Short answer: An orthodontic face mask is a removable device that rests on the forehead and chin and is used to guide the upper jaw forward in growing children whose upper jaw is set back. It is usually worn between ages 6 and 10, for 12–14 hours a day, mostly at night. In most cases treatment lasts 6–12 months; regular follow-up until growth is complete and a second orthodontic phase in later years may be needed.
If you have noticed that your child's lower teeth close in front of the upper teeth, or that the middle part of the face looks set back in profile, your orthodontist may recommend an orthodontic face mask. A face mask is a removable device supported from outside the mouth that is used to guide the development of the upper jaw forward in growing children. In this article we explain how a face mask works, at what age it is effective, how it is worn day to day and what to expect afterwards.
What is a face mask and how does it work?
A face mask is an orthodontic device made up of pads that rest on the forehead and chin and a metal frame connecting them, which applies a light, continuous forward force to the upper jaw. In the literature it is also called “reverse headgear” or a “protraction mask.”
The working principle is quite simple. An appliance attached to the upper teeth sits inside the mouth; elastic bands hooked to small hooks on the front of this appliance are connected to the bar of the mask in front of the mouth. The elastics pull the upper jaw forward and slightly downward. During the growth years, the upper jawbone can respond to this force because the suture areas where it joins the other bones of the skull have not yet fully fused.
The intraoral appliance often also includes an expansion screw. Widening the upper jaw sideways both corrects a narrow palate and can support the forward pull by preparing the suture areas for movement. The orthodontist decides which appliance to use based on the child's jaw structure.
At what age and in which cases is it used?
A face mask is mainly used for skeletal Class III bite problems in which the upper jaw is set back, in growing children. The period when response to treatment is most pronounced is usually the early mixed dentition stage, when baby teeth and permanent teeth are present together; for most children this corresponds to roughly ages 6 to 10.
Some signs parents may notice are:
- The lower front teeth closing in front of the upper front teeth (underbite)
- The middle of the face looking flat or sunken when viewed from the side
- The lower jaw appearing noticeably forward
- Crossbite in the back teeth
Not every underbite is skeletal in origin. In some children the problem is only related to the angle of the teeth, or the child habitually slides the lower jaw forward. Which situation applies is determined by a clinical examination, X-rays and, if needed, cephalometric measurements. That is why the Turkish Orthodontic Society and the American Association of Orthodontists (AAO) recommend that children have their first orthodontic evaluation around age 7. For more information on orthodontic options by age, see our article at what age can you get clear aligners.
As the growth rate slows and the suture areas fuse, the skeletal effect of the face mask decreases significantly. It is usually not possible to achieve the same effect after puberty; that is why timing is one of the most critical elements of the treatment.
How many hours a day is a face mask worn?
A face mask is generally recommended to be worn 12 to 14 hours a day; most of this time is completed during nighttime sleep. If the mask is put on when the child gets home in the evening and worn until morning, most children reach the target time.
The amount of force is adjusted by the orthodontist, and the elastics are replaced at set intervals. Because elastics lose their stretch over time, you may be asked to change them daily. In the first days, slight pressure on the teeth and redness where the pads touch the forehead and chin may be felt; keeping the pads clean and checking skin contact reduces these problems.
Parents play a very large role in this treatment. A face mask worn at night may feel strange to children at first. Recording wear hours on a calendar, making the mask part of the evening routine and explaining the process to the child in age-appropriate language noticeably improve compliance.
- The mask does not have to be worn during school hours.
- It should be removed during sports and play.
- Elastics should be put on and taken off under parental supervision.
- Extra care should be taken with toothbrushing because of the intraoral appliance.
How long does treatment take and what are the results?
In most cases face mask treatment lasts between 6 and 12 months; the duration depends on the severity of the initial discrepancy and how consistently the child wears the mask. The goal is usually to achieve normal overlap of the front teeth and even a slight overcorrection.
With a face mask started at the right age and worn consistently, the aims are to support forward development of the upper jaw, correct the underbite in the front teeth and achieve a more balanced facial profile. Part of the effect is skeletal and part is at the level of the teeth.
There is one important point parents should know: lower jaw growth is largely genetically determined and continues throughout adolescence. Therefore, even after successful face mask treatment, the underbite may partially return during the growth period. This possibility does not mean the treatment failed; it is a biological condition that needs to be assessed with regular follow-up. In some severe skeletal cases, orthognathic surgery may be considered after growth is complete. Which path is appropriate is determined by the orthodontist through follow-up over the years.
Can a face mask be used together with clear aligners?
Changing the jaw relationship at the skeletal level is the job of the face mask; clear aligners, on the other hand, are mainly designed to move teeth. So the two methods do not replace each other, but they can complement each other at different stages of treatment. After jaw development has been guided early on, problems with tooth alignment can, in suitable cases, be addressed with options for children such as Invisalign First. We discuss the limits of what clear aligners can do for jaw structure in detail in our article can clear aligners correct jaw structure.
Is orthodontic treatment needed after a face mask?
After face mask treatment, most children need a monitoring period and a second phase of orthodontic treatment in later years. While early treatment focuses on correcting the jaw relationship, the alignment of the teeth and fine-tuning of the bite are planned separately once the permanent teeth have erupted.
After the mask is discontinued, the orthodontist may recommend a retention device worn at night for a while to maintain the correction achieved. As long as the child continues to grow, the jaw relationship is monitored with annual or six-monthly check-ups. When the permanent dentition is complete, the second phase can begin as needed with fixed braces or, in suitable cases, with Invisalign.
The scope and timing of this second phase differ for each child. Early treatment can help make later treatment simpler; however, whether it will be needed and how it will be done becomes clear through growth monitoring.
When should your child have an orthodontic evaluation in Ankara?
If you have noticed an underbite, crossbite or a clear imbalance in your child's facial profile, it is important not to wait for the growth period to pass before getting an evaluation. At our clinic in Oran, Çankaya, our orthodontist examines your child's jaw development, takes the necessary records and, if treatment is needed, plans the right timing together with you; for information and appointments, you can contact us.
Frequently asked questions
Does a face mask hurt children?
A face mask applies a controlled, light force. In the first days, pressure on the teeth and mild discomfort where the pads make contact may be felt; for most children this eases quickly. If there is significant pain, a skin sore or a loose appliance, see the orthodontist.
Does the face mask need to be worn at school too?
No, in most treatment plans the mask does not need to be worn at school. The recommended daily time is usually completed in the evening hours and during nighttime sleep. Keeping wear hours consistent is decisive for the effectiveness of the treatment.
Does a face mask work during adolescence?
The skeletal effect of a face mask is pronounced in the early stages of growth and decreases with age. The same effect is generally not expected after puberty. For a child of this age, the orthodontist evaluates suitable options based on the examination and records.
Can the problem come back after face mask treatment?
Because lower jaw growth continues throughout adolescence, the underbite may partially return in some children. That is why regular check-ups continue after treatment until growth is complete. If deemed necessary, additional orthodontic treatment is planned.
