Herbst Appliance

What is a Herbst appliance?

A Herbst appliance is a type of orthodontic device. Orthodontists use it to move your lower jaw forward and align your upper and lower teeth.

Herbst appliances work best in kids and teens who haven’t stopped growing yet. For most people, that’s between the ages of 9 and 14. Orthodontists rarely use Herbst appliances in adults. But when they do, it’s usually to treat sleep apnea.

What does the Herbst appliance do?

Orthodontists use Herbst appliances to correct some Class II malocclusions. Malocclusion means “bad bite.” If you have a Class II malocclusion, it means you have one of the following:

• Overbite (deep bite): When your upper front teeth vertically overlap your lower front teeth more than they should.
• Overjet: When your upper front teeth stick out (protrude) past your lower front teeth more than they should.
• An underdeveloped lower jaw: When your lower jaw is smaller than it ought to be.
• An overly prominent upper jaw: When your upper jaw is larger than it should be in comparison to your lower jaw.

Just because you have one of the conditions listed above doesn’t necessarily mean you need a Herbst appliance. Your orthodontist can tell you whether they recommend it as part of your treatment plan.

Parts of a Herbst appliance

Herbst appliances may have slight design differences, but they all have the same parts:

• Metal bands on your back upper-left and back upper-right molars.
• Metal bands on your back lower-left and back lower-right molars or premolars.
• Two metal arms (one on each side) that connect the bands on your upper and lower teeth.

In most cases, your Herbst appliance stays in your mouth permanently until your orthodontist removes it. Removable Herbst appliances exist, but they’re less common. A Herbst sleep apnea device is one example of a removable appliance.

How common are Herbst appliances?

Orthodontic treatments are much more common now than they used to be. Still, it can be challenging to convince your child that the benefits of wearing their appliance will outweigh any inconvenience. Pre-teen kids often want to avoid anything that makes them look or feel different from their peers. The good news is that a Herbst appliance is much less noticeable than orthodontic headgear. Most people will only see it when you laugh or open your mouth wide.

How does the Herbst appliance work?

The Herbst appliance places your lower jaw forward and puts slight backward pressure on your upper jaw. Over time, this steady force can bring both jaws into alignment and correct your bite.

Most kids will need braces in addition to their Herbst device. In some cases, your child may wear their appliance before they get braces. In other instances, they may wear their Herbst device and braces at the same time.

How long will it take to get used to my Herbst appliance?

For most kids, it takes a week or two to adapt to their new appliance. After that, their new jaw position should feel normal. It’s like wearing a ring. When you first put it on, you notice it all the time. Once you wear it for a while, you forget it’s there.

How to eat with a Herbst appliance

While it’s not a requirement, it’s a good idea to eat soft foods for the first few days. This can help you adjust to chewing with your Herbst appliance.

If you have a Herbst appliance, be sure to avoid:

• Chewy foods (bagels, pizza crust, jerky, chewy candies).
• Sticky foods (caramels, taffy, toffee, gum).
• Hard foods (nuts, popcorn, hard candies, raw vegetables).

These foods can break or damage your Herbst device and other orthodontic appliances.

Caring for your Herbst appliance

Proper oral hygiene is the best way to ensure your Herbst appliance stays in good condition. There are tiny nooks and crannies where bacteria can hide. To keep your mouth clean:

• Brush your teeth and your appliance thoroughly at least twice every day.
• Floss around the metal bands on your teeth one to two times a day.
• Consider using a water flosser to remove large pieces of food and debris. (Water flossing should never replace actual flossing, though.)

Your dentist, hygienist or orthodontist can show your child how to effectively clean around their Herbst appliance.

How long will I need to wear my Herbst appliance?

It depends on several factors, including the severity of malocclusion. On average, most kids wear their Herbst appliances for about a year. Some may finish treatment sooner. Others will need more time. Your orthodontist can tell you what to expect in your situation.

What are the pros and cons of a Herbst appliance?

Like any orthodontic treatment, a Herbst appliance has advantages and disadvantages:

Pros of a Herbst appliance

The main goal of any childhood orthodontic treatment is to reduce the need for more invasive procedures later, like jaw surgery.

A Herbst device can:

• Correct severe overbites and other types of Class II malocclusion.
• Reduce the likelihood that your child will need tooth extractions or other oral surgeries in the future.

Cons of a Herbst appliance

With a Herbst appliance, you won’t be able to move your lower jaw backward. But you’ll still be able to open and close your mouth normally. The main drawback for any orthodontic appliance is getting accustomed to it.

Kids with a new Herbst appliance may experience:

• Slight discomfort during the first couple of weeks.
• Eating challenges for the first few days.
• Irritation on the inside of their cheeks from the new appliance.

When should I call my child’s orthodontist?

If your child’s Herbst appliance breaks or becomes damaged in any way, it’s important to schedule a visit with their orthodontist. A broken device can stall treatment, so their orthodontist will want to repair it as soon as possible.

If your child isn’t having discomfort from the broken appliance, you can schedule an appointment during your orthodontist’s regular business hours. But if your child is in pain, they’ll need care right away. Most orthodontists have an emergency phone number you can call in these situations. But if your orthodontist isn’t available, take your child to an urgent care clinic or emergency room.

Does my child really need a Herbst appliance?

Not every child who needs braces will need a Herbst appliance. It depends on what type of malocclusion they have, and how severe it is.

A Herbst appliance is one of many orthodontic devices that can make changes to your child’s jaw while their bones are still growing. This is important because once bones stop growing, they’re much harder to move.

Let’s say that your child has a severe overbite, and your orthodontist thinks a Herbst appliance will correct the issue. A Herbst appliance can align the jaw now while your child is young. But once your child goes through puberty and their bones stop growing, a Herbst appliance won’t be effective. They’ll likely need oral surgery to correct the issue.

A note from Cleveland Clinic

Dental providers have been using Herbst appliances for over 100 years. In the right situations, these devices are an effective, minimally invasive way to align your child’s jaws. A Herbst appliance might even keep your child from needing oral surgery later in life. Still, not every child needs one. Talk to your orthodontist about possible treatment recommendations.