Lingual Braces: Fixed Appliances Behind the Teeth
Lingual braces are fixed braces attached to the inside of the teeth. For adults weighing them up, this page covers how they work, how visible they are, speech adaptation, tongue comfort, cleaning, bond failure and treatment time. The core point: the British Orthodontic Society calls them virtually invisible but lists speech, tongue soreness and cleaning as possible problems, and studies differ on how long speech takes to adapt.
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Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist, reviewed this page. He is a General Dental Practitioner: BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry, PG Cert Restorative and Aesthetic Dentistry.
How do lingual braces work?
Lingual braces are fixed appliances attached to the inside surface of the teeth, the British Orthodontic Society (BOS) explains. The name comes from lingua, Latin for tongue.
BOS says there are many lingual systems, including customised and non-customised options. How brackets and wires work together is on our page about fixed braces.
Can people see lingual braces?
BOS describes lingual braces as virtually invisible, because they are attached to the surface of the teeth facing the tongue.
How long does speech take to adapt to lingual braces?
There is no single timeline: studies measured speech in different ways and reported different results.
BOS lists initial difficulty in speaking among the problems that may be encountered with lingual appliances. A 2018 systematic review of 13 studies and 297 patients, covering several appliance types, says most speech impairments could return to normal within weeks, while distortion of the /s/ sound might last more than 3 months. It names lingual fixed appliances among those with an evident influence on speech, reports low evidence grading and urges caution. Labial means braces on the front of the teeth.
| Study | Appliance and sample | Measure | Time points | Result |
|---|---|---|---|---|
| 2013 randomised trial | 17 lingual, 17 labial; moderate upper crowding | Sound analysis of /s/ | Before, immediately after, 1 and 3 months | Significant deterioration. Lingual: every assessment. Labial: immediately after only. Significant group differences at all assessments |
| 2014 prospective study | 12 lingual, 12 labial with a bar across the palate; Kannada speakers | Sound analysis, speech pathologists, laypeople | Before, 24 hours, 1 week, 1 month | Authors' conclusion: comparable at 24 hours, labial recovered within a week, lingual still affected at 1 month, when it ended. Group differences varied by sound and rater |
| 2016 randomised trial | Two lingual brackets, 23 each; Arabic speakers; upper teeth, premolars extracted | Sound analysis of /s/ | Before and after extraction, 24 hours, 1 and 3 months | Smaller bracket: /s/ frequency significantly lower to 1 month, not at 3. Larger: still significantly lower at 3. Groups differed significantly to 1 month, not at 3 |
| 2024 survey | 36 lingual, 41 upper lingual with lower labial, 38 labial; customised | Recalled by questionnaire | Within a year of finishing | Speech difficulty, in that order: 91.67%, 87.8%, 71.05%. Lasting over 3 months: 42.42%, 22.22%, 33% (the paper's base is unclear). Only lingual against labial differed significantly |
A 2002 retrospective survey of 98 patients on lingual appliances reported a speech and function adaptation period of 1 to 3 weeks. In a 1999 retrospective survey of 111 adults, discomfort from tongue soreness, chewing fibrous food, pronouncing s and t sounds and tooth brushing eased with time, yet 20% to 46% felt it until after the braces came off.
The 2016 trial's authors link differences between studies to design, bracket type and language. The 2014 authors put the labial change mainly down to the bar across the palate. These are study results, not a timescale for any one person. If speech difficulty does not settle, tell the team treating your braces.
Do lingual braces hurt or make the tongue sore?
They can: BOS lists tongue soreness among the problems that may be encountered, and one review found more tongue pain with lingual braces.
A 2013 review of six studies, four of medium quality and two low, searched to December 2012, found the likelihood of overall pain similar with lingual and labial braces, with more tongue pain and less cheek and lip pain with lingual. A 2016 review of 11 trials and 407 patients, searched to July 2015, linked lingual braces with more overall oral discomfort and speech impediment, rated the evidence low and called it insufficient for robust recommendations.
A 2022 randomised trial of 38 adults, using one traditional lingual system, found overall quality-of-life impact greater with lingual than labial braces at 1 week and 1 month, not later. Physical pain and functional limitation scores stayed higher with lingual at every assessment after fitting, while psychological disability scores were higher with labial from 1 month. A 2020 study of 120 patients, 30 each on conventional, low-friction and lingual brackets and aligners, found the lowest mean dental pain scores with lingual brackets throughout the first week. Its authors note the groups were not homogeneous in sex or age.
