping: When /s/ and /z/ are hard to say. 2011. Available at: https://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=86:lisp&catid=11&Itemid=108 Accessed on 2025 aug 25.
    » https://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=86:lisp&catid=11&Itemid=108
  • 39 Silva MT, Teixeira LC. Usability and acceptability of digital activities for voice teaching in Speech-Language Pathology and Audiology. Distúrb. Comun. 2021;33(3):513-25. https://doi.org/10.23925/2176-2724.2021v33i3p513-525
    » https://doi.org/10.23925/2176-2724.2021v33i3p513-525
  • 40 Andrade JR de B, Machado L dos S, Lopes LW, Moraes RM de. Virtual simulations for health education: How are user skills assessed? Rev bras educ med. 2022;46(4):e130. https://doi.org/10.1590/1981-5271v46.4-20210389.ING
    » https://doi.org/10.1590/1981-5271v46.4-20210389.ING
  • A study conducted at the Universidade Estadual Paulista - UNESP, Faculdade de Filosofia e Ciências, Departamento de Fonoaudiologia, Marília, SP, Brazil.
  • Financial support
    Conselho Nacional de Desenvolvimento Científico e Tecnológico
  • Data sharing statement
    I declare that the research data cannot be shared.
  • Artificial Intelligence tools statement
    During the preparation of this study, the authors used OpenAI. (2024) CHATGPT-4 version to correct the grammar and fluency of the text. After using this tool, the authors revised and edited the content as needed. Furthermore, they assume full responsibility for the content of the publication.

Edited by

  • Chief Editor
    Hilton Justino da Silva
  • Associate Editor
    Leandro Pernambuco

Data availability

I declare that the research data cannot be shared.

Publication Dates

  • Publication in this collection
    09 Feb 2026
  • Date of issue
    2026

History

  • Received
    31 Aug 2025
  • Reviewed
    22 Sept 2025
  • Accepted
    03 Nov 2025
Creative Common - by 4.0
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
location_on
ABRAMO Associação Brasileira de Motricidade Orofacial Rua Uruguaiana, 516, Cep 13026-001 Campinas SP Brasil, Tel.: +55 19 3254-0342 - São Paulo - SP - Brazil
E-mail: revisora1@revistacefac.com.br
rss_feed Acompanhe os números deste periódico no seu leitor de RSS
Reportar erro