Elastics

[18daystobrace]

Got braces last month. Next week will be the official first tightening and elastics put on first time. So far I do not see my teeth moving significantly.

How much more movement do I expect after elastics put on.

[Zoso]

Impossible to predict - we're all different. Not to mention that there are a plethora of different elastics configurations (depending what the orthodontist is trying to achieve) and also different sizes and weights ("strengths") of elastics.

[Sunny]

18 ask your ortho what you can look forward to while wearing elastics. Hopefully you'll then see the changes that they're being added for.

You've not had your braces on for long, so maybe your teeth are still in the 'getting ready' to move phase and your progress will be more obvious soon.

Hope your first adjustment is good one and your ortho is happy with the how your teeth are looking.

[Zoso]

As the forces from the archwire are transferred via the brackets to the roots of the teeth, the periodontal ligament (the tissue that attaches the root to the bony socket) is compressed, and special cells called osteoclasts will break down the bone to relieve this compression. On the other side of the tooth the PDL will be stretched, and cells called osteoblasts will generate new bone as a result. The osteoclast (breakdown) process takes about 72 hours to get fully underway, whereas the osteoblast (rebuilding) process takes about 90 days. This is why teeth often feel a little bit wobbly during orthodontic treatment!

Understanding this, I don't think that a month or more into treatment someone's teeth would be "getting ready to move" Remember though that tooth movement is generally a slow and steady process, and it's usually impossible to see changes from one day to the next. Often it can be weeks before the cumulative change is enough for you to see the difference, and then only if you can look back and compare to your starting point - which is why it is a nice thing to do for yourself to take pictures at regular intervals, so that you can look back and actually see the progress. Most commonly the first changes people will "see" are not visible ones, but things like noticing it has become easier (or sometimes hard, depending what's going on) to floss between particular teeth, or perhaps where teeth were crossed in front of one-another, a stain becomes visible where it was previously impossible to clean properly.

Please don't be discouraged if there is not too much visible progress right away - you'll get there in the end.

[18daystobrace]

My ortho said will take two months to untwist the one tooth and also fix molar to be more inward. This is hard to believe it will take only two months.

Can feel the PRESSURE!! Got wire replaced on both top and bottom. Got chained elastics on lower jaw. Got a hook put on inner side of molar (anyone has this done?seems like a an orthordox technique) - on upper jaw, elastics hook on upper and lower molar.

[Sunny]

Sounds good 18!

We put hooks on the 'inside' surface of a tooth for elastics, if the tooth is inward facing and/or in the crossbite position. This seems to be common practise and works successfully.

Good luck with your progress!

[Mikelaw84]

My ortho schedules appointments around 6-7 weeks apart. At my last visit I started with elastics and they gave me two bags and said they would last me until my next visit. Well I am about 4 weeks away and Ive gone through 3/4 of my supply, my question is how often SHOULD I be changing them? I have been at least 2-3 times a day, but since my supply is this low already I am assuming thats too much. Not a big deal I can get more whenever I need them.

[Sunny]

Mike this is a question for your ortho.

I've been told to change my elastics once a day, and when I was wearing an elastic on my left side, which had over-corrected, I was given a bigger size and told to change it only when it broke, which was about every three or more days.

Good luck with your elastics!

[eatyourpeas]

Mike this is a question for your ortho.

I've been told to change my elastics once a day, and when I was wearing an elastic on my left side, which had over-corrected, I was given a bigger size and told to change it only when it broke, which was about every three or more days.

Good luck with your elastics!

What is suggested of the patients where you work, Sunny??? Surely you have some idea of those directives in addition to your own.

I changed mine (as directed) after every meal, every morning and whenever one broke. Basically about 4 per day for each side.

[18daystobrace]

I find the cylindrical hook on the inside surface of the molar is interfering with eating , my tongue is getting poke. Placing wax takes away 100% of discomfort but when eating the wax comes off.

Is there a product out there to help cover the pointy cylindrical hook?

