Will I Need Headgear With Braces?

Will I Need Headgear With Braces?
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Will I Need Headgear With Braces?Clinical Content Reviewed by Licensed DDS
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Table of Contents

  1. What Is Headgear?
  2. Headgear Usage
  3. When Is It Needed?
  4. Types of Headgear
  5. Potential Issues
  6. Alternative Options
  7. Can Aligners Help?
  8. References

When we think of a smile, we think of a bright, white curve. If you need braces, your smile will probably be bright with metal. And if you need headgear, it might be hard to see your smile at all.

If you have something called a deep bite, where your front teeth tap on soft tissues in your lower jaw, you could need headgear. But your orthodontist might choose another solution instead, as other options are available.

What Is Headgear?

Pressure moves your teeth. Wires and brackets apply a push while you're wearing braces, but some people need a little bit more. Headgear provides that extra emphasis.

Headgear has three main components:

  1. Wire: A piece of bow-shaped metal sits outside the mouth, and a similar piece sits inside your mouth.
  2. Straps: Your external wires connect to this soft, elastic piece. Internal wires connect to a device inside your mouth.
  3. Neck pad: Straps attach to another soft piece that wraps around the back of the head.

Wearing headgear shouldn't be painful. But it's not exactly comfortable. The straps and bands can restrict the free movement of your head, and you can poke your face and eyes as you take the device on and off.

People typically wear headgear all day and all night. It's hard to wear it too much. Researchers say there's no clear demographic that doesn't follow instructions. Most people try to do what their dentists ask of them.

But it's likely that people let out a little cry of joy when they're no longer required to wear all of this metal and strapping and wires. And if you don't want headgear at all, you're not alone.

People with deep bites may need headgear to attain a healthy smile, but if your orthodontist recommends this appliance, you have options.

What Is Headgear Used For?

Braces are powerful, and when they're applied by professionals, they work effectively and quickly. But sometimes, people need a little more help than brackets and wires can provide.

Headgear is considered the "gold standard of treatment" for people with a class II malocclusion. Typically, that involves a deep bite. When you close your mouth completely, your upper teeth touch soft tissues in your lower jaw.

Headgear applies pressure on the upper jaw, and that allows:

  • Growth restriction. Your upper jaw is held in place, and your lower jaw is allowed to get longer and bigger. In time, your lower jaw might be as big as the upper, and that could correct your bite.
  • Alignment adjustment. Your upper jaw is pushed back, in relation to the lower version, with headgear. In time, your jaw could take on this new position naturally.

Some people use headgear at the same time as braces. While their jaws are moving, their teeth are taking up new positions too. But some people use headgear before they start treatment with braces.

When is Headgear Needed?

Headgear is becoming less common in orthodontic treatment, but it is still an important form of orthodontia used to shift children’s growing jaws into proper alignment.

Typically, children 7 years old or younger benefit the most from headgear. During adolescence, the jaw stops growing as much, so headgear will not adjust the size or position of the jaw, even when they can shift some teeth.

Types of Headgear

types of headgear

There are different types of headgear that work for different types of malocclusions.

  • Cervical pull headgear: This device wraps around the head and pulls the child’s upper teeth and jaw into proper alignment, and slows growth of the upper jaw. This treats overbites and overjets.
  • Reverse pull headgear: This orthodontic device attaches to the forehead and chin. It pulls the lower jaw forward to treat underbites and crossbites.
  • High pull headgear: This device attaches to the top of the head and adjusts growth of both jaws to manage an open bite. This is a rare dental condition in which both top and bottom teeth jut outward and do not meet when the mouth is closed.

Issues with Headgear

Since there have been several improvements to orthodontic treatment in the last few decades, orthodontists are less likely to prescribe headgear unless it is absolutely necessary.

There are potential side effects of wearing headgear that can plague adults, including severe sleep apnea from malformed jaws, breathing problems while awake, and chronic jaw pain and strain. In rare cases, headgear has caused eye injuries and changes to the shape of the skull, which can last a lifetime.

