Short answer: Headgear is an orthodontic device that applies force to the teeth and upper jaw from outside the mouth by connecting a bow inside the mouth to a strap around the head or neck. It is used during the growth years to manage upper jaw protrusion and guide the position of the molars. In most programs it is worn for roughly twelve to fourteen hours a day, in the evening and at night. Suitability is determined by an orthodontic examination.
The image of a head cap or neck strap extending outside the mouth brings to mind one of the most dreaded devices in orthodontic treatment. Yet headgear (an extraoral appliance) is still a valuable tool in the right cases and when worn consistently. In this article we answer the question of what headgear is, explain when and how it is used, how many hours a day it should be worn and the rules for using it safely. We also cover alternative methods at the end.
What is headgear?
Headgear is an orthodontic device that allows a bow or bands placed in the mouth to be pulled from outside the mouth by means of a strap around the head or neck. Because it is used at night and at home, it is also popularly known as an orthodontic head cap.
The device consists of three parts: a bow inside the mouth (face bow) that connects to bands usually placed on the upper first molars, a strap that goes around the back of the head or neck, and an elastic connection that links the two and adjusts the force. Because the bow inside the mouth is connected to the teeth, the force is transmitted directly to the molars and the upper jaw. You can see the general range of orthodontic appliances on our orthodontic appliances page.
When is headgear used?
Headgear is an extraorally anchored method used in growing children to address upper jaw protrusion or forward drift of the upper molars. Because the force pulling on the teeth or jaw comes from an anchor outside the mouth, no load is placed on the other teeth inside the mouth; this feature sets headgear apart in certain cases.
Orthodontists usually plan the device for the following purposes:
- Limiting the forward growth of the upper jaw during the growth years.
- Moving the upper molars back to create space for crowded or protruding teeth.
- Controlling space closure after tooth extraction by preventing the molars from shifting (anchorage support).
- Guiding the vertical position of the molars in a deep bite or a tendency toward open bite.
We explain how protruding upper front teeth relate to different treatment options on our page clear aligners and protruding teeth. For details on the vertical dimension of the bite, see our deep bite page.
What types of headgear are there?
Types of headgear are classified by the direction of pull, and each serves a different purpose. The direction of pull is determined by where the extraoral strap is placed.
- Cervical (neck strap) headgear: Applies force from the back of the neck; it pulls the molars back and slightly down. It is mostly used in children with a tendency toward deep bite and a short or normal face height.
- High-pull (top of the head) headgear: Because the force is directed toward the top of the head, it pulls the molars back and up. It may be preferred in children with a tendency toward open bite and a long face height.
- Combination headgear: Adjusts the direction of pull by using neck and head straps together.
This choice is made taking into account the child's facial structure and bite relationship; because an incorrectly chosen direction of pull can lead to unwanted tooth movements, the type should be determined by the orthodontist.
How many hours a day should it be worn?
In most programs, headgear is worn for roughly twelve to fourteen hours a day; this time is arranged to cover the evening hours and the night. It does not need to be worn during school hours, so it affects the child's social life less.
Consistent wear is essential for it to be effective, because with insufficient wear the desired tooth movement slows down, and when the force stops, the teeth can slide back toward their old positions. If the device is worn for short periods in the first weeks and the time is then increased, the child adapts more easily. Keeping a wear chart and having a parent check during sleep at night that the device is worn correctly are helpful. The wear time and amount of force are set according to the orthodontist's plan; you should not increase the force yourself at home.
Things to keep in mind when using headgear
Headgear is a safe device, but because it works around the face, certain rules must be strictly followed. Safety is the most important topic here.
- The device should only be put on as the orthodontist has shown; the bow should be placed in the tubes inside the mouth first and the strap attached afterwards.
- The device must never be worn during sports, play, running around or fighting; there is a risk of impact to the face or eye injury.
- The headgear used today has a safety release mechanism that separates the strap from the bow if there is a sudden pull; if this mechanism does not work, the device should not be used.