[Sunny]

Eatyourpeas the instructions vary, but mostly I've heard - change them once a day and change twice a day (morning and night).

18 keep using wax and puttng more on when you're eating. If you find your tongue is not coping after a few weeks, you could check with your ortho, to see if the hook can be pressed closer to the tooth.

[Zoso]

How strange. Because amongst all the people I've talked to on this topic, by far the most common prescription is to change them after every meal, and at your bedtime brushing.

[18daystobrace]

My ortho told me to replace my elastics with a new one only once a day. I guess saving a few $ for him / customer based on time performance / end quality result.

A 6 week elastic supply is moderately expensive, cost about $30-40 if you replace it once a day or about 25-30 days of coffee expense!

The Orthodontic Store

I am going to ask my ortho for an extra bag per visit after seven months of treatment so I can change them twice a day. I thick the begin treatment phase does not require as much strength so I will wait until seven months or around that time frame feel tooth movement is slower.

[Sunny]

18 I can assure you it's not about saving dollars for orthodontist's. Elastics are purchased in bulk and cost very little when bough using a trade account. For example we purchase in 100's of bags of each size, and the price is under $1 per bag.

Most of our patients are instructed to change elastics once a day, as they work sufficiently for this period of time. I have seen a couple of patients using the tiny elastics, that are required to stretch further for long periods of time, being instructed to put new elastics in at night and the morning.

It's important to follow your orthodontist's instructions, as if the elastics 'over correct', then it takes longer to fix the mistake.

thick the begin treatment phase does not require as much strength so I will wait until seven months or around that time frame feel tooth movement is slower.

Most ortho's achieve more movement, by using smaller elastics, rather than the need to change elastics more frequently.

Talk to your ortho and if you feel this person is ripping you off, you're best to change to someone you feel you can trust.

[Zoso]

If the ortho intends the force applied by the elastics to be that indicated by the advertised strength and diameter of the elastic, then more frequent than daily, or even twice daily changes would be necessary, due to the marked loss in elasticity that occurs during the first few hours in the mouth.

[Sunny]

Your throughts are interesting ... but the people I work for don't agree and neither do the suppliers of orthodontic elastics request this to be done.

The movement that is required by using elastic bands includes many things, and orthodontist's must decide what is best to achieve the movement needed, for the best health of the teeth and gums. I wear elastics for one day on one side and until the break on the other. The side that I change when they break, often two or three days after having put the elastic on, is still in one piece and still has stretch.

Maybe the guys I work for, purchase superior products, but when I was researching orthodontic suppliers for them, most of the information provided was identical, so it didn't indicate much difference in quality or price of the products.

[Zoso]

My thoughts are "interesting"? Your post is patronising.

The suppliers of orthodontic elastics just make products to a certain specification and sell them to the docs (it's up to the orthodontists to decide how they are used) so it's moot what the suppliers do or do not think. Of course, I'm sure they'd love for all orthos to have all patients change elastics more frequently, but they can't do much about that. (After all, if they produced a product that required changing more often, docs would just choose another supplier ) And in that one respect I do agree with your post: scientific studies have suggested that the behaviour of elastics over time is pretty much invarient from one brand to another, at least between the brands I've seen compared in the studies I've looked at.

Now, whilst the ortho you see may request only daily changes, that is far from being the rule across the entire profession. (And your own prescription seems rather unusual) You may be a dental assistant, but passing instruments to the ortho doesn't make you an authority (in fact in certain cases your comments have proven you to be very much mistaken in some of your beliefs/understandings) and it's evident from the fact that numerous orthodontists request elastics be changed FOUR times per day (after meals and before bed) that you are mistaken if you do hold any belief that doing so is in any way inappropriate to tooth movement or to the health of the roots. Your implication that I don't understand how elastics work in orthodontia, or that the forces applied have an impact not only on movement but also on the overall dental health was extremely patronising, and entirely mistaken.

