Brace Yourself for DIY Orthodontia

Richard Gawel


Do-it-yourself braces. Really. People are wearing orthodontia that they made themselves. No, they aren’t trained clinicians. They’re mostly teenagers who have seen videos of other kids doing it online, so they decided they could do it themselves too. And it’s not just a few people, either.

One popular YouTube video explaining how elastic bands could be used to move teeth has more than 830,000 views. Another one showing dental floss being used to tie teeth together has more than 780,000 views. A couple of videos explain how to remove your braces on your own using needle-nose pliers. And, quite a few clips show kids making “fake braces” for costume purposes or even just to be trendy.

(No, we aren’t linking to these videos. That would only encourage them.)

The detrimental consequences are obvious. Indeed, many commenters on these videos berate the posters and beg them to see a real orthodontist instead. But with an audience of hundreds of thousands, it’s difficult to say that their good advice is having any effect. So, we spoke with Dr. Juan Rendon, DDS, MSD, of Jefferson Dental Clinics to get a clinician’s view of this troubling fad.

Q: What is driving this trend of people making their own braces?

A: People are looking for aesthetics. They want to correct features that they consider unattractive, especially on their anterior teeth. There may be some kind of financial hardship and they cannot afford treatment. So, they do not want to reach out to the orthodontist. This also plays an important role for teenagers. Social media and the Internet are used to find the answers to their questions. They find media showing that there is an easy way to go themselves and might have a successful outcome.

Q: So social media is a major factor?

A: Yes, because they can look it up, and they’ll find instructions on how to do it. Normally the users show the good results, but they’re never going to show the bad results because they are going to be embarrassed, showing that something that they did was bad or caused some kind of damage.

Q: Is there anybody out there who got it right?

A: I’m not going to say it’s right. The space was bothering them, and somehow the space was diminished, made smaller. That might be considered successful, even though the tooth movement was not done properly, and the final root position and crown position is not adequate.

Q: What are some of the common “techniques” that these do-it-yourselfers are using on their teeth?

A: The most common technique is the use of rubber bands to close the spaces between their anterior teeth. They can use rubber bands from hairbands or they can even purchase orthodontists’ rubber bands online. The rubber band is stretched out around 2 or 4 teeth, and it will recover its original size, and the teeth will move together. That’s basically how they do it. They try to wrap the rubber band around the teeth and they’ll wait for the effect of getting them all together.

Q: What kinds of problems result from do-it-yourself braces?

A: Due to their elasticity, elastic rubber bands have a tendency to move toward the narrower portion of the tooth, to the gingival portion. This occurs because there is not an attachment mechanism to hold the rubber band in place, so the rubber band will be free to move around on its own. If undetected, the rubber band will initiate a foreign body reaction that can create aggressive, presumptive bone loss. Patients usually experience a painful sensation and inflammation at the interdental area. The rubber bands are not detected by x-rays. They are radiolucent, so locating them is more difficult. Other risks can include an allergic reaction to latex.

Q: So the rubber band can become so embedded that if these people go to their dentist, their dentist or hygienist might not spot it right away?

A: Sometimes they can’t even see it. These patients don’t tell the hygienist or the dentist that they have been using the rubber bands.

Q: How long does it take for some of these problems to manifest once patients have put on their own braces?

A: Once they put on the rubber bands, they’re going to have a lot of pressure. In a couple of hours, there will probably be pain, but it’s going to start to dissipate. The shape of the teeth determines how soon the rubber band is going to start going into the gingival portion. If the rubber band is left in contact with the soft tissues, the damages will continue to exacerbate. The longer they are there, the more and more damage they are going to cause.

Q: In some of these videos, it looks like the teeth have moved into place. Are they shifting, or is this an illusion?

A: As a result of the pressure created by the rubber band, the teeth will get together as they tilt toward each other. That’s not an ideal tooth movement. We want to have a controlled movement of the teeth, where there is no tipping or tilting. The roots should appear to be parallel to each other. When the rubber band slips into the gingival sulcus, it acts as a foreign body, resulting in an inflammatory reaction affecting the soft tissues and bone, thereby destroying the periodontal attachments. Basically, it’s an induced periodontal disease.

Q: What happens to the teeth once the self-made orthodontia is removed?

A: Any dental movement without proper retention will tend to relax. The problem occurs when the rubber band is inside the gums. It is going to create bone destruction. Severe bone loss is also going to change the prognosis of the teeth. They might be really mobile. Construction might be needed at that time.

Q: So the patient runs the risk of losing the teeth.

A: Yes. When the rubber band embeds into the gingival tissue, the teeth will undergo severe periodontal damage. The teeth can get mobile and extrude. The rubber band will continue its displacement along the root, damaging all the supporting structures. The teeth may eventually become loose and have to be removed.

Q: If a patient shows up at an orthodontist with these problems, what kinds of solutions will be required to fix them?

A: It depends on how bad the damage is. The rubber band could be treated by a combination of periodontal surgery and orthodontics. Moving the teeth when you have the periodontal support compromised is more difficult. Dentition eventually is going to have severe mobility and extrusion of the teeth. If the patient confirms that he or she has used rubber bands, and exploratory surgery by the periodontist may be indicated, you get cases where extraction of the affected teeth is recommended. The patient then may need orthodontic training to obtain adequate space for dental implants or restorative treatment.

Q: It sounds much more complicated than an otherwise healthy patient going in for a standard set of braces.

A: Yes, because they’re going to have to use all the specialties to first get the patient healthy and all the inflammation removed, and then you can proceed to determine if it’s a tooth you can save. Once it has healed, you can proceed with orthodontics and start moving the tooth to the normal position. But it’s going to be different, because the amount of bone support is different than a tooth that has all the bone surrounding the roots.

Q: Even if the situation is treated, could there still be long-term and permanent effects?

A: Yes, because if the rubber bands are given enough time to damage the periodontal tissue around the teeth, it’s going to change how the gums look. The prognosis is virtually decided by the separation of the dentition. In many cases, it’s going to influence the healing.

Q: What can the dental community do to put a stop to this trend?

A: We need to communicate with our community and our patients. They need to understand that when they do some kind of treatment on their own, there are side effects and risks that they cannot control. When trained personnel like orthodontists perform the treatment, the risks are minimized, and long-term stability is improved. Patients need to be more analytic of all the information they can get, especially if the procedures will change or affect their own body.

Dr. Juan Rendon completed his DDS degree at CES University (Medellin, Colombia) in 1989. He then continued his studies at the same university and completed his master’s degree in pediatric dentistry and interceptive orthodontics in 1995. He practiced and taught in Colombia until 2001 and then moved to the United States, where he received another master’s degree in orthodontics from Saint Louis University (Saint Louis, Mo) in 2004. During his residency in St. Louis, he also completed a one-year fellowship in the cleft palate and craniofacial anomalies program at the Cardinal Glennon Children’s Hospital. For the last 11 years, he has worked in the Dallas-Fort Worth area for large orthodontic groups and currently works as the orthodontic director for Jefferson Dental Clinics. He also has his private practice, Rendon Orthodontics, in Allen, Tex.