- When removing the device, the strap should be released first and the bow taken out last; the child should not be allowed to pull the bow out on their own.
- If the device comes out while the child is sleeping or pain is felt in the mouth, contact the clinic.
In addition, the device needs to be cleaned every day, the bands checked for loosening and appointments attended regularly. If the device breaks or stops working, do not try to repair it yourself.
How long is headgear used?
In most cases, headgear is used for anywhere from several months to a few years; this range is determined by the treatment goal and the child's compliance with the device. If the goal is to guide upper jaw growth, the time is usually longer; if the goal is only to maintain the position of the molars, it may be shorter.
During treatment, check-up appointments are usually every four to eight weeks. The orthodontist assesses the length of the bow, the amount of force and the changes in the child's mouth. Stopping use of the device before the necessary time is up can lead to partial loss of the correction achieved so far. When the goal is reached, the orthodontist plans the transition to other devices or the braces stage; afterwards, a retainer is used to maintain the results. For more on retainers, see our article on the Hawley retainer.
How does a child get used to headgear?
Many children find the device strange in the first days; this reaction is perfectly natural. A few approaches families often use speed up adjustment: putting the device on at home first, for short periods while the child is awake; linking it to the evening routine (for example, after brushing teeth); taking care that it is not worn at school so that siblings or friends do not tease the child; and supporting consistent wear with small rewards.
If the device disturbs the child's sleep, causes sores in the mouth or irritates the neck, the orthodontist should be told; often adjusting the pillow, a soft cover on the strap or a small adjustment is enough. If the child really cannot adapt, the orthodontist works on a different plan rather than forcing use of the device.
Are there alternatives to headgear?
Yes; depending on the patient's age, bite type and expected compliance, there are various methods that can be used instead of headgear. These options come to the fore if it is thought the child will not be able to wear the device consistently.
- Functional appliances: Used during the growth years to guide the lower jaw forward; you can find the general framework in our article on orthodontic appliances.
- Elastics (rubber bands): Elastics used between the upper and lower jaws together with fixed braces or clear aligners help correct a Class II relationship in many cases.
- Mini-screw anchorage: Small screws placed in the mouth to move the molars back can reduce the need for extraoral force.
- Fixed molar distalizers: Mechanisms that work inside the mouth and depend less on the child's compliance.
- Clear aligners: In teenagers of a suitable age and adults, orthodontics with Invisalign can be planned, together with elastics when needed.
For other devices that guide the lower or upper jaw, you can read our article on the orthodontic face mask. Which method is suitable can only be determined by an orthodontic examination and X-ray assessment.
Assessment in Ankara
If your child's upper jaw is thought to be too far forward, or there is no room for the teeth because of the position of the molars, an examination by an orthodontist is carried out at our clinic in Park Oran, Çankaya. After the necessary imaging, whether headgear is needed, what the alternatives are and how treatment will proceed are shared in writing together with fee information. You can use our contact page to make an appointment.
Frequently asked questions
How many hours a day is headgear worn?
In most programs, roughly twelve to fourteen hours a day are recommended; this time covers the evening and night. It may not need to be worn during school hours. The exact time is set by the orthodontist.
Who needs headgear?
It is usually planned for growing children whose upper jaw is too far forward or whose molars have drifted forward. Whether it is needed is determined by an examination and X-ray assessment.
Does headgear hurt?
In the first days there may be sensitivity and a feeling of tension in the teeth. This feeling usually eases quickly. If pain increases or the device causes sores, contact the clinic.
Can you play sports with headgear?
No. The device should be removed during sports, play and running around because of the risk of facial injury. Which activities require a mouthguard should be discussed with the orthodontist.
Can another device be used instead of headgear?
Yes; functional appliances, elastics, mini-screw anchorage and, in some cases, clear aligners can be considered. The suitable method is determined by age, bite type and the child's compliance.
