dental instruments and oral health

What is Orthodontic Headgear?

Headgear is a common orthodontic appliance that is used to treat a variety of different bite problems associated with irregular jaw positioning. The appliance is usually attached to a patient’s face or head with a neck strap and is 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.

The most common age group that uses headgear are children 9 years of age and older.

During this stage of life, a child’s jaw and bones are growing rapidly. Headgear helps reposition jaw abnormalities early and helps prevent the need for jaw surgery later on.

When is Headgear Necessary During Orthodontic Treatment?

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

Cervical pull headgear consists of a strap that is worn around the neck (cervical area) and attaches to the braces inside the mouth.

Class II malocclusions (overbites and overjets) require cervical pull headgear:


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.


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)

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:


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.


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 Bites

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.

Instructions for Wear and Safety Precautions

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.