In a 2016 trial of two lingual brackets on the upper teeth only, every patient reported some tongue irritation at 24 hours. At 3 months, all with the smaller bracket and 95.7% with the larger reported none, with no difference between groups. On restricted tongue space at 3 months, 86.9% with the smaller reported none and about half with the larger reported some, not a significant difference. In a 1999 survey of 111 adults, 20% to 46% felt discomfort, which included tongue soreness, until after removal.
As non-urgent advice, NHS guidance says to contact the team treating your braces if your teeth are painful for more than a few days after braces are fitted or adjusted. Tongue soreness that does not settle is also worth raising with them.
Are lingual braces harder to clean?
Sources differ: BOS lists possible cleaning problems; one review indicates no obvious gum health difference from labial braces, on very low to low quality evidence.
A 2016 review of eight articles, searched to October 2014, suggests people wearing lingual appliances have more problems maintaining oral hygiene. A 2022 review of eight studies and 223 patients, searched to June 2022, found a lower plaque index with lingual braces, pooled from three studies, though no follow-up subgroup differed significantly, and no significant difference in bleeding, gum index or pocket depth. It graded the evidence very low, except low for the gum index.
In a 2013 study of 20 patients, 10 per group, plaque scores rose significantly by 4 and 8 weeks with lingual braces and not with labial. Bleeding scores were significantly up at 8 weeks with lingual; with labial they rose at 4 weeks, then fell. Plaque scores did not differ significantly between groups at any point. For cleaning, food and everyday care with braces, browse this section.
Questions about this treatment? Book online or call the practice.
How often do lingual brackets come off?
The two studies here are limited: one reports no comparison group and the other is a laboratory test.
In a 2016 questionnaire study of 33 patients on one lingual system, eight practitioners recorded an average of 2.1 bracket bond failures over two years of treatment, about 1 per patient per year. A 2017 laboratory test on 100 bovine teeth found no significant difference in bond strength between four metal lingual brackets and a labial control, and its authors say this needs confirming in patients. If a brace breaks, NHS guidance gives this as non-urgent advice: contact the team treating your braces.
How long does treatment with lingual braces take?
Two studies differ on whether lingual treatment takes longer than labial, and neither gives a timescale for any one person.
In a 2022 randomised quality-of-life trial of 38 adults aged 18 to 25, with moderate crowding and no extractions, treatment averaged 13.8 months with lingual braces and 14.3 with labial, not a significant difference. In a 2026 study of past records from 200 adults, 100 on digital straightwire lingual braces and 100 labial, half of each with extractions, treatment took longer with lingual than labial and longer with extractions.
Who wears lingual braces?
BOS says they are most often worn by adult private patients who want their teeth straightened but do not want to be seen in braces.
A 1999 survey of 111 adults found deeper bites went with more tongue soreness, tooth pain and difficulty chewing tough food, and larger overjets with more tongue soreness. Authors of a 2014 speech study advise a detailed briefing on possible speech changes, especially for people in speech-intensive jobs such as front desk staff and public speakers.
Wider guidance is on our page about straightening teeth as an adult. Aligners are compared on our page about choosing between fixed braces and aligners.
When should you speak to a dentist about lingual braces?
Tell the team treating you before fitting if a front tooth was ever knocked or damaged, as it may need further treatment, NHS guidance says.
NHS guidance also says to keep having regular dental check-ups while wearing braces. As non-urgent advice, it says to contact the team treating your braces if:
- your teeth are painful for more than a few days after your braces are fitted or adjusted
- you have braces and your gums are very red, swollen or painful
- your braces are broken
Are lingual braces priced on the practice's fee list?
The practice's current fee list does not name lingual braces, and it does not say whether any of its lines covers them.
Does the practice offer lingual braces?
Yes. Fixed metal, ceramic and lingual braces are offered at Deepcar Dental Care, and orthodontic treatment at the practice is for adults only.
See orthodontics at Deepcar Dental Care for the treatments offered.
Frequently asked questions
Are hidden braces the same as lingual braces?
Not in those words. The British Orthodontic Society's FAQs say lingual braces are placed on the back of the teeth, and list ceramic brackets and aligners as other discreet options. If you see hidden braces, it helps to ask which appliance is meant.
Are lingual braces available on the NHS?
NHS guidance does not name lingual braces. Fixed metal braces are commonly used on the NHS. Braces are usually only free on the NHS for people under 18 who have a problem with their teeth. The NHS Business Services Authority says adult NHS orthodontic care is not usually available but may be approved case by case for health reasons.
Do lingual braces mark the teeth less than standard braces?
Less likely, the British Orthodontic Society says. A split-mouth study it cites found white spot lesions developed or progressed 4.8 times more on outer surfaces than inner. A review searched to 2014 found no significant caries difference by bacteria counts. In 630 mostly adolescent patients on two lingual appliances, new decalcification to first molars affected about 22% and 40%.
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