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Orthodontic headgear is a type of orthodontic appliance attached to dental braces that aids in correcting severe bite problems.
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Need for treatment and concurrent corrections
The most common treatment headgear is used for is correcting anteroposterior discrepancies - for instance the top teeth being too far forward relative to the lower teeth ("increased overjet", also known as a malocclusion) The headgear is attached to the braces via metal hooks or a facebow and is anchored from the back of the head or neck with straps or a head-cap. In some situations both are used. Elastic bands are then used to apply pressure to the bow or hooks. Its purpose is to slow-down or stop the upper jaw from growing, hence preventing or correcting an overjet.
Other forms of headgear treat reverse overjets (where the top jaw is not forward enough.) It is similar to a facemask, also attached to braces, and encourages forward growth of the upper jaw.
The headgear can also be used to make more space for teeth to come in. The headgear is then attached to the molars (via molar headgear bands & tubes), and helps to draw these molars backwards in the mouth, opening up space for the front teeth to be moved back using braces and bands. Multiple appliances and accessories usually go along with their headgear, such as power chains, coil springs, twin blocks, plates or retainers, facemasks, a headgear helmet (a headgear helmet is a cervical headgear with a cap that covers the entire head), lip bumpers, palate expanders, elastics, bionaters, herbst appliances, wilson appliances, other headgear, hybrid twinblocks, positioner retainers, and jasper jumpers. Many patients wear a combination of, or all of these appliances at any given time in their treatment.
Forms of headgear treatment
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Headgear needs to be worn approximately 12 to 16 hrs each day to be effective at all in correcting the overbite, usually anywhere from 6 to 12 months depending on the severity of the overbite and how much a patient is growing.
The orthodontic headgear will usually consist of three major components:
Face bow: firstly the face-bow (or J-Hooks), which fits with a metal arch onto headgear tubes attached to the rear upper and lower molars. This face bow then extends out of the mouth and around the face. J-Hooks are different in that they hook into the patients mouth and attach directly to the brace (see photo for example of J-Hooks). Head-cap: the second part consists of a head-cap, which consists of a number of straps fitting around the head. This is then attached with elastic bands or springs to the face-bow. Additional straps and safety attachments will be used to ensure comfort and safety (see photo). Attachment: the third and final component (typically rubber bands, elastic or springs) joins the face bow or J-Hooks and the head cap together, providing the force to move the teeth backwards.
Soreness of teeth when chewing, or when the teeth touch, is typical. Teenagers usually feel the soreness to 2-3 hours later, but younger patients tend to react sooner, (e.g., 1 to 1 1/2 hours). The headgear is one of the most useful appliance available to the orthodontist.
Facemask & Reverse-Pull Headgear
Facemask or Reverse-pull Headgear is an orthodontic appliance typically used in growing patients to correct under bites (known as a Class III orthodontic problem) by pulling forward and assisting the growth of the upper jaw (the maxillary), allowing the upper jaw (mandibular bone) to catch up.
Facemasks or Reverse-pull Headgear needs to be worn approximately 18 to 24 hrs to be truly effective in correcting the under bite, usually anywhere from 12 to 110 months depending on the severity of the bite and how much a patient is growing.
The appliance normally consists of a frame or a center bars that are strapped to the patient's head during a fitting appointment. The frame has a section which is positioned in-front of the patient's mouth, which allows for the attachment of elastic or rubber bands directly into the mouth area. These elastics are then hooked onto the patient's braces (brackets and bands) or appliance fitted in his or her mouth. This creates a forward 'pulling' force to pull the upper jaw forward.
The orthodontic facemask will consist of three major components:
- Face frame: firstly the face-frame, is a metal and plastic structure which is adjusted to fit onto the patient's face. The frame normally is stabilized on the child's face with the aid of a "chin cup" and a "forehead pad". These are padded to ensure patient comfort. The frame typically as a "mouth-yoke" which the orthodontist will adjust so it is positioned in-font of the patients mouth. The mouth yoke has a number of hooks (4 to 6 depending on type - see photo with 6 hooks) which allows the orthodontist to attach elastics or springs directly into the patients mouth. The frame allows the patient to move his or her head freely and to talk. All other oral activates are however restricted although drinking is recommended with a straw so as not to remove the whole appliance at night or in the day when thirsty.
- Head-cap: some facemasks and all reverse-pull headgear have a second part which consists of a head-cap, and is made up of a number of straps fitting around the patient's head. In this case the head-cap is used to stabilise the face-frame described above and to ensure it is held correctly in position (see photo example of reverse-pull headgear with head-strap / cap).
- Attachment: the third and final component is the mouth attachment, typically using rubber bands - joins the face-mask from the mouth-yoke, into the patient's mouth. The elastics hook on the patient's braces or other such suitable oral appliance. As the elastics are flexible up to six elastics may be used to provide various forward and sideways forces on the patients teeth and arch, while still allowing the patient to open and close his / her jaws.
In some cases it will be required to use surgery and a face-mask / reverse-pull headgear, although many parents and doctors recommend using early intervention (ages 7 to 13) using a facemask to avoid costly and painful surgical procedures later.
The appliance is very effective in correcting Class III orthodontic problems in younger or adolescent patients that are still growing.
Initially it can be difficult for children to wear a mask or headgear, however most doctors and parents agree that children and adolescence adapt quickly to such changes and requirements. Parents should be aware that their child is often better-off wearing a facemask or headgear to avoid later surgery and the patient, friends and school peers normally get used to the new appliance after just a few weeks of wear.
Complications and Risks
There are many complications and issues of having orthodontic headgear. These include a child's fear of mockery and harassment with regards to the appearance of the headgearcitation needed, troubles eating, sleeping, and other motions or actions which involve the head or jaws.
The need for headgear as a useful appliance for orthodontists and its use has increased greatly as less and less orthodontists use temporary implants ("temporary anchorage devices") inside the patients mouth, to perform the same tooth movements.
Moving the top row of teeth back to meet the bite of the lower teeth can result in various problems. TMJ and jaw pain are typical problems. The jaws of some patients cannot open completely, and thus they are unable eat some foods, and are unable to yawn. Some patients have chronic neck and head pain for the rest of their lives.
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- This page was last modified on 1 November 2008, at 18:51.
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