Orthodontic Bands and Your Braces

Orthodontic bands, also known as molar bands, are rings that are fitted around your back teeth when constructing a set of braces. They are used in orthodontics to provide a solid anchor to the archwire that runs along the span of the braces. Not everyone needs them, but those who do should take care to maintain the integrity of the bands so they don't come loose or damage teeth.

Unlike the square-shaped brackets that are cemented to the face of a tooth, orthodontic bands completely encircle the tooth. The bands are traditionally made of stainless steel. Once fitted, the bands are secured into place with a durable, non-toxic cement.

An orthodontic band may have a hook onto which removable elastics or Forsus springs (used to correct an overbite) can be attached. Others will have a tunnel-like sleeve through which the archwire can be strung. As the archwire is gradually shortened, the alignment and spacing between teeth can be corrected.

Indications

Not everyone with braces requires orthodontic bands; some only need brackets and archwires to achieve the desired correction.

Orthodontic bands are primarily indicated for those who require a major correction of their bite and/or tooth alignment. They may also be used if certain appliances are needed that require attachment to the bands. These include people with extremely wide-tooth gaps, severely uneven bites, or who are older and have less malleable bone structure. Depending on the extensiveness of the correction, two or more bands may be needed.

These are often an ideal choice for children whose teeth have not fully grown in yet, as they better isolate teeth. It is also an appropriate option for teeth with large fillings (providing a more stable base than a cemented bracket) or people who require headgear to correct an overbite (offering a more solid connection point).

Pros and Cons

Orthodontic bands increase the risk of periodontal (gum) disease and tooth decay. Because the tooth will be entirely surrounded, any food that gets trapped between the band and tooth can go unrecognized until the damage is done.

While proper daily dental care can help reduce the risk, it does not entirely mitigate it.

Cost

Traditionally speaking, metal braces cost between $2,500 to $7,000. The same pair of ceramic or plastic braces can run anywhere from $4,000 to $8,000. As an alternative, some doctors will recommend metal bands in the back and ceramic brackets in the front, if appropriate.

Other orthodontists may recommend internal lingual braces in which the metal appliances are affixed to the back of the teeth, rather than the front. While aesthetically pleasing, internal braces have an even higher price tag ($8,000 to $10,000, on average). They may also irritate the tongue, affect your speech, and make it harder to clean your teeth.

Installation

Two separate appointments are needed to install an orthodontic band. The aim of the first appointment is to ensure there is enough space around the tooth so that the band can be slipped on comfortably. The aim of the second appointment is to install and cement the orthodontic bands into place.

First Appointment

Before the procedure begins, the orthodontist will make a dental impression and/or create a digital model of your teeth so that the bands can be correctly sized. The dental impression is typically done with impression material and an impression tray in the shape of your upper and lower teeth.

Once the tray is pressed into place, the impression material will be allowed to solidify. The impression will then be used to create a plaster replica of your teeth. A digital model can be obtained by scanning the teeth directly with an intraoral scanner or by scanning the replica made from the dental impression.

After your mouth is rinsed and cleaned, the orthodontist will begin inserting elastic separators between your teeth with a pair of pliers. The procedure doesn't require anesthesia or cause any pain, but it may feel as if a seed is stuck between your teeth. Several separators may be needed depending on how many bands the orthodontist intends to install.

Once the separators are inserted, you will need to avoid flossing, eating sticky foods, or chewing gum for the next week or so. If you experience any pain from the increased pressure between your teeth, you can take an analgesic such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug like Advil (ibuprofen).

Second Appointment

Your second appointment would be scheduled in around a week. Based on your dental impression, the orthodontist will have obtained the correct-sized bands for each tooth.

After the elastic separators are removed, each band will be test-fitted. The band is gently pressed into position and a tool called a "bite stick" is placed over the band. You will be asked to bite down to push the band into place.

Once the orthodontist has ensured that the sizing is correct, the bands will be removed. Your teeth will be polished, and the bands reapplied with dental cement. The bands stay in place until the treatment is complete, in around 12 to 18 months.

Proper Care

One of the more common complaints about orthodontic bands is that they can come loose over time. Because the dental cement is not meant to be permanent, any extreme pressure placed on a molar can cause the cement to crack and break loose. While this won't affect the tooth enamel, it may loosen the band and, with it, the architecture of the braces.

To keep the bands clean and avoid tooth decay, be sure to brush and floss between every meal.

Avoid whitening toothpaste, which can leave dark spots or patches once the brackets and bands are removed. If you want to prevent staining of your ceramic or plastic appliances, the best thing to do is avoid foods like coffee, tea, red wine, and tomato sauce. Rinse your toothbrush thoroughly with every brushing, and change it every month or so for a new one.

A water flosser may be the easiest option as it pushes food particles from between gaps and crevasses in your dental hardware, which may be otherwise hard to get at. Follow up with an antiseptic mouthwash.

You should also gargle with salt water when your braces are first applied and with every adjustment thereafter. This can help reduce the inflammation that typically develops when the tissues are strained.

What to Do If a Band Comes Loose

If you have a loose orthodontic band, the first thing you need to do is call your orthodontist. Unlike a loosened bracket that remains attached to the archwire, a loosened band can slip off entirely and become a choking hazard.

If your orthodontist is unable to see you immediately, try lifting off the band with your fingers or a clean pair of tweezers. You can ask a friend to try as well. Don't be rough with the tooth or use excessive force.

If you can remove the band, place it in a plastic bag and bring it with you when you next see your dentist. If the loose archwire is irritating you, take a sterilized pair of toenail clippers and snip it as close to the adjacent bracket as possible, taking care not to swallow the clipping.

If you can't remove the band and your orthodontist is unable to see you until the next day, consider visiting a walk-in clinic if there is any chance the band will slip off overnight. You can then get the band replaced when possible.