Actually, Sunny, I start to suspect that perhaps I might have a better grasp of much of the science behind orthodontia than do you. (And I am quite certain I know more about orthognathic surgery.) Yes, your rubber bands are still "stretchy" when they come out. But they will, with an absolute certainty, not be able to exert the same force that they did when they were initially placed. The rubber will inevitably be altered by the environment in vivo, and that will equally inevitably impact its elasticity. (If, as is common in many configurations, the elastics are from one arch to the other then the loss of force is exacerbated by the additional cycling of how much the elastics are stretched as the mouth is opened and closed.) Of course, one of the studies I've seen does suggest that different strengths of elastics behave differently with respect to loss of elasticity over time in vivo, with heavier elastics tending to fare significantly better over time - though the authors did not investigate or explain why, my theory (and this comment alone should be taken as nothing but the musing of an educated comsumer) is that this is simply because heavier elastics have a greater surface area/volume ratio (so less change due to environment); this particular study did not compare static vs. cycled elastics.

Now, maybe your orthodontist's intent is that for the majority of the time they are in play the elastics should be working at a significantly reduced force, in which case leaving them in place longer would be the way to achieve exactly that, particularly as the loss in force does tail off markedly as time increases. (And I am in no way trying to imply that this is not a valid approach - after all, unlike you or I, this decision is made by someone with an advanced dental degree) But the science and logic of my statement above holds: if the elastic is to be expected to exert anywhere close to the forces "advertised" - the ones indicated by the weight or force written on the packet - then they must be replaced more frequently, because a significant percentage of the initial force is lost within the first couple of hours in vivo. Of course, the trained orthodontist understands this, and plans accordingly. It's just that there's not just one correct strategem - the daily or twice daily plan that you cite - and changing elastics more frequently is equally valid.

If you'd like to educate yourself more about the loss of force in orthodontic elastics in vivo, I'd suggest you check out the paper by Hixon et al in J.C.O., Vol. 57, No. 5, p. 481., and that by Kersey et al in The Angle Orthodontist, Vol. 73, No. 2, p. 181.

[Zoso]

Oh, one point to add: the loss of force over time in vivo is markedly different for non-latex "elastics" than for the more commonly used latex elastics. Whilst the force loss in the latter tails to near zero after a few hours, it continues significantly, albeit at a reduced rate, for non-latex elastics. Of course, I am sure that any ortho who needs to employ these elastics (due to a patient's allergy to latex) will adjust the instructions for changing elastics accordingly.

Anecdotally, I have also heard that the non-latex elastic are also more prone to breakage.

[18daystobrace]

Sunny thanks for good advice, never thought about over correction and longer treatment as a result. Today I ate one elastic while having a big meal for the first time. Should have taken it out.

My questions is how bad are the elastic to your health and how long does it take to flush out of the system. Thanks.

I notice the elastics loss alot of force after I eat with it on, next time will take it out.

[Sunny]

18 as part of my treatment, I have to leave my elastics in when I eat, as chewing helps with the movement I need. I've eaten quite a few elastics (I've been wearing them for two years), and during the first few months, I asked my ortho the question about side affects from swallowing them. He said to his knowledge there were none, and we've also had a vegetarian patient check if elastics were animal product free, and they were.

Check with your ortho, to hear what he thinks. Also ask if you can eat with them out, as although I'm used to wearing mine at least 23 hours a day, I'm sure it must be nice to take them out to eat.

Good luck with your elastics do the exact job your ortho is wanting them to do!

[Zoso]

My OMS had me keep the elastics in place even whilst eating. My orthodontist, on the other hand, is one who advocates removing them when you eat (and placing new ones afterwards ). So once I was released from my OMS back into my OD's treatment, I went from keeping them in place to removing them for meals. But during my time eating with them in place, I had a good number of them snap, and one or two "mysteriously" vanished, undoubtedly swallowed with the food. No harm came of it, nor would I have expected it to, as they are tiny and not toxic. (Of course, I don't actually recommend going out and eating a couple of bags-full at a single sitting ) I'm afraid I can't tell you how long it took for them to pass through my system - I didn't really feel inclined to check on that