Braces and aligners have long been framed as tools for straighter smiles, but a new narrative review argues that the timing of orthodontic care may matter for something less visible: the way children learn to speak. Published in Frontiers in Oral Health, the review synthesized 34 articles identified through a PubMed search covering 2017 to 2026, using title-field keywords such as speech disorders, malocclusion, orthodontic, and children. Of 126 records initially screened, 86 were excluded for failing to meet the review objectives and six because their full texts were unavailable. The authors, a team of community medicine, dentistry, and pediatric dentistry researchers from institutions in Nagpur, Jammu, Pune, and Wardha in India, conclude that malocclusion and other dentofacial abnormalities may be associated with alterations in speech production, but they are equally emphatic that the percentage of speech disorders directly attributable to misaligned teeth remains uncertain. Speech development, they stress, is multifactorial and should never be attributed solely to dental alignment.
The review arrives amid a remarkable global rise in orthodontic treatment among children and adolescents, driven largely by increased awareness of dental esthetics, improved dental function, and the perceived benefits of early intervention. A cross-sectional study in Germany found that roughly 26 percent of girls and 21 percent of boys had received orthodontic treatment, with significant increases across all age groups studied. Another study in Southern Italy reported that nearly 20 percent of the pediatric age group expressed a need for orthodontic care. Yet access is far from uniform. Socioeconomic status remains a powerful determinant of who receives treatment, which is why the review’s authors call for public health interventions to promote optimal oral health rather than relying on families to seek out specialist care on their own. The stakes, they argue, extend well beyond appearance, because childhood is precisely when speech development and dental changes unfold simultaneously.
The technical case for a dental-speech interface rests on how sound is physically produced. Teeth act as contact points for the tongue and lips, shaping the clarity of consonants and vowels, so malocclusions such as overbites, crossbites, and open bites can interfere with tongue placement and airflow during articulation. Crowded teeth or a narrow dental arch can restrict tongue motion, producing improper articulation and altered sounds. A well-formed hard palate is essential for proper resonance, while jaw size governs the spatial relationship among tongue, teeth, and lips that speech sounds depend upon. Early loss of primary teeth and persistent oral habits, including thumb-sucking and prolonged pacifier use, can further compromise speech clarity. Dentofacial attributes such as anterior open bite, posterior crossbite, increased overjet, and altered tongue posture are closely interrelated with speech development during childhood, establishing what the authors describe as an important interface between orthodontic and speech-language care.
The empirical evidence assembled in the review supports association, not causation. In a cross-sectional epidemiological study of 547 schoolchildren aged 7 to 13 in Santa Maria, Brazil, children with anterior open bite were 2.36 times more likely to exhibit an altered tongue position, with a 95 percent confidence interval of 1.59 to 3.49, while posterior crossbite was associated with a greater prevalence of speech distortion, at a prevalence ratio of 1.77 with a confidence interval of 1.09 to 2.88. These findings suggest that specific occlusal characteristics, rather than malocclusion as a single entity, may influence tongue posture and speech production. A cross-sectional study of 290 children aged 4 to 7 in Valencia, Spain, identified a statistically significant association between malocclusions, including anterior open bite, edge-to-edge bite, increased overjet, and anterior crossbite, and phonetic changes, with sigmatism and rhotacism frequently observed. Evidence from 105 Swedish children showed malocclusion in 61 percent of participants with speech sound disorders and motor speech involvement, compared with 29 percent of subjects with typical speech development.
Further support comes from a Riyadh study of 100 participants evaluated with the peer assessment rating index, in which increasing malocclusion scores were significantly associated with improper articulation of selected speech sounds, at p values of 0.004, 0.017, and 0.01 for specific sounds. Twenty-seven participants demonstrated improper articulation, although the adult sample limits direct generalization to children. A clinical speech and acoustic investigation in Chapel Hill, North Carolina, found that speech abnormalities were substantially more frequent in patients with skeletal anterior open bite and dentofacial deformity, providing objective perceptual and spectral evidence of speech differences. Taken together, these studies cumulatively support an association between dentofacial morphology and speech production. However, because most available studies are observational and cross-sectional in origin, the review insists they should not be interpreted as showing that malocclusion independently causes speech disorders. Longitudinal research incorporating standardized orthodontic and speech-language assessments is needed to establish temporality and causal links.
The multifactorial nature of speech development is where the review becomes most cautious. Dental alignment represents only one of several anatomical, sensory, neuromotor, developmental, and environmental factors influencing speech production. A 2022 systematic review of 13 studies assessing speech, language, and literacy outcomes in children with mild-to-moderate hearing loss reported poorer performance than hearing peers across multiple speech and language domains, although the review emphasized substantial heterogeneity. A recent clinical cohort study evaluated 198 children with speech sound disorders and 77 age-matched controls, examining 31 medical, developmental, oral-behavioral, and hereditary risk factors, and found that children with speech sound disorders may have multiple coexisting developmental and oral-motor characteristics, justifying comprehensive assessment. Developmental language disorders, oral-motor dysfunction, craniofacial anomalies, neurological conditions, respiratory patterns, and oral habits may all contribute. Evidence linking ankyloglossia, or tongue-tie, directly to speech remains inconsistent and generally low quality, underscoring the need to rule out non-orthodontic contributors before attributing a speech difficulty to malocclusion.
