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Illustration showing tooth movement using lingual braces.

If you want to straighten your teeth without being conspicuous about it but you’re not a good candidate for clear plastic aligners, lingual braces might be the answer. In this orthodontic treatment approach, the apparatus used to realign teeth (brackets, wires and elastics) is mounted on the back (the tongue side) instead of the front of the teeth. The chief advantage of this approach is that the braces are largely hidden from view except perhaps when you yawn and don’t cover your mouth! Lingual braces can be more efficient than clear plastic aligners in achieving complex movements like tooth rotation or changing the height of teeth.

How Braces Move Teeth

Although the location of the appliance used is reversed, lingual braces share many similarities with conventional ones in terms of the type of hardware and orthodontic principles involved. In both scenarios, the thin, flexible wires that are threaded through the brackets slowly straighten and in doing so exert light pressure on teeth, which moves them in preplanned, controlled ways.

Teeth are able to be moved because they are not rigidly planted in the supporting jaw bone. They are suspended like a hammock, each in its own socket within the bone, by elastic periodontal (“peri” = around; “dont” = tooth) ligaments that attach on one end to the roots of teeth and on the other end to the surrounding jaw bone. The bone and ligaments are living tissue that renew or “remodel” themselves by shedding and adding cells in response to pressure from the tooth roots. On the pressure side, ahead of the direction in which teeth are moving, bone and ligament tissues are absorbed to make room, while on the tension side that teeth are moving away from, new bone and ligament are formed to fill in the space. It can help to visualize this by imagining an upright stick being drawn through sand. The sand falls away in front of the advancing stick, and simultaneously fills in behind it.

Special Considerations

While lingual treatment offers an aesthetic advantage, it comes with potential challenges that accompany all fixed orthodontic devices as well as some that are unique to the “backward” approach.

It can take longer to get used to wearing lingual braces than it does for conventional ones. Interference with normal speech is a common problem, at least initially. Your tongue makes contact with the backside of your upper front teeth when forming certain sounds, the same place where your lingual braces are situated, so you may notice a lisp or a whistling sound when you speak. Over time, most people adapt.

Another potential problem, especially during the first few weeks of wearing new lingual braces, is tongue irritation from rubbing against the brackets and wires in the process of speaking and eating. Several options exist for soothing or countering this phenomenon. Frequent rinsing with warm saltwater can encourage healing. An over-the-counter product containing a mild anesthetic such as benzocaine can temporarily numb your tongue. Orthodontic wax—available from your orthodontist, dentist or in the dental section of many drug stores—can be placed over the sharp edges of brackets and wires as a protective measure. And your orthodontist may be able to provide protective silicone pads to wear over the braces.

Like other fixed orthodontic appliances, lingual braces can complicate eating. Food is more easily trapped in them and sticky, chewy, crunchy or hard foods should be avoided because they can damage brackets and wires and loosen the cement bond affixing the brackets to your teeth. All types of fixed braces can also complicate brushing and flossing and make it harder to avoid common dental problems like gingivitis (inflamed gums), tartar buildup, erosion of protective tooth enamel, and cavities (tooth decay).

Lingual braces can work for adolescents/teens and adults alike, but they may not be the best choice in every case. The only way to know whether they are a viable option is in consultation with your orthodontist.

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