Orthodontic Headgear

What is orthodontic headgear?

Orthodontic headgear is a device that helps position your child’s teeth and jaws into alignment. It treats what orthodontists call malocclusion or “bad bites.” With bad bites, your front and bottom teeth don’t align as they should when you close your mouth. Over time, this can cause dental problems, jaw problems and even trouble speaking and eating. It can also make your child feel self-conscious about their smile.

Orthodontic headgear fixes malocclusion by placing gentle pressure on your child’s teeth and jaws. Over time, the headgear encourages their still-forming jaw bones to align. Orthodontic headgear fixes:

• Overjet (“buck teeth”): When your upper front teeth stick out diagonally above your lower front teeth.
• Overbite: When your upper teeth overlap your lower teeth more than they should.
• Underbite: When your lower teeth stick out beyond your upper teeth.

Types of orthodontic headgear

Two main types of orthodontic headgear fix overbite and overjet, and one fixes underbite. Your child may need them with or without braces to straighten their teeth.

Types include:

• Cervical pull headgear: Fixes an overjet or an overbite. It includes a U-shaped wire (facebow) that attaches to your child’s upper back teeth. The wire connects to a strap that wraps around your child’s neck, providing gentle pressure to hold their upper jaw back.
• High pull headgear: Includes parts similar to cervical pull headgear and also fixes overjet and overbite. The main difference is that high pull headgear has two straps. One rests on the back of your child’s head and the other goes on top. They encourage your child’s upper jaw back and up.
• Reverse pull headgear: Fixes an underbite by pulling the upper jaw forward. It includes a vertical frame that goes in front of your child’s face that’s held in place by a forehead pad and a chin cup. A wire mouthpiece that fits onto your child’s upper back teeth extends from the frame, pulling their upper jaw forward.

Do kids still wear orthodontic headgear?

Orthodontic headgear isn’t used as much as it once was, but your child may still need one.

Increasingly, orthodontists recommend alternatives to orthodontic headgear. For example, clear aligners fit over your child’s teeth and can correct mild alignment problems. The Herbst extraoral device repositions your child’s jaws but fits inside their mouth. Children usually prefer it since they can always wear it, and it remains hidden from their peers.

Still, the device your child needs depends on their bite. Your child’s orthodontist can advise you on what will work best.

What should I expect during treatment?

For this treatment, your child’s orthodontist will fit them with headgear. Then, they’ll need regular visits afterward. During these appointments, the orthodontist will check your child’s bite. They’ll gradually adjust the tension on the headgear to position their growing jaw bones into alignment.

During the first visit, the orthodontist will give you detailed instructions about how long your child should wear their headgear each day and how to care for it. Encourage them to wear it daily for as many hours as their orthodontist says — without skipping. Even skipping a day can roll back progress.

To keep your child and the device safe, they should remove their headgear when they’re:

• Eating.
• Drinking (unless they’re using a straw).
• Playing or being active (and at risk of falling or an injury).

They should be able to brush and floss with their headgear on, but most kids find it easier to take it off.

How long will my child need to wear orthodontic headgear?

Most children need to wear headgear for 12 to 14 hours daily. Total treatment time may be as short as six months for some or as long as a few years for others.

Your child’s orthodontist will tell you how long they’ll need to wear headgear depending on their bite and how frequently (and consistently) they’re wearing it.

Realistically, though, getting your child to wear their headgear may take some doing — and with good reason. Wearing a dental accessory that everyone can see can feel embarrassing, no matter the health benefits. And kids — whose emotional intelligence is still developing — can be mean. Children may be tempted to hide their headgear away when they’re supposed to have it on.

To make things easier, your orthodontist may recommend having your child wear their headgear for a few hours at first and gradually increase their wear time. They may be able to skip wearing it at school but put it on first thing when they get home. It’s especially important that they wear it at night because this is when children’s bones do most of their growing.

Your child’s orthodontist can help you find a treatment schedule that feels doable for you and your child.

What are the side effects of orthodontic headgear?

Orthodontic headgear is a safe and effective way to fix your child’s bad bite. Still, the experience can feel unpleasant at times. For example, it’s common for your child’s teeth to feel sore at the beginning of treatment. There may also be some soreness and even some loose teeth as their bones grow and shift.

To help ease the pain:

• Apply ice packs to the sore part of their jaw.
• Switch to soft foods until the pain gets better.
• Give your child pain medicine (ask their provider about which ones are safe).

You can also assure them that the pain will go away and that they won’t have to wear orthodontic headgear forever.

Is there anything I can do to make this treatment easier for my child?

One of the best things you can do as a parent is to be sensitive to your child’s feelings about wearing headgear. Reassure them that it’s OK to wish they didn’t have to wear it. But remind them that the more consistently they wear it daily, the sooner they can be done with it for good.

You can also take steps to improve the experience for your child:

• Schedule the first appointment on a Friday (if possible). Your child may not be in the best spirits after getting headgear. Scheduling their appointment when they don’t have school the next day gives them some time to adjust. Spend the next day doing things your child enjoys.
• Have fun, low-key after-school activities planned. Your child can’t play sports or roughhouse with orthodontic headgear on. But they need to know they can still have fun. Make it easy for them to participate in other activities, like playing games, watching movies and reading.
• Have tasty, soft foods on hand. It’s a good idea to have soft foods nearby for those days when your child’s mouth feels sore. Ice cream, smoothies and mac & cheese are all good options.
• Help your child sleep better. Your child may have trouble sleeping with their headgear at first. If they’re belly sleepers, they’ll have to adjust to an entirely new position. To help, make sure they’re keeping a set bedtime and winding down for rest. You may invest in a new comfy pillow that provides extra neck support so they can sleep on their back.

When should I call my healthcare provider?

Call your child’s orthodontist if a piece of the headgear breaks or becomes loose. Also, let them know if your child is experiencing serious discomfort. Ensuring that the headgear is in working condition and fitted properly is essential to fixing your child’s bite.

A note from Cleveland Clinic

Orthodontic headgear is a safe and effective way to nudge a bad bite into alignment. But it may involve major changes to both your child’s routine and yours — as you do everything you can to get them to wear it consistently without feeling embarrassed.

Work with your child’s orthodontist to find a treatment schedule that fixes their bite while allowing them to participate (as much as possible) in activities they enjoy. Keep the lines of communication open. The more you know about how your child’s feeling, the more you can offer the support needed to get them to that point where they can leave the headgear behind.