There are many different types of headgear used in dentistry, each of which can be configured to treat specific alignment disorders. They are most effective when used during early adolescence to the later teen years.
Orthodontic headgear is primarily used to correct bite alignment problems, referred to as anteroposterior discrepancies. The problem can involve the maxilla (upper jaw) and/or mandible (lower jaw). Issues include:
- Overjet, known commonly as “buck teeth,” in which the upper front teeth protrude at an outward angle toward the lip
- Overbite (retrognathism), in which the upper front teeth excessively overlap the lower front teeth
- Underbite (prognathism), in which the lower front teeth and jaw protrude in front of the upper front teeth
- Crossbite, in which the upper and lower teeth do not align when you bite down
The misalignment of the jaw and teeth is referred to as a malocclusion. An overjet and overbite are considered Class II malocclusions, while an underbite and crossbite are both Class III malocclusions. Some of these conditions can co-exist—such an overbite and crossbite—and require an individualized approach to correct both at once.
When an Overbite Can Become a Serious Problem
Orthodontic headgear is generally used for children 9 and older with jaw growth discrepancies. At the stage in a child’s development, the bones of the jaw will still be actively growing. By holding back the growth of the jaw with consistent pressure, a malocclusion may be resolved noninvasively. This is often a far better solution than dealing with the problem as an adult when corrective surgery is more likely needed.
By the age of 13 to 18, medical evaluation may be needed to determine if the child is still growing. This can be done with a cephalometric X-ray to inspect the bones of the spine (the clearest indicators of bone growth potential). If no further growth is expected, orthodontic headgear will offer little, if any, benefit.
In non-growing children and adults, orthodontic headgear is occasionally used to correct severe spacing problems when braces alone are not enough.
How Headgear Works
As per its name, orthodontic headgear is worn on the head. There are different types used, some of which are attached with straps to the back of the head or neck and others of which are worn as a full-head cap.
A variety of appliances can be anchored to the headgear, including J-hooks, elastic bands, coil springs, retainers (to hold the teeth in place), power chains (to adjust the position of the teeth), lip bumpers, and facebows (external wire apparatus that extends across the face and into the mouth).
These appliances are attached to the braces with hooks. The orthodontist will then adjust the tension between the headgear and braces to stop, alter, or slow the growth of the jaw. The amount of pressure exerted is between 350 to 450 grams per side (more or less the same level of tension used for braces).
Broadly speaking, there are two types of headgear used for orthodontic treatment: a cervical and high- pull headgear or a reverse-pull facemask.