Orthodontic Headgear: Types & When Treatment is Necessary

What is Orthodontic Headgear?

Headgear is an orthodontic appliance that treats bite problems associated with irregular jaw positioning. The appliance attaches to a child’s face or head with a neck strap.

The most common age group that uses headgear is children nine years of age and older.

During this stage of life, a child’s jaw and bones are growing rapidly. Headgear repositions the jaw early on, preventing the need for jaw surgery later in life. 

Why is Headgear Used With Braces?

Orthodontic headgear is always used in combination with braces. Braces correct teeth positioning, while headgear influences the growth of the jaws. 

Headgear is usually unnecessary if a child needs braces but does not have severe bite problems.

Basic Parts of Headgear

Orthodontic headgear has several parts that are adjusted depending on the jaw’s condition. The parts of headgear include:

• A head cap
• Fitting straps
• Face bow
• Elastic bands, tubes, or hooks
• Chin cup
• Forehead pad
• Mouth yoke
• Braces

Not all headgear contains the same parts. For example, some types of headgear use hooks or bands to attach to braces, while others do not. 

Can Adults Wear Headgear?

Adults usually do not wear headgear because of fully developed jaws and teeth. You may only see an adult with headgear if they need minor bite correction or teeth straightening due to an accident.

If an adult somehow loses teeth, headgear may be necessary to keep the remaining teeth in place while preparing for dental implants or dentures.

What to Expect From Wearing Headgear

These are what you can expect when you wear headgear:

• You may need to wear your headgear from 12 to 14 hours daily for one to two years. 
• Wearing orthodontic headgear can be uncomfortable and painful, especially during the first few days or when an orthodontist deepens or adjusts the pressure. 
• Your child must wear their headgear at home even while watching television, doing homework, and sleeping. 
• Your child must remove their headgear before playing sports, eating, and brushing their teeth. 

What to Expect From Orthodontic Appointments

You can expect to have regular orthodontic appointments for your headgear. Here’s what you can expect:

• You must bring your child’s orthodontic headgear to every appointment.
• The orthodontist will adjust the headgear at every appointment.
• An orthodontic appointment should occur every four to 12 weeks.
• Contact your orthodontist if your child’s headgear breaks or becomes loose.

How Do You Wear Headgear?

Headgear is necessary for 12 to 14 hours a day. To ensure treatment is effective, orthodontists recommend:

• Wearing the appliance while sleeping
• Avoiding sports or outdoor activities while wearing the headgear
• Wear the appliance for just a few hours a day in the beginning to adjust to its sensations

Visiting an orthodontist for regular monitoring of the headgear and changes to your bite is essential. Once the teeth have moved into their correct positions, the orthodontist can shorten the time the headgear is necessary each day. 

Potential Side Effects of Headgear

Some patients experience minor side effects with headgear, while others may develop more severe issues. It’s normal for the teeth and jaw to become sore during the first few weeks of treatment. It’s common to feel pain or discomfort as the teeth adjust to the headgear.

Dentists recommend taking ibuprofen or over-the-counter (OTC) pain relievers when needed. Typically, the pain goes away after a few days.

Call or visit an orthodontist if you or your child experiences any of the following possible but rare side effects:

• Developing (or worsening) sleep apnea
• Unusual pain that worsens over time
• Loose or ill-fitting headgear
• Detachment of the bands from the back teeth (first molars)

Benefits of Wearing Headgear

There are three main benefits of wearing orthodontic headgear, including the following:

1. It speeds up the orthodontic process — Headgear can speed up treatment time or make treatment possible for conditions that may be too complicated to treat with braces alone.
2. It provides additional force — In some cases, teeth need more pressure to move, so headgear can provide the necessary additional force to speed up realignment. 
3. It might be the necessary correction — Sometimes, headgear is recommended as the only option for treating severe overbites and underbites. Therefore, it is sometimes necessary. 

How Much Does Headgear Cost?

Headgear can cost anywhere between $1,000 and $9,000. Several factors affect the price, including the length of treatment and the specific device needed.

Speak with an orthodontist to determine a payment plan, insurance coverage, and treatment times.

What are the Different Types of Headgear?

Several varieties of headgear exist to treat the following bites and misalignments:

• Overbite
• Underbite
• Overjet
• Crossbite
• Open bite 

Common headgear appliances include:

Cervical Pull Headgear

A cervical pull headgear treats class II malocclusions (overbites and overjets).  The device is worn to move the front teeth and jaw backward and closer to the lower teeth.

Class II malocclusions include:

• Excessive overbite — A condition where the upper front teeth overlap the lower front teeth
• Excessive overjet — A condition in which the upper front teeth severely protrude outwards over the lower front teeth

Cervical pull headgear is typically used to correct an excessive horizontal overbite in children. However, adults who need help maintaining a proper bite and correcting tooth spacing after extraction can also temporarily utilize the appliance. 

The headgear has three parts:

Face Bow

The face bow contains an outer and inner wire. The outer wire attaches to the elastic strap, while the inner wire attaches to a child’s mouth via two tubes cemented onto the child’s teeth. 

Elastic Strap

The elastic strap is worn behind the head and neck to secure the headgear to the head and as an attachment point for the outer wires. 

Neck Pad

The neck pad ensures the wearer's elastic strap is comfortable.

Reverse-Pull Headgear (Facemask or Facebow)

Reverse-pull headgear treats Class III malocclusions (underbites and crossbites). The headgear shifts the upper jaw forward to align with the upper and lower jaws. Examples of Class III malocclusions include:

• Underbite — A condition where the lower teeth overlap the upper teeth. Braces alone cannot treat underbites
• Crossbite — A condition where the upper and lower teeth do not align correctly when the patient bites down.

Reverse-pull headgear rests on the front of the face to pull the top jaw and teeth forward. Part of the mechanism sits on the chin, while the other sits on the forehead. These two parts are connected by a metal frame attached by elastics to a Rapid Maxillary Expander (RME) on the top teeth. The RME also serves to widen the top jaw. 

High-Pull Headgear

A high-pull headgear is often used to treat open bites, a rare malocclusion affecting 0.6 percent of the U.S. population. 

An open bite is a problem where the top and bottom teeth slant outwards. This slant causes a gap between the top and bottom teeth, making the teeth look “open” when the mouth is closed. 

High-pull headgear is similar to cervical pull headgear, consisting of a wire that attaches to braces on the teeth. The difference lies in the strap that wraps around the back and top of the head, resulting in an upward pull on the teeth. 

Alternatives to Orthodontic Headgear

While orthodontic headgear is effective, it is often uncomfortable and considered unattractive or embarrassing. Therefore, your child might prefer one of the many alternatives to orthodontic headgear, including:

• The Herbst appliance ⁠— Attaches to the back molars on both sides of the upper and lower jaws to line up the top and bottom jaws and improve the bite.
• The Twin Block appliance ⁠— Consists of two bite blocks, upper and lower, which interlock at 70° to hold the lower jaw in a forward position to treat an overbite.
• Bionator – Removable, acrylic appliance worn full-time to correct a patient’s bite.
• Orthopedic Correctors ⁠— A jaw-repositioning appliance that moves the mandible forward to correct a deep or open bite.

Summary

Headgear is an orthodontic appliance that treats jaw misalignment and bite problems. Specific types of headgear treat different bite issues. 

Headgear can complement braces and speed up the orthodontic process. There are minimal side effects associated with wearing headgear. Because headgear can eliminate the need for jaw surgery later in life, the benefits generally outweigh the inconveniences.

The appliances must be worn for 12 to 14 hours daily for up to two years.