What This Guide Covers and Who It Is For
This guide explains orthodontic headgear, including its types, how it works, and what wearing it is actually like day to day.
Headgear is an appliance worn partly outside the mouth. It attaches to braces or bands on the back teeth and uses straps around the head or neck to apply gentle, steady force to the jaw. The goal is to change where the jaw grows or to hold it in place while the teeth move into better positions.
If your child's orthodontist has recommended headgear, or if you are an adult exploring options for a significant bite problem, this article covers the information you need. You will learn about the three main headgear types, who benefits most, how long treatment lasts, what it costs, and when a modern alternative might work instead.
For a broader look at what orthodontic specialists treat and how they differ from general dentists, visit the orthodontics page.
How Orthodontic Headgear Works and the Main Types
Headgear works by applying external force to the upper or lower jaw to change its growth pattern or position relative to the skull.
Braces move individual teeth. Headgear moves bone. That is the key difference. When a patient has a skeletal discrepancy, meaning the upper and lower jaws do not line up properly, tooth movement alone often cannot solve the problem. Headgear provides an anchor point outside the mouth so that force can be directed at the jaw itself. This is especially effective during childhood and adolescence, when the bones of the face are still developing. [3]
Cervical-Pull Headgear for Overbites
Cervical-pull headgear uses a strap around the back of the neck to slow the forward growth of the upper jaw. It is the most common type and is used primarily to correct Class II malocclusions, which most people know as overbites. The facebow, a U-shaped wire, inserts into tubes on the upper molar bands and connects to the neck strap.
By pulling the upper molars and upper jaw backward and restricting further forward growth, cervical-pull headgear reduces the gap between the upper and lower jaws. This creates room for crowded teeth and brings the bite into a more balanced relationship. [1] The direction of force is slightly downward, which makes it a good choice for patients whose bite does not have a significant vertical component.
High-Pull Headgear for Vertical Growth
High-pull headgear attaches to a strap that wraps over the top of the head rather than around the neck. This changes the direction of force so it pulls upward and backward. It is prescribed when the orthodontist needs to control vertical growth of the upper jaw, a pattern sometimes called a "long face" tendency.
Patients with an anterior open bite, where the front teeth do not touch when the back teeth are closed, often benefit from high-pull headgear. A review of open bite treatment confirmed that controlling vertical jaw growth with appliances like high-pull headgear can reduce or sometimes eliminate the need for surgical correction later. [2] High-pull headgear may also be combined with cervical-pull elements in what is called a combination-pull headgear for cases that need both backward and upward force.
Reverse-Pull Facemask for Underbites
A reverse-pull facemask works in the opposite direction from the other two types. Instead of holding back the upper jaw, it pulls the upper jaw forward. It is used for Class III malocclusions, commonly called underbites, where the lower jaw sits ahead of the upper jaw.
The facemask rests on the forehead and chin. Elastic bands connect the mask to hooks on the upper braces or a palatal expander inside the mouth. The elastics pull the upper jaw forward over time. A meta-analysis of 12 controlled trials found that facemask therapy combined with maxillary expansion produces statistically significant forward movement of the upper jaw in growing patients, confirming it as one of the most effective nonsurgical tools for Class III correction. [5] This treatment is typically started early, sometimes as young as age 7 or 8, because the upper jaw's growth plates respond best to this kind of force before they begin to fuse. [3] According to the American Association of Orthodontists, early evaluation by age 7 allows orthodontists to identify these skeletal problems and begin interceptive treatment at the ideal time. [3]
Age, Timing, and Practical Details About Headgear
Headgear is most effective in children and adolescents whose jaws are still actively growing, typically between ages 7 and 14.
Why Age Matters for Headgear Treatment
The jaw bones grow most rapidly during childhood and early adolescence. Headgear takes advantage of this growth by redirecting it. Once the bones mature and the growth plates close, usually in the mid to late teens, the jaw becomes much less responsive to external force.
For underbite correction with a reverse-pull facemask, treatment often begins around age 7 to 9. For overbite correction with cervical-pull or high-pull headgear, treatment typically starts between ages 9 and 14. [3] The American Dental Association recommends that children see a dentist regularly and get an orthodontic evaluation if bite problems are suspected. [4] Adults with skeletal discrepancies who are past their growth phase may need orthognathic surgery (jaw surgery) instead of headgear, because the bones no longer respond to these forces in the same way.
How Many Hours a Day and for How Long
Most orthodontists prescribe headgear for 12 to 14 hours per day. This typically means wearing it from after school or dinner through the entire night. The appliance does not need to be worn during school, sports, or meals.
Treatment duration varies, but most patients wear headgear for 12 to 18 months. Consistent daily wear is critical. Skipping hours or nights reduces the force on the jaw and can significantly extend treatment time. Some patients see results faster with excellent compliance, while others with more severe skeletal issues may need a longer course of treatment. Your orthodontist will monitor progress with regular checkups, usually every 4 to 8 weeks.
