Title	Lingual Appliances Are Associated with an Increase in Oral Discomfort and Eating Difficulties
Clinical Question	In patients undergoing treatment with fixed orthodontic appliances, are lingual appliances associated with more adverse effects than conventional labial appliances?
Clinical Bottom Line	The orthodontic lingual appliances are associated with more oral discomfort than traditional appliances. Also, they cause difficulties in eating and tongue movement. If a patient is considering lingual appliances for esthetic reasons, they need to be aware of the oral discomfort to make a well-informed decision.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26916846 Papageorgiou/2016 13 articles/407 patients Systemic review and meta analysis Key results The included studies were parallel or split-mouth randomized and non-randomized prospective controlled trials. This article shows that lingual appliances are associated with an increase in overall oral discomfort as opposed to traditional or labial appliances. The article reports a standard mean difference (SMD) of 0.78 with a 95% confidence interval (CI) of 0.17 - 1.38. Also, lingual appliances were associated with an increase in eating difficulty with a SMD of 5.35, 95% CI, 0.97 - 29.50.
Evidence Search	("tongue"[MeSH Terms] OR "tongue"[All Fields] OR "lingual"[All Fields]) AND ("lip"[MeSH Terms] OR "lip"[All Fields] OR "labial"[All Fields]) AND ("orthodontic appliances"[MeSH Terms] OR ("orthodontic"[All Fields] AND "appliances"[All Fields]) OR "orthodontic appliances"[All Fields]) AND ("therapeutics"[MeSH Terms] OR "therapeutics"[All Fields] OR "therapeutic"[All Fields])
Comments on The Evidence	Validity: the study included randomized and non-randomized clinical trials. The Cochrane tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assesse the risk of bias within and across studies. However, the study mentions that there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances in terms of their therapeutic and adverse effect, as the quality of evidence was low. Also, the risk of selection bias and detection bias (blinding of outcome assessment) is said to be high. There was no limitation concerning language and publication year. The identified titles were screened by two authors and a subsequence duplicate independent check against eligibility criteria was done by a third author which makes this paper more valuable There was no actual or perceived financial or other conflict of interest regarding this study.
Applicability	For a younger group of patient in need of orthodontic appliances, labial appliances offer the benefit of less complications in terms of oral discomfort and eating difficulty. However, older adults, who are more concerned about the aesthetic aspect of the orthodontic appliances, might prefer lingual appliances, but they need to be warned about oral discomfort and eating difficulties associated with lingual appliances.
Specialty	(Orthodontics) (Pediatric Dentistry) (Periodontics)
Keywords	Fixed appliances, labial appliances, lingual appliances, orthodontics
ID#	3239
Date of submission	04/27/2017
E-mail	mostafavi@livemail.uthscsa.edu
Author	Delaram Mostafavi
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Peter Gakunga, BDS, MS, PhD
Faculty mentor e-mail	Gakunga@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available