A long time ago, when I first got my braces to correct an overbite, I had four main concerns:
- Could I continue to play the euphonium?
- I wish I could eatTanker?
- Would girls talk to me?
- Could I enter public speaking competitions?
It turned out that the answers were - in order - "yes" (with the help of orthodontic wax), "no" (I found that out the hard way), "no" (although I doubt the central question was the hangers) and happily "Yes".
Braces and speech
Malocclusion – an imperfect position of the teeth when the jaws are closed – can have a major impact on your smile, your well-being and your quality of life (Ata-Ali et al., 2016). As a result, many children and adults get braces to help improve their bite.
Some questions we receive every now and then are:
- Do braces affect speech?
- if so, in what ways?
- If so, how long?
- If so, should we wait with speech therapy?
Do braces affect speech?
A bracket for the first usebe able toinfluence the speech. But not always: one study shows that approximately 57% of people experience some speech problems immediately after wearing a brace (Paley et al., 2016). A significant minority reports no problems.
If so, in what ways?
For those affected, braces do not affect all speech sounds. Research shows that the sounds most often affected are:
/S/
/v/
/R/
/l/
"ch"
/F/
/T/
/N/
"sh"
"J"
This is because the maxillary (upper jaw) and mandibular (lower jaw) arches are directly or indirectly involved in the production of these sounds; and braces change the morphology (shape, shape) of some surfaces (e.g. of the teeth, tongue and lips) used to articulate these sounds (Khattab et al., 2013).
The most commonly affected sounds are /s/ and /t/, and this appears to be the case across languages (Paley et al., 2016).
For example, one study found that after wearing a brace, the average frequency (or pitch) of the /s/ sound drops significantly for many people and then gradually increases over the next two to three months (e.g., Khattab et al. , 2013). . Immediately after receiving braces, many people appear to temporarily produce /s/ with a forward tongue position, or place their tongue tip against their teeth when producing /s/, rather than up, at or near the alveolar ridge.
Bron: Gray's Anatomy, plaat 190.
Not all braces affect speech to the same extent; and there is some evidence that lingual braces (braces on the inside of the teeth, facing the tongue) may cause a greater degree of speech problems and last longer than oral and labial braces (braces on the outside of the teeth, facing the cheeks and lips) (e.g. Ata-Ali et al., 2016; Khattab et al., 2013).
How long do speech problems last?
Most studies show that speech problems are temporary and that most speech problems resolve within 2 to 3 months (Paley et al., 2016; Khattab et al., 2013). Some people seem to adjust to their braces almost immediately.
About 17% of people with braces (buccal/labial braces) continue to experience speech problems after two months, and some people take six to eight months to correct their errors. An interesting question for these 'slow correctors' is whether the resolution of these problems is partly due to the extent and correction of their bite problems. It appears that the ability to correct errors may depend to some extent on the severity of the malocclusion (Paley et al., 2016).
Does it make sense to undergo therapy for speech or other communication problems while wearing a brace?
The evidence tells us that speech problems actually existcausesThe brace usually disappears on its own within a few months and does not require speech therapy.
Nastyresidual speech defectsunrelated to braces (i.e. problems that existed before braces), there is no reason to delay treatment just because you have braces – especially if the errors are phonological in nature – although we usually recommend wait a few monthslisp-therapieand use a lot of auditory bombardment to focus on the sound of the target(s) first.
For language, stuttering, voice, reading or accent training, there is no clinical reason to delay therapy with braces.
Clinical baseline
For people considering braces – especially adults in jobs that require clear speech – it is important to understand the potential effects a brace will have on speech, what types of sound abnormalities they may have, and how long the abnormalities may last. About 40% of people will experience no changes in speech at all. For many people, the effects are relatively minor and transient. For others, it may take a few months or even longer to correct errors. The sound /s/ is most often affected.
Related articles:
- Beyond flashcards and glue sticks: what to do if you or your 9-25 year old are still having trouble with speech sounds
- How to use the principles of motor learning to improve your speaking skills
Main sources:
Ata-Ali, F., Ferrer-Molina, M., Cobo, T., De Carlos, F., Cobo, J. (2016). Adverse effects of lingual and buccal orthodontic techniques: a systematic review and meta-analysis.American Journal of Orthodontie en Dentofacial Othopetics, 149(6), 820.
Khattab, TZ, Farah, H., Al-Sabbagh, R., Hajeer, M.Y., Haj-Hameed, Y. (2013). Speech ability and oral impairment with lingual and labial orthodontic appliances in the first phase of fixed treatment – a randomized controlled trial,Angle orthodontist, 83(3), 519.
Paley, J.S., Cisneros, G.J., Nicolay, F. Olivier, LeBlanc, E.M. (2016). Effects of fixed labial orthodontic appliances on speech sound production,Angle orthodontist, 86(3), 462.
Image: https://tinyurl.com/y3esndcs
Hello, my name is David Kinnane.
Head speech therapist, Banter Speech & Language
Onstalented teamof certified practicing speech-language pathologists provides seamless, personalized and evidence-based speech-language pathology care to children and adults in inner-west Sydney and beyond, both in our clinic and via telehealth.
David Glove
Speech-language teacher. Lawyer. Sheep. Reader. Author. Speaker.
