What Is Orthodontic Headgear?
Orthodontic headgear is an appliance that attaches to the braces or teeth inside the mouth and connects to a strap worn around the back of the head or neck. It applies a steady, gentle force to the teeth and jaw over time. Unlike braces, which move teeth within the jawbone, headgear influences the growth and position of the jaw itself.
Headgear is prescribed when a patient has a skeletal discrepancy, meaning the upper and lower jaws are not growing in proportion to each other. A skeletal overbite (upper jaw too far forward), a skeletal underbite (lower jaw too far forward or upper jaw too far back), or excessive vertical growth of the jaw are the most common reasons an orthodontist prescribes headgear.
Types of Orthodontic Headgear
There are three main types of orthodontic headgear, each designed to apply force in a different direction depending on the problem being corrected.
Cervical-Pull Headgear
Cervical-pull headgear attaches to the upper molars inside the mouth and connects to a strap that goes around the back of the neck. It pulls the upper jaw and upper teeth backward, slowing the forward growth of the upper jaw. This is the most common type and is used to correct Class II malocclusion (overbite) in patients whose upper jaw is positioned too far forward relative to the lower jaw.
High-Pull Headgear
High-pull headgear connects to the upper molars and attaches to a strap that goes over the top of the head. It directs force upward and backward, which restrains both the forward and downward growth of the upper jaw. This type is used for patients who have an overbite combined with excessive vertical growth (a long face pattern). It is sometimes combined with cervical-pull headgear for comprehensive control.
Reverse-Pull Headgear (Facemask)
Reverse-pull headgear, also called a protraction facemask, is used to treat underbites caused by an underdeveloped upper jaw. It consists of a frame that rests against the forehead and chin, with elastic bands that connect to hooks on the upper braces or a palatal expander. The elastics pull the upper jaw forward. This type is most effective in younger children (ages 7 to 10) whose midface sutures are still pliable enough to respond to protraction forces.
When Is Orthodontic Headgear Needed?
Headgear is not a routine part of every orthodontic treatment. It is reserved for cases where the problem is skeletal (involving jaw position) rather than purely dental (involving only tooth position).
Your orthodontist may recommend headgear if you or your child has a significant overbite where the upper jaw sits too far forward, an underbite where the upper jaw is underdeveloped, severe crowding in the upper arch that requires the molars to be moved backward to create space, or excessive vertical growth that is creating an open bite or a long face profile.
The ideal time for headgear treatment is during the growth spurt, typically between ages 9 and 14 for most patients. In younger children with underbites, treatment with a facemask may begin as early as age 7. Once jaw growth is complete (usually by the late teens), headgear is no longer effective at changing jaw position, and surgical correction may be needed instead.
What to Expect When Wearing Headgear
Starting headgear takes an adjustment period. Your orthodontist will fit the appliance, attach the inner components to your braces or molar bands, and show you how to connect and disconnect the outer strap. You will practice putting it on and taking it off until you are comfortable doing it yourself.
How Long Do You Wear It?
Most orthodontists prescribe headgear for 12 to 14 hours per day. This typically means wearing it from after school or dinner through the night until morning. Some cases may require longer daily wear. The total treatment duration is usually 12 to 18 months, though this varies based on the severity of the jaw discrepancy and how consistently the patient wears the appliance.
Compliance is the single biggest factor in headgear success. Wearing it for fewer hours than prescribed significantly reduces its effectiveness and can extend treatment time. Many modern headgear appliances include wear-time indicators that help the orthodontist track actual usage.
Does Orthodontic Headgear Hurt?
When first placed, headgear causes pressure and mild soreness on the teeth it attaches to, similar to the discomfort after a braces adjustment. The neck or head strap may feel awkward at first. Most patients adjust within a few days to a week.
If the headgear causes persistent pain, sores on the skin where the strap contacts, or sharp discomfort in the jaw, contact your orthodontist. The appliance may need adjustment. Headgear should produce steady pressure, not sharp pain.
Is Orthodontic Headgear Still Used Today?
Yes. While the overall frequency of headgear use has declined as alternative techniques have developed, headgear is still prescribed when other methods cannot achieve the needed result. For certain skeletal problems, particularly in growing patients, headgear delivers forces that no intraoral appliance can replicate.
Advances in orthodontics have made headgear less common than it was in the 1980s and 1990s. Temporary anchorage devices (TADs), functional appliances, and early interceptive treatment have replaced headgear in many situations. However, orthodontists continue to use headgear for cases where these alternatives are insufficient or not appropriate. The reverse-pull facemask, in particular, remains a standard treatment for young patients with underbites.
Alternatives to Orthodontic Headgear
Depending on the specific problem, your orthodontist may recommend one of these alternatives instead of or in addition to headgear.
Temporary Anchorage Devices (TADs)
TADs are small titanium screws placed into the jawbone to serve as fixed anchor points for moving teeth. They can provide some of the same anchorage that headgear offers without an external appliance. TADs are effective for moving teeth but have limited ability to influence jaw growth in the way that headgear can.
Functional Appliances
Appliances like the Herbst device, Twin Block, and MARA are fixed or removable appliances worn inside the mouth that encourage the lower jaw to grow forward. They are used to correct Class II overbites and are an alternative to cervical-pull headgear in some patients. They cannot replicate the effects of a reverse-pull facemask for underbite correction.
Orthognathic Surgery
For adults and older teens whose jaw growth is complete, surgical correction (orthognathic surgery) performed by an oral and maxillofacial surgeon is the primary option for skeletal jaw discrepancies. Surgery physically repositions the jawbones and is combined with orthodontic treatment before and after the procedure.
Orthodontic Headgear Cost
Orthodontic headgear is typically included in the overall cost of orthodontic treatment rather than billed as a separate item. The total cost of orthodontic treatment with headgear generally ranges from $3,000 to $7,000, depending on the complexity of the case, the length of treatment, and the geographic area. Costs vary by location, provider, and case complexity.
Most dental insurance plans with orthodontic coverage apply their orthodontic benefit to treatment that includes headgear, typically covering a lifetime maximum of $1,000 to $2,500. Many orthodontic offices offer monthly payment plans that spread the cost over the treatment period.
When to See an Orthodontist
The American Association of Orthodontists recommends that children have their first orthodontic evaluation by age 7. This allows the orthodontist to identify developing jaw problems early, when headgear and other growth-modification appliances are most effective.
If your child has a noticeable overbite, underbite, or crossbite, or if their dentist has flagged a jaw growth concern, schedule an orthodontic consultation. Early evaluation does not mean early treatment. In many cases the orthodontist will monitor growth and begin treatment at the optimal time.
Find an Orthodontist Near You
Every orthodontist on My Specialty Dentist has verified specialty credentials. Search by location to find orthodontists experienced with growth modification and headgear treatment in your area, review their qualifications, and schedule a consultation.
Search Orthodontists in Your Area