The Use of Headgear With Braces
Straight teeth and perfectly meshed bites sometimes require orthodontic help. For most people, this help comes in the form of braces. Braces come in several varieties, from the traditional metal bands and wires to virtually invisible clear plastic or off-white ceramic braces. Some orthodontic problems, however, are more than braces alone can handle. For these situations, a headgear appliance provides the additional pressure and guidance necessary to move teeth and align the jaw.
Headgear is an appliance worn outside of the mouth to move teeth and guide jaw growth. Massachusetts orthodontist Menachem Roth describes the headgear apparatus as consisting of three parts: Bands cemented to the molars, or back teeth; the U-shaped wire that attaches the headgear to the bands; and the headpiece, which slides over your head or behind your neck to hold the headgear in place.
Headgear corrects over- and underbites in children, notes Roth. The apparatus applies a specific amount of pressure at particular angles to hold the upper jaw back to allow the lower jaw to grow into the correct position for a proper bite. Headgear may also be used to move the upper molars further back into your mouth to correct an overbite, says OrthoKinetics Corp., manufacturers of headgear. The headgear is customized to pull teeth backward and upward, or forward to correct an underbite. Headgear is most commonly worn by children whose jaws are still growing. Adults rarely wear headgear.
Two types of headgear are available, explains Louis F. Mascola, an orthodontist based in Massachusetts. The most common type is the facebow. Facebow braces consist of a wire bow that attaches to the upper molars. The bow then attaches to the headpiece with a strap that sits behind your neck or over your head. The second type of headpiece is the J hook. Instead of the wire bow, the J hook attaches to your braces with two wire loops. The J hook attaches to your head with the same neck or head strap as traditional headgear.
Duration of treatment with headgear depends on the specific orthodontic problem that needs correcting, notes Roth. Children typically wear headgear 12 to 14 hours per day for 9 to 18 months. Instructions posted on the website of orthodontist Elise Z. Harnois, in Hinsdale, Ill., advise patients that treatment will be longer if they do not wear the headgear for the prescribed number of hours daily. Harnois writes the headgear does not need to be worn for 12 to 14 consecutive hours, but rather that amount of time during a 24-hour period. In other words, you can wear your headgear for an hour in the morning, remove it to go to school, and wear it again for 11 hours while you relax n the evenings and sleep. If you do not wear your headgear, your teeth could move and erase your progress. You must wear your headgear for 10 hours to maintain progress, Harnois says. Positive progress occurs when the appliance is worn longer than 10 hours.
Your molars may hurt or feel loose when you first begin wearing your headgear, but this is a normal adjustment, says Mascola. If pain persists, see your orthodontist. Always remove your headgear before playing sports or roughhousing to avoid damaging the appliance or injuring your teeth or face. Be sure to wear your headgear for the prescribed time and clean it as you were instructed.
- Louis F. Mascola: Orthodontic Headgear
- Elise Z. Harnois: Headgear Wear and Instructions
- Papageorgiou SN, Kutschera E, Memmert S, et al. Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis. Eur J Orthod. 2017;39(2):176-187. doi:10.1093/ejo/cjw041
- KidsHealth. TMJ Disorders. Updated July 2015.
- Almuzian M, Alharbi F, McIntyre G. Extra-oral appliances in orthodontic treatment. Dental Update. 8 Jul 2017;43(1). doi:10.12968/denu.2016.43.1.74
- American Association of Orthodontists. What Is a Crossbite? Nov 1, 2019.
- Henriques FP, Janson G, Henriques JFC, et al. Effects of cervical headgear appliance: a systematic review. Dental Press J Orthod. 2015 Jul-Aug; 20(4): 76–81. doi:10.1590/2176-9451.20.4.076-081.oar