Orthodontic Headgear: Types & When Treatment is Necessary
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What Is Headgear Used For?
Headgear is an orthodontic appliance that treats a variety of different bite problems associated with irregular jaw positioning. The appliance attaches to a patient’s face or head with a neck strap.
The most common age group that uses headgear are children 9 years of age and older.
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During this stage of life, a child’s jaw and bones are growing rapidly. Headgear works by repositioning jaw abnormalities early on and helps prevent the need for jaw surgery later in life.
Why is Headgear Used With Braces?
Orthodontic headgear can only be used in combination with braces. Braces only correct teeth positioning, while headgear is capable of influencing the growth of the jaws. Although, if a patient does not have severe bite problems, wearing headgear during the duration of braces treatment is usually not necessary.
Types of Headgear & Conditions They Fix
Headgear is typically necessary when a patient has an overbite, underbite, overjet, crossbite, or open bite. The kind of headgear needed also depends on the type of malocclusion the patient has.
Common appliances include cervical pull headgear, reverse pull headgear, and high pull headgear:
Cervical Pull Headgear
Class II malocclusions (overbites and overjets) require cervical pull headgear:
Overbite
Cervical pull headgear is used to treat “overbites,” which is when the upper front teeth overlap the lower front teeth. An overbite is a class II malocclusion (teeth misalignment) and cannot be treated with braces alone. The appliance holds a patient’s upper teeth and jaw in place while the lower jaw shifts forward.
Overjet
This type of malocclusion is also referred to as “upper front teeth protrusion” or “buck teeth” and is when the upper front teeth severely protrude outwards over the lower front teeth. Similar to overbites, cervical headgear is commonly used to treat a severe overjet of the upper front teeth.
Reverse-Pull Headgear (Facemask or Facebow)
Reverse pull headgear consists of pads that attach to the forehead and chin with a facemask frame in between.
Patients connect rubber bands from the anchorage device on the braces to the frame.
Class III malocclusions (underbites and crossbites) may require reverse pull headgear:
Underbite
Reverse pull headgear is used to treat “underbites,” which is when the bottom front teeth protrude in front of the top front teeth. An underbite is a class III malocclusion and cannot be treated with braces alone. The appliance helps to shift the upper jaw forward, which aligns the upper and lower jaws over time. Using headgear to correct an underbite at a young age can eliminate the need for jaw surgery later in life.
Crossbite
A crossbite is when the upper and lower teeth do not align correctly when the patient bites down. Crossbites occur when some bottom teeth are located outside the upper teeth when the two jaws are closed. Similar to underbites, reverse pull headgear shifts the upper jaw forward to align the teeth in the upper and lower jaws over time.
High Pull Headgear
High pull headgear attaches to the top of the head, back of the head, and the upper jaw. The appliance directs jaw growth and improves alignment.
Open bites, a very rare type of malocclusion that only affects 0.6 percent of the U.S. population, may require high pull headgear:
Open Bite
High pull headgear is commonly used to treat open bites, which is when the front upper and lower teeth slant outwards and do not touch when the mouth is closed.
Side Effects of Wearing Headgear
There are a few negative side effects of headgear. Some patients experience minor side effects, while others may develop more serious issues.
Call or visit your orthodontist if you or your child experiences any of the following possible, but rare, side effects:
- The development (or worsening) of sleep apnea, which is a potentially serious condition that results in breathing that stops and starts while sleeping.
- Unusual pain that worsens over time. This is rare but can occur in some patients. It is crucial to visit your orthodontist if the pain does not decrease or gets worse after a few weeks of normal wear.
- If the band on your back teeth (first molars) that attaches to the headgear detaches.
- The headgear is not fitting properly or becomes loose.
How Do You Wear Headgear?
Headgear must be worn for 12 to 14 hours each day. To ensure treatment is effective, orthodontists recommend:
- Wearing the appliance while sleeping, rather than throughout the day at school. The longer and more often the headgear is worn, the quicker the jaws and teeth will move.
- In the beginning, patients should wear the appliance for just a few hours each day and slowly build up to wearing it for 12 to 14 hours per day. It is normal for the teeth and jaw to become sore during the first few weeks of treatment.
- Once the teeth have moved into their correct positions, patients should visit their orthodontist to shorten the amount of time the headgear is worn each day.
- Headgear should never be worn while playing sports or participating in activities that could pull or push the appliance.
Questions and Answers
How much does headgear cost?
The cost of headgear varies greatly. This is because the length of treatment and device needed is different for every patient. It is important to talk with your orthodontist to determine a payment plan, if insurance is accepted, and how long treatment will take. On average, headgear treatment can cost anywhere between $1,000 and $9,000.
Does headgear hurt?
Most patients experience mild to moderate pain at the beginning of treatment. This is because the teeth are adapting to the device, which can cause pain and soreness around the teeth and gums.
Your child can take ibuprofen or over-the-counter pain relievers when needed if the device causes soreness. The pain typically subsides after a few days of normal wear.
Can adults wear headgear?
Adults are usually not candidates for headgear because their jaws and teeth have fully developed. The only time you may see an adult with headgear is if they need minor bite correction or teeth straightening due to an accident.
If an adult loses a few teeth or they are knocked out somehow, then headgear may be necessary. The device keeps the patient's remaining teeth in place while they are preparing for dental implants or dentures.
How long does headgear take to work?
Headgear is typically worn for 12 hours a day. Many patients prefer to wear headgear while they are asleep, and then for a few hours the following day. Headgear treatment takes 1 to 2 years.
Cobourne, Martyn T., and Andrew T. DiBiase. Handbook of Orthodontics E-Book. Elsevier, 2015.
Proffit, William R., et al. Contemporary Orthodontics. Elsevier/Mosby, 2019.
We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