As a result, modern orthodontists will try to avoid it. But for children with the potential for severe jaw malformations and dental malocclusions, their pediatric dentist may prescribe headgear to manage the problem.

Headgear can be finicky for young children, as the device must be worn for 12 to 14 hours per day for anywhere between one and two years. Since younger children are the primary people who benefit from headgear but are less likely to comply with the requirements, an orthodontist may try other devices or consider surgery later in life to manage potential overjets, overbites, underbites, or open bites.

When headgear was originally developed, it was applied to both Class II and Class III malocclusions. Since then, orthodontists have found that headgear is less effective at treating or even preventing Class II malocclusions after treatment, as the jaw grows differently. There can be serious long-term issues with jaw health.

However, with Class III malocclusions, one of the jaws is smaller than the other, so the teeth do not fit together. The tongue does not fit well in the mouth. This type of malocclusion benefits from treatment with headgear early in life.

Headgear is not prescribed for orthodontic treatment in adults. There are other appliances that can change jaw size problems, dental alignment, and overbites or underbites.

What Else Can We Try?

alternatives to headgear

Experts agree that people with deep bites need careful and individualized treatment plans. Something that works for one person may not work for all. For example, while headgear is right for some, it isn't your only choice.

Your doctor may choose something called a Frankel functional regulator to adjust your bite instead of headgear. Research suggests that both tools are equally effective.

A Frankel functional regulator sits inside your mouth. Wires wrap around your teeth, and plastic pieces push on your jaw. It's much harder to see a device like this, but it's working to either restrict jaw growth or push the jaws back.

Your dentist could also choose:

  • Elastics. Strong rubber bands connect your upper and lower jaws. They offer traction that could inhibit growth or change alignment.
  • Braces alone. Changing the position of your teeth can mean altering the position of your jaws, even without extra appliances.
  • Watching and waiting. Some young people have unusual jaws that amend themselves with growth and time.

If you're deeply opposed to headgear, you could ask your dentist to examine these options and see if they're right for you.

Can Aligners Help?

Headgear typically attaches to something inside of your mouth. Braces are an obvious choice. But don't think that people with headgear can never use aligners.

Plenty of people amend a jaw placement issue with headgear, and when that's fixed, they move on to straighten teeth with aligners. Clear, plastic trays apply pressure to teeth until they take up ideal positions. Treatment doesn't involve scraping and scratching from metal braces, but it's just as effective.

If you're looking for help with your smile, consider treatment with Byte aligners. Our telemedicine platform can lower your costs while heling you preserve your smile. The process begins with an easy, at-home assessment. We'd love to have you join us!

References

The Role of Psycho-Social Factors in Headgear Compliance. (June 2005). European Journal of Orthodontics.

Dental and Skeletal Effects of Combined Headgear Used Alone or in Association With Rapid Maxillary Expansion. (October 2015). Dental Press Journal of Orthodontics.

Headgear. British Orthodontic Society.

Treatment of Class II, Division 2 Malocclusion in Adults: Biomechanical Considerations. Journal of Clinical Orthodontics.

Headgear Versus Function Regulator in the Early Treatment of Class II, Division I Malocclusion: A Randomized Clinical Trial. (January 1998). American Journal of Orthodontics and Dentofacial Orthopedics.

Frankel Functional Regulator. (2021). Medizin.

Preadolescent's Oral Health-Related Quality of Life During the First Month of Fixed Orthodontic Appliance Therapy. (September 2013). Journal of Orthodontics.

Headgear Appliances. Capan Orthodontics.

Orthodontic Headgear: Types & When Treatment Is Necessary. New Mouth.

The Role of Headgear in Growth Modification. (March 2006). Seminars in Orthodontics.  

Developing Class III Malocclusions: Challenges and Solutions. (June 2018). Clinical, Cosmetic, and Investigational Dentistry.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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