Most children who are given headgear never wear it to school. It goes on after school and stays on overnight, usually adding up to somewhere around 10 to 14 hours a day, and that total is what decides whether it works. The appliance uses a child's own growth to change how the upper and lower jaws line up, so it belongs to a fairly narrow window of childhood and early adolescence.
A light, steady pull on the upper jaw and back teeth
In the usual design, a metal facebow slots into tubes on the upper back teeth or bands, and a padded strap around the neck or over the head supplies a gentle force. Depending on how it is set up, that force can:
- slow the forward growth of the upper jaw while the lower jaw continues to grow, reducing the gap between the upper and lower front teeth
- move the upper back teeth slightly backwards to create room for crowded teeth in front
- hold the back teeth in place while other teeth are moved, which orthodontists call anchorage
It is most often used for a child whose upper front teeth sit well ahead of the lower teeth, sometimes with crowding in the upper arch. Our guide to straightening crooked teeth describes the wider range of crowding and bite problems.
Hours worn matter more than the design
The force only acts while the appliance is on. Children who reach their prescribed hours most days tend to see the planned change. Children who wear it on some nights and not others tend to see much less, and the treatment can stall. Families sometimes find it helps to treat headgear like pyjamas: it goes on at the same point each evening and comes off at breakfast. Many plans include a wear chart, and some appliances record wear time, so progress can be discussed honestly at each visit.
Four common types
| Type | Where the force comes from | Typical use |
|---|---|---|
| Cervical | A strap behind the neck, pulling back and slightly down | Upper teeth ahead of lower teeth, moving upper molars back |
| High-pull | A strap over the top of the head, pulling back and up | Similar problems where a downward pull is unwanted, such as a long lower face |
| Combination | Neck and head straps together | Balancing the direction of pull |
| Reverse-pull facemask | Pads on the forehead and chin, with elastics pulling forward | Underbite where the upper jaw sits too far back |
The facemask is the odd one out. Instead of restraining the upper jaw, it encourages it forward. It is usually started young, often around seven to ten, while the upper jaw is still growing, and it is sometimes paired with an expander. Some of the improvement can be lost with later growth, so results are followed over time. The other three types are generally used a little later.
Timing follows growth
For a child whose upper teeth are ahead of the lower teeth, headgear is usually worn in the late primary or early teenage years, often around the pubertal growth spurt. Started after most growth has finished, it has little effect on the jaws, and other approaches such as braces with tooth movement alone, or for larger adult discrepancies, jaw surgery, come into the picture. That is a strong reason to have a child's bite assessed before the teenage years.
Headgear is rarely the whole treatment. It is commonly followed by fixed braces to finish aligning the teeth, much as a twin block or Herbst appliance may be used first to influence growth before braces.
Less common than it was, but still in use
Headgear is prescribed less often than a generation ago. Fixed functional appliances and temporary anchorage devices, which are small screws placed in the bone, can now achieve some of the same aims without depending on a child to wear an external appliance. Even so, headgear has a long research record, and for restraining forward growth of the upper jaw in a cooperative child it remains a reasonable option. The choice depends on the specific bite, the child's age and how likely they are to wear it.
Day to day with headgear
The appliance is removed for meals, brushing, sport and school. Teeth may feel tender for a day or two after it is first fitted or adjusted, and the usual children's pain relief is generally enough. Modern headgear uses safety straps that release if the facebow is pulled, which reduces the small risk of injury, and children are shown how to take it on and off slowly with both hands. Rough play while wearing it is off limits.
Headgear is usually part of a wider orthodontic plan rather than a separate item, and the overall cost depends on what the full treatment involves. Current options are listed on our offers page, and a written plan can be discussed at a consultation.
What families ask
Does it hurt to wear?
It should not hurt when fitted correctly. Mild tenderness after an adjustment is normal and settles within a day or two.
Can teenagers who have finished growing use it?
Its effect on the jaws depends on growth, so it does little once growth is complete. Older teenagers and adults with similar bites are usually treated with other methods.
Will it change my child's face?
Headgear aims to improve how the jaws and teeth relate, which can affect the profile in some children. The amount of change varies and cannot be predicted precisely, so it is best discussed at the assessment.
What if my child will not wear it?
Tell the practice early. Another appliance that does not rely as heavily on cooperation may be more suitable.
Getting a child's bite assessed
A clear overbite, underbite or crowding in a child is worth having checked while growth can still help. The team at Lumi Dental can assess your child's bite and either plan treatment or refer to a registered orthodontist where that suits the case. Get in touch through our contact page.
This article is general information and is not a substitute for individual advice. An orthodontic assessment is the best way to plan treatment for a child.
