Treatments & Appliances

6 min read · By Dr. Kevin Baharvand, Diplomate, American Board of Orthodontics

What orthodontic headgear actually is

Headgear is one of the older tools in orthodontics, and it still looks the part. A metal framework fits around the head or neck and connects to the teeth or an appliance inside the mouth. The part people picture, the wire bow across the front, is called a facebow. It hooks into small tubes on the back molars and links to straps that anchor against the head or neck.

Here is the key idea. Braces and aligners move teeth against each other. Headgear does something braces cannot: it reaches outside the mouth for anchorage, which lets an orthodontist apply force to the whole upper jaw, not just the teeth. That external leverage is what makes it useful for the bite problems that come from how the jaws are positioned, not just how the teeth are lined up.

How headgear works

The whole thing runs on a simple principle: light, constant force applied over time reshapes how bone and teeth develop. In a growing child, the upper jaw (the maxilla) is still moving forward and down each year. Headgear taps into that growth. Depending on the setup, it can slow the forward growth of the upper jaw, pull upper molars backward to open up space, or in the reverse configuration, encourage an underdeveloped upper jaw to come forward.

Because it depends on active growth, timing is everything. Use it while the jaws are still developing and you can steer them. Wait until growth finishes and the same appliance does very little. That is why headgear is a kids-and-teens tool, and why your orthodontist watches jaw growth so closely during the early years.

The main types of headgear

Not all headgear looks or acts the same. The three you are most likely to hear about differ by where they anchor and which direction they pull.

What headgear treats

Headgear earns its place with jaw-based problems. A severe overbite, where the upper teeth and jaw sit too far ahead of the lower, is the classic case for cervical or high-pull headgear. A true skeletal underbite in a young child, where the upper jaw lags behind, is the case for a reverse-pull facemask. It also helps create room in a crowded arch by moving molars back so the other teeth have somewhere to go.

Wearing headgear day to day

This is where treatment succeeds or stalls. Headgear only does its job while it is on, and most kids need 12 to 14 hours a day to see results on schedule. The realistic plan is simple: put it on after school and wear it through the evening and overnight. That gets you to the target without wearing it to class.

A few things make it easier. Take it off for meals, brushing, and contact sports, then put it right back on. Expect three or four tender days after each adjustment, which regular over-the-counter pain relief handles fine. And build it into a routine, because the kids who treat it like a nightly habit finish far sooner than the ones who wear it in fits and starts.

Modern alternatives to headgear

Honest take: we reach for headgear far less than orthodontists did a generation ago. The tools have improved. Temporary anchorage devices, tiny screws placed in the bone, can provide the same anchorage headgear gives without anything worn on the head. Palatal expanders handle many width problems. Functional appliances address certain bites. And for the right cases, Angel Aligners or other clear aligners can do work that once required more hardware. Most people call clear aligners "Invisalign," but that is one brand in a category with several strong systems, and we prefer Angel Aligners in most cases for fit and value.

That said, headgear has not disappeared for a reason. In select growth cases, especially early underbite correction, a facemask still does something no aligner can. The right question is not headgear versus everything else. It is which tool fits your child’s specific jaw pattern and stage of growth, and that is exactly what an exam sorts out.