Orthodontics headgear: what kind of teeth need headgear?

While braces and clear aligners can straighten teeth that are out of alignment with each other, headgear allows your  orthodontist the ability to correct the way the teeth come together and align the jaw for the best possible smile. Bringing the bite together properly is also important for good oral health.

Proper care and cleaning of your orthodontic headgears are crucial to get the best from them. You should also learn how to wear and remove the headgears properly. Your appliances should be brought along when visiting the dental office. Orthodontic headgears might initially cause some discomfort, but the result they give will put a beautiful smile on your face.



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.

Headgear components

Headgear describes an appliance that is worn on the outside of the mouth to apply gentle pressure, which can dramatically change the way teeth come together. When used during the early years, it can even guide the growth of the jaw.

Most headgear consists of three parts:

  • The facebow (or J hooks) which are attached to bands on the upper and lower molars and extends to the outside of the mouth and around the face.
  • The headcap, which consists of straps which secure the facebow to the head comfortably and safely.
  • Attachments, which may be elastic bands, rubber bands, or springs that join the facebow and the headcap together in such a way as to provide the right pressure to move the upper teeth (and jaw) back in line.


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. 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. Some malocclusions can co-exist—such an overbite and crossbite.

Types of Headgear

One common type of headgear is called the cervical pull type. This appliance has a U- shaped wire that attaches to the bands on your back teeth, and a strap that is worn behind your neck.

A similar device is the high-pull headgear, which also has a wire connecting to the teeth, plus a strap that goes behind and over the head. These types of headgear are typically used to correct an excessive horizontal overbite (technically called an “overjet”) in children, by holding back the growth of the upper jaw. They can also be used for adults who need help maintaining a proper bite and correct tooth spacing after tooth extraction. Generally, these types of headgear are designed to be worn from 12-14 hours each day.

Another type of headgear is the reverse-pull or “facemask” type. This appliance is generally used to correct an underbite. It gently pulls the upper jaw forward (instead of back), which allows it to catch up with the lower jaw. It consists of two pads — one resting on the forehead, the other on the chin — connected by a vertical frame. Elastics or wires, which connect from the frame to the braces, exert the pulling force. It may be necessary to wear this appliance from 14-16 hours daily.

Benefits Of Orthodontic Headgear

Benefits Of Orthodontic Headgear

Below are some ways in which orthodontic headgear can benefit patients:

  • Necessary in Some Cases – Orthodontics only use headgear when it is necessary. This includes situations when a large gap needs to be closed, the front teeth need to be moved forward, or when a severe underbite or overbite is impeding your smile.
  • Exerts Additional Force –In most cases, the back molars provide plenty of support to serve as an anchor to move the teeth. However, in some cases, extra pressure is needed to move the teeth more accurately. Headgear provides a strap that goes behind the neck or head to apply this pressure.
  • Speeds Up Treatment Time –Lastly, one of the major benefits of headgear is that it can speed up treatment in cases that may otherwise be complex and time-consuming to treat.

In most cases, you and your orthodontist can work together to create a schedule that will allow your child to wear their headgear at home. Keep in mind that you must strictly adhere to the plan you and your orthodontist create to ensure optimal results.

While orthodontic headgear isn’t necessary for all cases of treatment, both adults and children can benefit from it in certain situations. With the help of headgear, your treatment will be over relatively quickly!



Whichever type of headgear you’re wearing, there are some important things you should know. Probably the most essential one is this: In order for it to be effective, you must carefully follow instructions about wearing your headgear — that means putting it on each day for the time specified. If you wear headgear at night and you miss one night, you must make up the time the following day — otherwise, everything you’ve accomplished in the previous seven days of wear could be wiped out!

Consulting with orthodontist will help prepare you or your child for the exact treatment planned, but these basic tips will help prepare your family for having headgear in the house:

  • Expect some tooth soreness after the headgear is fitted, especially when touching the teeth together or chewing. Eating soft foods and taking ibuprofen, naproxen, or acetaminophen will help ease this temporary discomfort.
  • Depending on the type of headgear and the severity of the problem being fixed, it might be possible to wear the orthodontic headgear only in the evening and while sleeping, to meet the number of hours your orthodontist recommends.
  • Especially with young children, it might be recommended to gradually increase the hours of wearing the appliance until the goal time per day is reached.
  • At regular visits, the tension on the headgear will be adjusted, which may cause tooth or jaw soreness afterward, as the angle is changed or pressure is increased.
  • You should not play sports while wearing the appliance.
  • You may be asked to keep a log of the hours the headgear is worn.
  • While headgear should be removed when eating, it can remain in while drinking with a straw.


  • The molars (back teeth) might become loose—this is normal; however, if there is severe pain, you should report this to your orthodontist’s office immediately.
  • If a band comes loose or the headgear suddenly does not seem to fit, it is important to see your orthodontist right away or progress made might be lost.
  • When the adjustments are complete, headgear might still be worn to keep the jaw in place until it stops growing.
  • In rare situations, minor surgery might be recommended to improve the results or speed up the process.
  • Your orthodontist will determine when to have braces fitted if that will be the next step toward a winning smile.


To keep your orthodontic headgear working as it should — and to maintain your overall oral health — it’s important that you follow instructions about care and cleaning. It’s also important that you learn to put headgear on and take it off properly and safely. Remember to bring it with you every time you have an appointment at office — but leave it behind when you’re playing sports, or even horsing around in the living room!

Wearing orthodontic headgear may seem like a big adjustment — and nobody would deny that it takes some getting used to. But remember that you’re part of a team, which includes your general dentist… and you! When everyone works together, it’s possible to achieve your goal: a beautiful smile that you’ll have for your whole lifetime.

In order for your appliance to provide the best results, there are a few rules to live by when wearing headgear:

  • Follow your individualized instructions and consistently wear your headgear for the recommended times of day.
  • If you normally wear your headgear at night, and you miss a night, make up all the hours the very next day. Missing one night without making the time up can set progress back an entire week!
  • Keep in mind that every hour missed will set back progress and increase the amount of time that you will need to wear headgear.
  • Fast progress can be made at a young age, so starting early is the most efficient way to change a growing issue.
  • There is no such thing as wearing the appliance too much, as long as you remove it to eat, play sports, and to clean.
  • Clear braces or even Invisalign trays might be a follow-up treatment to improve minor tooth alignment after the headgear phase is complete.


Depending on what type of headgear you have, your orthodontist may have specific instructions for care and maintenance, in addition to these general guidelines:

  • Brush your teeth as often (or more often) than you did before treatment, paying particular attention to removing any food particles around the bands and hooks.
  • Floss as your orthodontist recommends. You may need to avoid certain spaces between teeth to avoid loosening the bands.
  • Brush the parts of the facebow that are inside your mouth with a toothbrush and toothpaste or wash the metal parts with clear antibacterial soap and rinse well before replacing.
  • The straps and other parts of your headgear should not need to be washed regularly. If they do become stained, wipe with a damp cloth or follow your orthodontist’s cleaning instructions.
  • When removing your headgear, detach the elastic strap first by unlocking it from the bow, in order to protect your eyes and put less stress on the appliance.