On the treatment side, the review outlines the orthodontic arsenal and its documented speech effects. Fixed appliances treat crowding, spacing, and malocclusion, while functional appliances correct jaw discrepancies, and clear aligners offer esthetic advantages, easier oral hygiene, and dental flexibility. Notably, the appliances themselves can transiently alter speech during adaptation. In a parallel randomized clinical trial of 40 patients with Class I malocclusion and moderate crowding in Londrina, Brazil, clear aligners produced significantly greater early speech alterations than fixed appliances immediately upon placement and at three days, at p less than 0.001, but no objective differences between the groups persisted after 30 days, at p equal to 0.487, or 180 days. This indicates that appliance-related speech changes are predominantly transient and resolve with adaptation. A systematic review of rapid maxillary expansion covering seven interventional studies and nearly 200 patients reported changes in acoustic speech parameters, including vowel fundamental frequency and fricative formant frequencies, though two studies reported deterioration and others documented temporary changes during active treatment followed by improvement after appliance removal.
The review is blunt about what the evidence cannot yet claim: there is inadequate evidence to state a specific percentage of speech improvement or prevention of speech deterioration attributable to orthodontic treatment alone in children with malocclusion, and these findings should not be read as showing that orthodontic treatment by itself improves a pre-existing developmental speech disorder. Changes in the articulation of sibilant sounds and temporary lisping have been reported with clear aligners and other appliances, but future longitudinal studies should report standardized pre-treatment and post-treatment speech outcomes, the proportion of subjects showing clinically meaningful improvement, the share with persistent or worsened speech abnormalities, and the contribution of concurrent speech-language therapy. Such data would help differentiate the effects of orthodontic correction from natural developmental changes and from speech-language interventions. The authors also acknowledge that while early orthodontic assessment may identify dentofacial risk factors before functional problems become established, insufficient evidence exists that orthodontic treatment prevents future speech deterioration, so preventive benefits should be framed as a clinical rationale for early assessment rather than a treatment effect.
From a public health perspective, the review proposes a layered strategy. Awareness campaigns should educate parents on the connection between oral health and speech development and the necessity of early detection, with educational materials created in multiple languages to reach culturally diverse populations. Dental health education and preventive measures belong in preschool and daycare curricula, while school programs can discourage thumb-sucking, pacifier use, and mouth breathing, reducing the possibility of malocclusion and associated speech difficulties. Regular dental and speech assessments in school settings could identify children with malocclusions and speech delays for specialist referral, with children carrying known risk factors such as cleft palate targeted first for early combined assessment. Space maintainers can preserve dental arch relationships, potentially reducing one dentofacial factor that could later contribute to altered oral function. Clinics offering combined orthodontic and speech-language pathology services, specialized training for orthodontists, speech-language pathologists, and primary care providers, and community health workers screening underserved areas round out the delivery model, alongside government-funded or subsidized coverage for low-socioeconomic families, telehealth and mobile apps for education and virtual consultations, and registries to track intervention impact.
The review’s limitations deserve equal attention, because the authors themselves frame them as a research agenda. Most cited literature examining malocclusion and speech derives from cross-sectional observational studies, which can demonstrate coexistence or statistical association but cannot determine the direction of causality. Speech production may also be influenced by age, language, neuromotor development, oral habits, respiratory pattern, craniofacial morphology, and previous speech-language intervention. Heterogeneity in malocclusion classification, speech-assessment methods, languages studied, and outcome measures prevents direct comparison across studies, and the review calls for urgent longitudinal and controlled interventional research using standardized orthodontic and speech-language outcomes. Its bottom line is a call for timely implementation of combined orthodontic and speech-language pathologist services to improve both functional and esthetic outcomes, treating the developing mouth and the developing voice as a single clinical conversation rather than two separate specialties.
Subject of Research: Strengthening speech development through timely delivery of orthodontic care: a narrative review
Article Title: Strengthening speech development through timely delivery of orthodontic care: a narrative review
Article References: Shrivastava, S. R., Bobhate, P. S., Borkar, S., Petkar, P. B., Siddique, A., & Fulzele, P. (2026). Strengthening speech development through timely delivery of orthodontic care: a narrative review. Frontiers in Oral Health, 7, Article 1938356. https://doi.org/10.3389/froh.2026.1938356
Image Credits: AI Generated
DOI: 10.3389/froh.2026.1938356
Keywords: Strengthening, speech, development, timely, delivery, orthodontic, care, narrative, review, scientific research
News Source: Ophelia Keating. (October 26, 2026). Timely Orthodontic Care May Support Speech Development in Children, Review Finds. Scienmag.
