Why Your Child May Need Orthodontic Headgear

Beautiful girl at the dentist getting a check up on her teeth

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Orthodontic headgear, sometimes referred to as extra-oral appliances, are devices that help correct malocclusion—when the teeth do not align properly. Headgear is most often used along with braces: While braces correct the position of teeth, orthodontic headgear—which as the name suggests is worn on the head—is most often added to orthodontic treatment to help alter the alignment of the jaw, although there are some situations in which such an appliance can help move teeth, particularly molars.

Whatever the purpose, orthodontic headgear works by exerting tension on braces via hooks, coils, elastic bands, metal orthodontic bands,and other attachable appliances. It's most effective for children and teenagers because their jaws are still developing and can be easily manipulated. (If an adult is fitted with headgear, it's usually to help correct the position of teeth that have shifted after other teeth have been extracted.)

Orthodontic headgear isn't used as often as in the past, but it's not obsolete and has been found in studies to be particularly effective for certain types of malocclusions.

Uses

Orthodontic headgear is used most often to correct malocclusions that result when there is misalignment between the maxilla (upper jaw) and mandible (lower jaw).

There are several types of malocclusion, including Class 2, or overbite (retrognathism), in which the upper front teeth overlap the lower front teeth excessively and Class 3, or underbite (prognathism), in which the lower front teeth and jaw protrude in front of the upper front teeth.

Other types of malocclusion include overjet (buck teeth) and crossbite, in which one or more upper teeth fit inside the lower teeth, according to the American Association of Orthodontists. Some malocclusions can co-exist—such an overbite and crossbite.

How It Works

There are three main types of orthodontic headgear:

  • Cervical headgear: Anchors at the back of the neck and is meant to correct an overbite
  • High-pull headgear: Similar to the cervical headgear, anchors at the back of the head to correct an overbite. It's often used when a child also has an open bite, which means the upper and lower teeth do not touch when the mouth is closed.
  • Reverse-pull facemask: Anchors on the forehead and chin in order to move the upper jaw forward and correct an underbite

Headgear typically is enhanced with additions such as J hooks (which apply more force to the jaw and teeth), elastic bands (for bite alignment), retainers (to hold teeth in place), power chains (to adjust the position of the teeth), lip bumpers (which make space for lower teeth), and facebows (external wire apparatuses that extend across the face and into the mouth).

What to Expect

Whether being used to treat an overbite or underbite, orthodontic headgear must be worn for a minimum of eight hours, during sleep, as this is when growth hormone is produced and growth occurs. Ideally, it should also be worn during the day for an additional four to six hours. However, it should be removed when a child is playing sports, roughhousing, or eating. Drinking through a straw while wearing orthodontic headgear is OK.

It may take a while for your child to adjust to wearing headgear. It can be uncomfortable and even painful at first. Many orthodontists recommend a ramping-up period during which a child will wear their device for one hour on the first day and increase the duration every day after until the target time is reached.

As headgear begins to achieve results, the orthodontist will adjust the tension. This can be uncomfortable at first, until a child become used to it. During any periods of pain or discomfort, there are things you can do to make your child more comfortable, such as having them eat soft foods and applying cold packs to achy areas of the face or jaw.

Although some misalignment problems can be corrected in as few as six months with the help of orthodontic headgear, it's not unusual for a child to need to wear it for as long as a year.

A Word From Verywell

Malocclusion is more than a cosmetic problem. If not corrected, misaligned teeth can increase the risk of other health issues, such as sleep apnea and temporomandibular joint disorder (TMJ). Many children may balk at wearing orthodontic headgear, but if an orthodontist feels it's necessary to effectively correct malocclusion, parents should do all they can to make sure their child complies. It can be helpful to explain that by wearing their headgear consistently, they may be able to get rid of it sooner rather than later.

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Article Sources

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  1. 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

  2. KidsHealth. TMJ Disorders. Updated July 2015.

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