Have you seen braces on a friend or family member that looks like the braces are on the back side of their teeth? What exactly are those? Are they really braces? How do they work? Are they right for me?
The braces you see behind the teeth are called “lingual braces” and they are one of many different options for braces treatment. In this article we go into all the details of lingual braces from how they work to whether or not they may be a good option for you.
Are you especially concerned about ensuring your braces treatment is invisible? Perhaps you play an instrument and do not want braces to affect your lips and the way you play your instrument? Maybe you were hoping to have aligners but you were not a candidate for aligner treatment? All of these are possible reasons why someone might choose lingual braces. In short, lingual braces are braces that are attached behind your teeth.
A linguist is a person who speaks several languages fluently. Notice the similarity between the word linguist and lingual. In Latin, lingua means “tongue” or “speech, language” (https://www.etymonline.com/word/lingual). When we say lingual braces, we mean braces that are attached to the surface of the teeth pointing towards the tongue. By attaching braces to the back of the teeth instead of the front of the teeth, the braces are said to be "invisible since they are not seen from the front. Lingual braces can be a good option, but just as with all orthodontic treatments, there are different benefits to lingual braces as well as some concerns to keep in mind in order to make the best decision for your healthcare.
In this article we discuss lingual braces and how they work. We will then compare them to other braces systems and why you may or may not choose to go with lingual braces. At Skarin Orthodontics, we want all of our patients to be informed to make the best decision for their dental care. Each treatment option has its own unique qualities, which makes it important to know how different treatment options work on a deeper level.
Lingual braces are often said to be "invisible" since they are behind the teeth. Being largely invisible is one of the biggest advantages of lingual braces. The second main reason to use lingual braces is due to the amount of "control" an orthodontist is able to have with your teeth.
What do we mean by “control?” Different treatment options have different levels of control and how directly they affect tooth movement. Aligners, for example, require orthodontists and dentists to assess whether or not a patient is a good candidate for treatment with aligners. The reason why orthodontists have to assess patients for aligners is because aligners do not have the same amount of “control” and their ability to move teeth in comparison to regular braces. Aligners can be great for lots of people, but mechanically, they simply cannot treat more difficult cases.
Aligners often have less "attachments" or small "bumps" on the outside surface of the teeth (although, it is not uncommon for aligners have just as many attachments on the teeth as regular braces), but less attachments also mean the orthodontist has less mechanical ability to move teeth. For patients that need significant movement, aligners simply cannot mechanically move the teeth well in comparison to regular braces. Orthodontists need brackets and wire on the teeth in order to do more heavy-duty vertical, rotational, and torsional movements of the teeth.
What if a patient really needs an invisible treatment option, but they also really need some heavy-duty tooth movement that aligners cannot accomplish well? That is when lingual braces could be a good option. Since lingual braces use both brackets and wire, an orthodontist is able to get the control of regular traditional braces that would not be possible with aligners. In addition, since the brackets and wire are on the back of the teeth, it it also basically invisible.
In a nutshell, lingual braces work similarly to traditional braces, but for the orthodontist, the mechanics are a bit reversed. Braces are still applied to each individual tooth, just like traditional braces, and a wire is still placed between all the brackets within a slot just traditional braces. Where there are differences is in how the orthodontist adjusts the wire, what the shape of the wire look like (we call this the "arch-form"), and attachments on the teeth in order to position your teeth and jaw. Since the brackets are now on the inside instead of the outside, the mechanics work a bit differently, and are somewhat limited in their scope, which is what makes moving teeth with lingual braces a bit more difficult. It is also mechanically limited in comparison to traditional braces placed on the front of the teeth.
Most likely, yes. To make sounds when you speak, your tongue touches the back of your teeth. Unfortunately, since lingual braces are on the back of your teeth, your tongue will hit the braces. It will feel odd, and yes, it will affect your speech. The good news is that patients usually learn to adapt and adjust their speed over a period of a month or two. It all depends on adjustments that patients make with their tongue in order to better speak with lingual braces.
It also important to keep in mind that every person will respond to the challenge differently. Some individuals are better with adjusting their tongue than others. It is also important to keep in mind that there are different brands of lingual brackets, and they can vary in their shape and design sizes. Generally, the larger the bracket, the more it may affect your speech. Overall, the speech changes can be overcome, but it is something to keep in mind if choosing lingual braces.
The most obvious difference is that traditional braces are placed on the outside of the teeth while lingual braces are placed on the inside of the teeth. Lingual braces are usually metal, which means that they can sometimes be seen depending on the angle of the mouth. Traditional braces also come in metal but are more obvious on the front of the teeth. Aesthetic braces in clear or tooth color are available for traditional braces, but aesthetic options are much more prone to breakage, so it is important to consider durability in your decision.
When it comes to office visits, lingual braces often take a bit more time to apply to the teeth. Also, being on the inside of the teeth makes the process of applying braces and adjusting braces a bit more difficult. Due to the increased difficulty, many orthodontists do not offer lingual braces simply because the benefits do not outweigh the benefits that other options can deliver. This can make it difficult for patients to find a doctor to work on their braces if there is a dental emergency of if they move to a new area. Due to the increased difficulty and fewer offices using lingual braces, it is also not uncommon for lingual braces to be significantly more expensive than traditional braces.
Lastly, even though lingual braces have more control and are better equipped to deal with severe orthodontic problems over aligners, lingual braces do not have the same kind of leverage or the many helpful and frequently necessary auxiliary appliances and devices that traditional braces can use. This almost always results in longer treatment time than what it may take with conventional braces, but individual results will vary depending on the severity of how much tooth movement is needed.
Since lingual braces are on the inside of the mouth, cleaning the back side of your teeth is more difficult, but not impossible. Plaque tends to accumulate most behind our teeth, especially the lower teeth, so it will require careful brushing and flossing behind the teeth. Having a mechanical toothbrush can definitely help in this area.
Generally speaking, lingual braces will cost more than traditional braces, Skarin System, or aligners, but that will depend on your insurance coverage. We wish we could give you a definitive answer, but since everyone’s insurance coverage is different, it is best to check with your individual provider.
Dr. Skarin can work on lingual braces, but we find that patients generally prefer different treatment options once they have an overview of all the options that are available. Usually, people put a priority on speed and the least amount of pain, and there are other great options out there that cater to that.
Lingual braces are particularly important to people that absolutely cannot have anything on their teeth (models, musicians, etc.).
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