When and Why Orthodontic Headgear Is Recommended for Kids

If your child’s orthodontist has recommended headgear as part of their treatment plan, you might feel surprised it’s not as common as it once was. But for certain jaw alignment issues, orthodontic headgear remains an effective, often essential, tool.

Designed to correct more than just the position of teeth, orthodontic headgear targets the alignment of the upper and lower jaw. And when used properly in growing children and teens, it can set the foundation for a healthier bite and better oral function for years to come.

What Is Orthodontic Headgear?

Orthodontic headgear, sometimes called an extra-oral appliance, is a device worn outside the mouth that works alongside braces. While braces shift individual teeth, headgear applies gentle but consistent force to guide jaw growth and correct misalignments, especially when there's a gap between where the upper and lower jaws should align.

Though headgear is prescribed less frequently today thanks to advances in other orthodontic devices, it remains the most effective solution for certain cases of malocclusion misaligned bites that include:

• Overbite (Class II): Upper teeth overlap the lower teeth too much

• Underbite (Class III): Lower jaw protrudes past the upper jaw

• Overjet: “Buck teeth” or front teeth that extend outward

• Crossbite: Upper teeth sit inside lower teeth when biting

Some children may have a combination of these issues, and headgear may help guide proper development during critical growth phases.

Types of Orthodontic Headgear

Your child’s orthodontist will recommend a headgear type based on the specific alignment issue. Common types include:

• Cervical headgear: Attaches behind the neck; corrects overbites by gently pulling the upper jaw back

• High-pull headgear: Anchors to the top of the head; useful for both overbites and open bites (where front teeth don’t touch when the mouth is closed)

• Reverse-pull facemask: Worn like a mask with forehead and chin supports; helps move the upper jaw forward to fix underbites

Additional components like elastic bands, J-hooks, facebows, and lip bumpers are often used to target specific parts of the bite or teeth, fine-tuning how pressure is applied.

Why Children Are the Best Candidates

Headgear works best in children and teens whose bones are still developing. During these growth years, the jaw can be gently guided into better alignment, making future dental complications like TMJ disorders, sleep apnea, or even speech issues less likely.

In rare cases, adults may be prescribed headgear to correct shifting after tooth extractions or failed earlier treatment, but results are more limited.

What to Expect When Your Child Starts Wearing Headgear

Wearing headgear does require commitment. Most orthodontists recommend:

• 8–10 hours of wear per day, often overnight and a few hours during the day

• Removal during meals, sports, and rough play

• Drinking through a straw is fine, but chewing food with headgear on is not recommended

At first, the device may cause soreness or discomfort, especially as your child adjusts or when the orthodontist increases tension. A slow build-up starting with just an hour on the first day and increasing gradually can ease the transition.

To manage discomfort:

• Offer soft foods during adjustment periods

• Apply a cold pack to achy areas

• Provide encouragement and reassurance, especially if your child is self-conscious

Most children wear headgear for six months to a year, depending on how quickly the jaw responds to treatment and how consistently they wear the appliance.

Why Compliance Matters

The more reliably your child wears their headgear, the shorter the total treatment time is likely to be. It may help to remind them that consistent use could mean getting rid of it sooner.

Some children may feel embarrassed about wearing headgear, especially if they need to wear it during the day. Framing it as a short-term step toward a confident, healthy smile and possibly fewer orthodontic appointments can help.

The Bigger Picture

Malocclusions aren’t just cosmetic. Without proper alignment, children may develop:

• Temporomandibular joint (TMJ) disorders

• Tooth wear and damage

• Difficulty chewing or speaking clearly

• Sleep-disordered breathing, including sleep apnea

Orthodontic headgear may be one of the most direct ways to prevent these issues from becoming lifelong challenges.

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