One of the most common “adjuncts” or additional tools that orthodontists use to straighten your teeth are orthodontic elastics or rubber bands. Why are they used? How do they work? How many hours do you need to wear them?
Braces and aligners are both effective ways of aligning your teeth. Braces are devices glued onto the teeth (either on the inside or outside) that move the teeth via forces produced by wires that span from tooth to tooth. Aligners (most commonly Invisalign) move teeth using a series of clear plastic shells that snap over the teeth and produce force by changing the shape of each successive aligner. Either technique can successfully align the upper and lower sets of teeth separately, but both require that something be connected between the arches to correct the bite.
While there are several options for correcting the relationship of the upper and lower sets of teeth (i.e. headgear, springs, functional appliances, surgery, etc.), the most common method is elastics (aka rubber bands(. Elastics are commonly used for several reasons. First, they are not as noticeable as other options (like headgear). They are usually tooth colored so that they blend in with the teeth (although they also come in bright colors that kids love!). Second, they are stretchy and flexible. This allows patients to maintain a full range of motion during talking, yawning, and other normal jaw functions. Third, elastics are easy for patients to remove and replace. This allows fresh rubber bands to be placed daily and facilitates eating and brushing. Fourth, elastics can be used to correct most types of bite problems (overbites, underbites, open bites, and crossbites). Few other devices are as versatile. Finally, elastics are more cost effective than other gadgets available for bite correction.
Although the advantages of rubber bands for bite correction outweigh the disadvantages, there are two issues I want to highlight. First, rubber bands rely 100% on patient cooperation. If they are not worn as prescribed, they will not work. For teeth to move, there must be constant pressure present for most of the day. Although I can’t quote a study that shows exactly how many hours you need to wear them, I will share my personal observations. Patients who take out their elastics only to eat or to brush (i.e. 23 hours per day) see fast, consistent results. Patients who wear them nights only (8 hours per day) rarely see any change at all. That is because any improvements that take place during those hours almost always relapse (or reverse) during the other 16 hours they are not in place. If a patient wears their elastics more than half of the day (12+) hours, they may see some improvement, but it will be much slower than if they are worn fulltime. My instructions to patients are: “Wear your rubber bands fulltime except for when you eat or brush.” Those who follow these guidelines see excellent results. Those who don’t never achieve their best smile.
The other issue with rubber bands is that there are potential side effects. First, rubber bands create force at both ends (equal and opposite reactions). If you want to move your top teeth backwards, rubber bands from the front upper teeth to the back lower ones can achieve this. Like it or not however, the same rubber bands will also move the bottom teeth forward. This can be a problem if you don’t have enough bone to permit the teeth to go that direction. Second, there are undesirable movements created along with the desirable ones. Since the elastics are pulling at an angle, not only do the upper front teeth move back, they also move down (and the lower teeth move up as well as forward). As a result, gummy smiles may be created or get worse and the depth of the bite will be reduced (creating or accentuating an open bite). Understanding and predicting these side effects is another reason why choosing an orthodontist with advanced specialty training is so important. It is possible for a simple orthodontic problem to become very complex if elastics are prescribed in the wrong way.
Orthodontic elastics work great in the right patients. If you are asked to wear them as part of your treatment, keep them in all the time except when you eat or brush. If you notice side effects like the ones I’ve mentioned, please notify your orthodontist right away. Good luck!
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 27 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has over 40,000 readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.