Preparing Your Child for Headgear
The idea of headgear can feel intimidating, especially for children. A few practical steps help the adjustment go smoothly. First, explain that headgear is worn mostly at home and during sleep, not at school. Second, expect mild soreness on the teeth and jaw for the first few days. Over-the-counter pain relievers like ibuprofen or acetaminophen, given at age-appropriate doses, typically manage this well.
Soft foods during the first week help reduce discomfort. A pillowcase over the pillow can make sleeping more comfortable while your child gets used to the straps. Most children adapt within one to two weeks. Praise and small rewards for consistent wear can make a real difference in compliance, which directly affects how well and how quickly the treatment works.
What Happens Step by Step During Headgear Treatment
Headgear treatment follows a predictable sequence: fitting, adjustment, home wear, and regular follow-up visits with the orthodontist.
The Fitting Appointment
At the fitting visit, the orthodontist places or checks the molar bands. These are metal rings cemented around the back molars. The facebow or facemask is then connected to tubes on the bands. The orthodontist adjusts the straps for a snug but comfortable fit and calibrates the force level.
This appointment typically takes 30 to 45 minutes. The orthodontist will demonstrate how to put the headgear on and take it off. You and your child will practice this several times in the office before leaving. The orthodontist also explains the wear schedule and what to watch for at home.
The First Two Weeks at Home
Mild pressure on the back teeth and some jaw soreness are normal during the first few days. This means the appliance is working. The discomfort usually peaks around day two or three and then fades. If the neck or head strap causes skin irritation, a thin cloth or gauze pad between the strap and skin often helps.
It is common for children to accidentally dislodge the facebow while sleeping during the first week. Modern headgear includes safety features like locking mechanisms on the facebow that prevent it from releasing unexpectedly. Make sure the locking mechanism is engaged each night.
Follow-Up Visits and Progress Monitoring
Every 4 to 8 weeks, the orthodontist will check the headgear and assess jaw movement. Force levels may be adjusted by changing elastics or tightening components. The orthodontist takes measurements and may order periodic X-rays to track skeletal changes.
If the bite is improving on schedule, no changes may be needed. If progress is slower than expected, the orthodontist will discuss whether wear time is being met or whether adjustments to the appliance are needed. Once the desired jaw position is reached, the orthodontist removes the headgear and, in many cases, continues treatment with braces or aligners to fine-tune the tooth positions.
Headgear Cost and Insurance Coverage
Orthodontic headgear itself is typically included in the overall cost of orthodontic treatment rather than billed as a separate item.
The total cost of orthodontic treatment that includes headgear generally ranges from $3,000 to $7,000 or more. Costs vary by location, provider, and case complexity. This range covers the headgear appliance, braces or other fixed appliances, all office visits, and retainers after treatment. Cases requiring longer treatment or additional appliances will fall toward the higher end.
Many dental insurance plans that include orthodontic benefits cover a portion of treatment. A common structure is a lifetime orthodontic maximum of $1,000 to $2,500 per patient, though this varies widely by plan. [4] Insurance companies sometimes require that the patient be under age 18 or 19 for orthodontic coverage. Ask your insurance provider about specific coverage limits before starting treatment.
Most orthodontic offices offer monthly payment plans that spread the cost over the treatment period. Some also offer a discount for paying the full amount upfront. Ask the office about all available options during the initial consultation.
When to See an Orthodontist About Headgear
A referral to an orthodontist is appropriate whenever a child or adult shows signs of a skeletal jaw imbalance that braces alone cannot correct.
Your general dentist may notice that your child has a significant overbite, underbite, or open bite during a routine checkup. These are signs of a skeletal problem rather than just crooked teeth. The American Association of Orthodontists recommends that every child have an orthodontic evaluation by age 7. [3] This early check allows the orthodontist to identify developing jaw problems and plan interceptive treatment, such as headgear or a palatal expander, at the age when it will be most effective.
Specific signs that may indicate a need for headgear include: a lower jaw that appears to sit significantly behind the upper jaw (overbite), an upper jaw that appears small or recessed compared to the lower jaw (underbite), front teeth that do not touch when the back teeth are together (open bite), and severe crowding linked to a small upper jaw. [1] [2]
General dentists typically refer patients to orthodontists for these conditions because orthodontists complete two to three years of specialty training beyond dental school. This training focuses specifically on tooth movement and jaw growth modification. While a general dentist can place braces in some states, headgear and skeletal treatment are almost always managed by an orthodontic specialist. Visit the orthodontics page to learn more about what orthodontists do and how to find one near you.
Find an Orthodontist Experienced with Headgear Treatment
If your child has been told they need headgear, or if you suspect a jaw alignment problem, an orthodontist can evaluate the situation and explain the best options. Use the My Specialty Dentist directory to search for orthodontists in your area who treat skeletal bite problems. You can filter by location and read about each provider's background before scheduling a consultation.
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