Gap bands and other DIY trends from TikTok

Quick answer: A gap band is an elastic band placed around the two front teeth to close a gap. Do not do this. The band squeezes day and night without anyone monitoring the force or the direction, and it can slip under the gum towards the root. The dental literature describes children who lost their front teeth this way.

Most parents hear about this from their child, or they suddenly see an elastic band around the two front teeth. On social media, TikTok among them, the gap band is shared as a free alternative to braces.

What such a video does not show is what happens beneath the gumline. That is what this article is about, written from our orthodontic practice in central Amsterdam. Further on, we also briefly look at a few other do-it-yourself trends.

A gap band is an ordinary elastic band, usually a hair elastic, that is placed around two front teeth to close the gap between them. In dental terms, that gap is called a diastema. The thinking behind it is not strange, because braces also move teeth using force. The difference lies in where that force is applied and whether anyone is keeping an eye on it.

There are two differences, and the second is the dangerous one.

The force acts only on the crown. An elastic band sits around the wide, visible part of the teeth and tilts the crowns towards each other, while the roots move the other way. In orthodontic treatment, the force is chosen precisely so that the tooth moves along root and all.

Nothing keeps the band in place. A tooth is not a cylinder, but becomes narrower towards the root. A tight elastic band therefore naturally seeks out the narrowest point, and that lies further down, below the gumline. From that moment on it can no longer be seen, while it keeps on squeezing.

Around the root lie the jawbone and the fibres that hold the tooth in place, together known as the supporting tissue. An elastic band that ends up there slowly works its way through it: the gum becomes inflamed, the bone disappears and the tooth becomes looser. Because it cannot be seen and usually does not hurt, it is noticed late.

This is not a theoretical risk. Dental journals contain case reports of patients for whom things went wrong.

• An eleven-year-old girl put an elastic band from a doll's hair around her two upper front teeth. It sank below the gum. After two months, both front teeth still had to be extracted (Alves et al., Case Reports in Dentistry, 2015).
• A nine-year-old boy developed acute inflammation around his upper front teeth after an elastic band had migrated towards the root tip. Here too, the teeth could not be saved (Konstantonis et al., American Journal of Orthodontics and Dentofacial Orthopedics, 2018).
• A sixteen-year-old girl had used the bands for about three months. The bone around two teeth had disappeared all the way down to the root tip. She kept her teeth, but that took surgery and years of follow-up (Xie et al., Clinical Case Reports, 2023).

What those reports do not tell you is how often this happens. There is no reliable figure. There are individual cases, plus a consumer warning that the American Association of Orthodontists published in its journal in 2014. For weighing up the decision, that makes little difference: this is a risk you do not need to take.

The gap band is not alone. Here are three others we come across, briefly and without instructions.

Filing your own teeth. Reshaping teeth with a file or something abrasive to make them more even. Enamel is the hardest tissue in your body, but it does not grow back. What is gone stays gone, and underneath lies dentine: softer, more sensitive and more prone to discolouration.

Gluing your own teeth. Reattaching a broken piece of tooth, a veneer or a loose crown with household glue. That glue does not belong in the mouth, does not seal out bacteria and makes a proper repair more difficult afterwards. Anything that has come loose is exactly something to have looked at quickly, see what to do in an emergency.

Ordering aligners without screening. Clear aligners sent by post based on photos or an at-home impression. Without a clinical examination and X-rays, nobody sees whether something else needs attention first: inflammation, a cavity, a tooth that has not yet come through. More on this in aligners without an orthodontist.

What these three have in common with the gap band: the visible result is imitated without anyone looking at what lies underneath. And a nuance about the platform straight away: TikTok is just as much a source of sound information from dentists and orthodontists. It is where these trends are found, not their cause.

First, something reassuring. In children in the mixed dentition (the stage when baby teeth are being replaced by adult teeth), a gap between the front teeth is very common, and it usually closes by itself once the canines come through (Kumar et al., International Journal of Clinical Pediatric Dentistry, 2011). If it stays once the permanent teeth are in, there is a reason behind it: a low-attached lip frenum (the small band of tissue between the upper lip and the gum), a small or missing lateral incisor, an extra tooth, or a habit such as thumb sucking or tongue thrusting.

Closing it is then usually very possible. In a controlled way means three things in practice.

1. First find out why the gap is there. If there is an extra tooth in between, or one is actually missing, squeezing the gap shut solves nothing and the space comes back. This becomes clear from an examination of the teeth, jaw and bite.
2. The right force in the right place. The force acts on a fixed point on the tooth, so that crown and root move together. With aligners, the plastic does this through the entire shape of the tooth. Which route suits you differs from mouth to mouth: see types of braces for correcting teeth, fixed braces, invisible braces and Invisalign aligners.
3. Keeping an eye on things while it happens. At every check-up the gums are examined, and X-rays are used to look at the bone and the roots. Regular braces treatment has downsides too, and they are set out honestly on risks and inconveniences. The difference is that they are spotted and adjusted for. That is exactly what is missing with an elastic band.

And a closed gap wants to reopen, so a retainer is part of it after treatment, even for a small correction.

1. Calmly ask how long it has been there. Children often do not mention this of their own accord. Getting angry only means you will hear about it later next time.
2. If the band is still fully visible around the crowns, it can come off straight away.
3. If you can no longer see the band, do not pull or pick at it yourself. If it has sunk below the gumline, it cannot be removed from there without causing damage. Have it assessed.
4. Red, swollen or bleeding gums around the front teeth, or a tooth that feels loose, are a reason not to wait and see. Call your own dentist or orthodontist, or see our emergencies page.
5. Explain what happened. Without that story, a practitioner sees inflammation with no explanation.

And then the most important point, because this article is about what can go wrong and that makes for worrying reading: getting there quickly really makes a difference. In the published cases where the band was found and removed in time, the supporting tissue often recovered largely or even completely. The cases that ended badly are precisely those in which the band went unnoticed for months. If you see it today, today is the right moment. No need to panic, but do act that same week.

Our practice is in Amsterdam, within walking distance of Museumplein, and treats children, teenagers and adults. Lotte Meereboer is a dentist specialising in orthodontics (Drs. MSc Orthodontics) and the face of the practice. See our clinic at Museumplein.

• We do not judge. If you have tried something you found online, you will not have that held against you here. We look at what is there and what is still possible.
• We first find out why a gap is there, before we close it.
• A no-obligation consultation commits you to nothing. Not sure whether your child is ready for a first assessment? Read when should my child see an orthodontist.

Is a gap band really dangerous, or is it not that bad?

The risk is not in the force itself, but in where the band ends up. It can slip below the gumline and damage the supporting tissue there. In published cases, front teeth have been lost this way. How often that happens is not known.

My child has already taken the band off. Do I still need to do anything?

If it was only there briefly and the gums look normal, a check at the next scheduled appointment is enough. If the gums are red, swollen or bleeding, or a tooth feels loose, have it looked at.

Does a gap between the front teeth close by itself?

In children in the mixed dentition it often does, usually once the canines come through. If the permanent teeth are in and the gap remains, there is generally a cause behind it. That cause also determines whether closing it will last.

Can you close a gap without visible braces?

Often, yes. Aligners and braces on the inside of the teeth are barely noticeable. What suits you depends on the cause of the gap and on your bite.

Is there a gap in your teeth, or your child's, that you would like to close? Book a no-obligation consultation at our practice in central Amsterdam.