Doubling up on orthodontic rubber bands, or elastics, is often considered by patients hoping to accelerate treatment. However, patients should never apply more elastics than prescribed without explicit instruction from their orthodontist. The forces used in tooth movement are carefully calculated, and self-modifying the treatment plan can lead to severe biological complications and actually slow down progress. Safely moving teeth through bone requires a delicate biological balance that must be respected.
The Purpose of Orthodontic Elastics
Orthodontic elastics are small, specialized rubber bands that apply precise, controlled forces to the teeth and jaws. They work alongside brackets and wires to correct the bite, or how the upper and lower teeth fit together. The orthodontist selects a specific elastic size and strength to deliver a light, continuous force, measured in ounces or grams, designed for a specific vector of movement.
This process relies on stimulating bone remodeling through constant, gentle pressure. When pressure is applied, the periodontal ligament (PDL) surrounding the root experiences compression and tension. Osteoclasts break down bone on the compression side, while osteoblasts build new bone on the tension side, allowing the tooth to migrate. Inconsistent wear or incorrect force application disrupts this biological cycle.
Risks Associated with Excessive Force
Applying excessive force, such as by doubling up on elastics, is counterproductive because it overwhelms the biological system. The ideal orthodontic force is light enough to compress the blood vessels in the periodontal ligament without completely cutting off the blood supply. Doubling the force magnitude can completely occlude these blood vessels on the pressure side.
This lack of blood flow leads to hyalinization, the death of cells and the formation of necrotic tissue in the periodontal ligament. When hyalinization occurs, tooth movement temporarily stops because osteoclasts cannot access the compressed bone surface directly. Movement can only resume through undermining resorption, a slow and unpredictable process where the body recruits osteoclasts from the adjacent bone marrow to remove the dead tissue.
This uncontrolled force also increases the risk of irreversible damage to the tooth root, known as external apical root resorption. Root resorption causes the shortening and blunting of the tooth roots, compromising their long-term stability and health. Extreme pressure can cause unintended side effects, such as tipping the teeth or extruding them beyond the planned movement. The result is often stalled treatment, increased pain, and permanent damage.
Strategies for Improving Treatment Compliance
Since increasing the force is unsafe, the most effective way to improve treatment time is through strict adherence to the orthodontist’s instructions. Most elastics are prescribed for near full-time wear, often 20 to 22 hours per day, only being removed for eating and brushing. Consistent daily wear is far more effective than trying to compensate with intermittent, excessive force.
Elastics should also be replaced at least once or twice daily, as instructed. This is because the material degrades and quickly loses its calibrated force magnitude in the moist, warm environment of the mouth. If a patient is concerned about a lack of perceived progress, the best approach is to schedule a conversation with the orthodontist. They can evaluate the movement, confirm the current treatment plan, and provide necessary adjustments, ensuring the process remains safe and effective.