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Updated on January 6, 2023
5 min read

Orthodontic Headgear: Types & When Treatment is Necessary

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What is Orthodontic Headgear?

Headgear is an orthodontic appliance that treats different 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 9 years of age and older.

During this stage of life, a child’s jaw and bones are growing rapidly. Headgear works by repositioning the jaw early on. This can help prevent the need for jaw surgery later in life.

Can Adults Wear Headgear?

Adults usually can’t wear headgear because their jaws and teeth are 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 remaining teeth in place while they prepare for dental implants or dentures.

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. 

However, if a child does not have severe bite problems, wearing headgear is usually not necessary; braces should suffice.

Basic Parts of Headgear

An orthodontic headgear has several parts. These parts are adjusted depending on the condition being corrected.

The different parts of headgear include:

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

Not all headgear uses the same parts. For example, some forms of headgear use hooks or bands to attach to braces.

What are the Different Types of Headgear?

Headgear is used to help people with the following conditions:

  • Overbite
  • Underbite
  • Overjet
  • Crossbite
  • Open bite 

A few types of headgear are available. They have different uses and improve different conditions. The kind of headgear a child needs can also depend on the type of malocclusion (teeth misalignment) they have.

Common appliances include:

Cervical Pull Headgear

image 13

Class II malocclusions (overbites and overjets) require cervical pull headgear. Examples of 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.

Both conditions require the headgear to hold a person’s upper jaw in place while the lower half shifts forward.

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. To use it, connect the rubber bands from the anchorage device on the braces to the frame.

image 14

Class III malocclusions may require reverse pull headgear. Examples of class III malocclusions include:

  • Underbite — A condition where the lower teeth overlap the upper teeth. This cannot be treated with braces alone.
  • Crossbite — A condition where the upper and lower teeth do not align correctly when the patient bites down.

A reverse-pull headgear shifts the upper jaw to align with the upper and lower jaws. Using the headgear properly can correct these issues and reduce the risk of jaw surgery in the future.

High-Pull Headgear

image 15

High-pull headgear attaches to the top of the head, the 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 — A rare misalignment where the upper and lower front teeth slant outwards. This slant causes the teeth to not touch when the mouth is closed. 

What to Expect From Wearing Headgear

Wearing orthodontic headgear can be uncomfortable and painful, especially in the beginning. But it becomes bearable over time.

Most misalignment problems can be corrected with headgear in about 6 months. However, some issues can take as long as 2 years.

Despite any problems with comfort, it’s important to keep wearing the headgear. The long-term benefits of wearing headgear are worth it.

Benefits of Wearing Headgear

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

  1. Speeds up the orthodontic process — Headgear can speed up treatment time and/or make treatment possible for conditions that may be too complicated to treat with braces alone.
  2. Additional force — In some cases, teeth need more pressure to move, so headgear can provide the necessary additional force.
  3. Necessary Correction — Typically, headgear is only recommended when it’s absolutely necessary. Headgear can help treat conditions like severe overbites and underbites. 

How Much Does Headgear Cost?

Headgear can cost anywhere between $1,000 and $9,000. There are a few factors that affect the price, such as the length of treatment and the device needed.

Speak with an orthodontist to determine a payment plan, if insurance is accepted, and how long treatment will take.

Potential Side Effects of 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 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)

It’s normal for the teeth and jaw to become sore during the first few weeks of treatment. It’s also common to feel some 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.

How Do You Wear Headgear?

Headgear must be worn 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
  • In the beginning, wear the appliance for just a few hours a day to adjust

It’s essential to visit an orthodontist regularly to be monitored. Once the teeth have moved into their correct positions, the orthodontics can recommend shortening the amount of time the headgear is worn each day. 

Headgear treatment can last up to 2 years.

Summary

Orthodontic headgear is an appliance used to treat jaw misalignment and bite problems. There are specific types of headgear designed for different bite issues.

Headgear can help complement braces and speed up the orthodontic process. There are minimal side effects associated with wearing headgear. However, the benefits they provide generally outweigh the negatives.

The appliances must be worn for 12 to 14 hours a day. Treatment can last up to 2 years.

Last updated on January 6, 2023
6 Sources Cited
Last updated on January 6, 2023
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

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).
  1. Cobourne, Martyn T., and Andrew T. DiBiase. Handbook of Orthodontics E-Book. Elsevier, 2015.
  2. Proffit, William R., et al. Contemporary Orthodontics. Elsevier/Mosby, 2019.
  3. Papageorgiou SN, et al.”Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis.” Eur J Orthod, 2017.
  4. Jaw surgery” Mayo Clinic Staff, 2018.
  5. Batista, K., et al. “Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents.” The Cochrane database of systematic reviews, 2018.
  6. Rosa, A., et al. “Effects of the cervical headgear in growing Angle Class II malocclusion patients: a prospective study.” Dental press journal of orthodontics, 2020.
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