Orthodontic headgear is an appliance worn partly outside the mouth that applies gentle force to guide jaw growth or hold teeth in place. It works best while a child is still growing, and today it is used for fewer patients than in the past, because other appliances can often do the same job.
What is orthodontic headgear?
The American Association of Orthodontists describes headgear as an appliance worn outside the mouth to provide traction for growth modification and tooth movement. It connects to bands or braces on the back teeth and to a strap that goes around the neck or head.
A facemask (also called reverse-pull headgear) is a related appliance. It rests on the forehead and chin and attaches to an appliance inside the mouth, often a palatal expander.
What problems does it treat?
- Upper teeth or jaw that sit too far forward (a large overbite or overjet): headgear can slow forward growth of the upper jaw while the lower jaw catches up.
- An underbite (Class III) in a growing child: a facemask, often with an expander, encourages the upper jaw to grow forward.
- Holding the back teeth in place while front teeth are moved back.
Why timing matters
Headgear and facemasks guide growth, so they only work while the jaws are still growing. That’s one reason the AAO recommends a first orthodontic check-up by age 7: some jaw problems are easier to correct in childhood than after growth is finished, when the only options may be braces with compromises or jaw surgery.
What is wearing it like?
Most headgear and facemasks are worn at home and while sleeping, not at school. Your orthodontist will tell you how many hours a day to wear it: results depend on wearing it as directed. The teeth may feel a little sore for the first few days. Take it off for sports and rough play, and never pull on the straps or face bow.
Are there alternatives to headgear?
Often, yes. Depending on the problem, rubber bands (elastics), appliances that stay inside the mouth, or temporary anchorage devices (TADs) can do some of the jobs headgear used to do. A 2019 review of clinical trials found mini-screws held the back teeth in place better than headgear while the front teeth were pulled back.
Functional appliances are another option for a large overbite in a growing child. They stay inside the mouth and hold the lower jaw forward to encourage it to grow into a better position.
At Behl Orthodontics, we use a facemask for underbites in growing children. Instead of traditional neck or high-pull headgear, we use elastics, TADs or functional appliances. Which one your child needs depends on the bite, the jaws and how much growth is left. Your orthodontist explains the options at the consultation.
Sources
- American Association of Orthodontists: Glossary of orthodontic terms (headgear)
- American Association of Orthodontists: Underbite causes and treatment options
- Alharbi F, Almuzian M, Bearn D. Anchorage effectiveness of orthodontic miniscrews compared to headgear and transpalatal arches: a systematic review and meta-analysis. Acta Odontol Scand. 2019;77(2):88–98
