Getting used to lingual braces

Lingual braces which are fitted behind the teeth are often said to be more uncomfortable than conventional (labial) fixed braces which are on the front of the teeth.  Comparative research into the sensation of wearing lingual and labial braces is limited. What there is indicates that patients with braces on the inside (lingual) have more tongue soreness, while those with braces on the outside of their teeth (labial) have more soreness in the cheek and lip areas of their mouth.

After an interesting conversation with a teeth-straightening patient, I have vowed to keep an open mind on the matter.  This is the background. The patient decided to have an upper lingual brace. Two weeks after I fitted it, she felt at home with it. She was using the Rainbow passage to practise speaking so that no one knew that she had a brace and she was keen to have her lower brace fitted. Because the lower teeth are slightly less visible and the appearance of braces are less of an issue, she decided to have conventional labial braces fitted in front of the lower teeth.

Her expectation was that after the experience of lingual braces, she would find lower braces easy to cope with. But she came back a few weeks later complaining of discomfort and wondering whether she should have lingual braces on both the lower and upper arches! This is not the first time this has happened. A fair proportion of my patients have lingual braces on the upper arch and labial braces on the lower arch and have reported greater dissatisfaction with the lower labial braces.

My conclusion is that comparisons between the two types of fitted appliances are too simplistic. The role of perception and experience cannot be underestimated. It’s likely that the lower brace is always harder to adapt to. The patient was assuming it would be better on the lingual surface when a lower lingual might still be worse than an upper lingual brace.

Communication is key. My strategy is to warn our patients prior to bond up that a lower brace can be difficult to get used to, whether on the outside surface or inside surface of the teeth. The fact is that getting used to having braces anywhere in your mouth is a challenge. So if you think your lower labial brace will be a doddle compared to the upper lingual brace, you may be disappointed. But then, on the other hand, perhaps you won’t!

While beauty is in the eye of the beholder, discomfort can only be assessed by the brace-wearer. And many of my patients tell me they experience virtually no discomfort at all!

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