Headgear is an orthodontic appliance worn outside the mouth, attached to braces with straps or bands, used to guide jaw growth or move upper and lower molars relative to each other in ways that braces alone can’t accomplish. It’s recommended far less often today than it was a generation ago, since palatal expanders and temporary anchorage devices now handle many of the same jaw and bite problems — but for certain cases, especially significant overbites or underbites in growing children, headgear is still one of the most effective tools available.
What Does Headgear Actually Do?
Braces are very good at moving individual teeth. What they’re not built to do on their own is influence how the upper and lower jaws are growing relative to each other. Headgear solves that by attaching to bands on the back molars and applying a steady, gentle pulling force from outside the mouth — either holding the upper jaw back (in overbite cases) or pulling it forward (in some underbite cases), while the lower jaw continues to grow.
Because it works with the bone rather than just individual teeth, headgear only works while a child’s jaw is still actively growing, which is why it’s used almost exclusively with younger patients rather than adults.
Common Types of Headgear
| Type | Used For |
|---|---|
| Cervical/high-pull headgear | Holding back upper jaw growth in overbite cases |
| Reverse-pull (facemask) | Encouraging upper jaw growth forward in underbite cases |
When Is Headgear Necessary?
Our orthodontists generally consider headgear when a growing child has a significant skeletal discrepancy between the upper and lower jaw — not just teeth that are misaligned, but jaws that are growing at mismatched rates or in mismatched directions. Waiting until that child is done growing usually means the only remaining fix is jaw surgery, so catching and treating it early, while there’s still growth to guide, is the entire point.
How Many Hours a Day Is It Worn?
Most headgear protocols call for 12 to 14 hours a day, which typically means overnight plus a few hours in the evening — not worn to school or during sports and activities. Consistency matters more than any single stretch of wear, since the jaw responds to steady, repeated pressure over months, not to occasional long sessions.
Is Headgear Uncomfortable?
There’s an adjustment period, and most kids notice some pressure on the back molars for the first several nights. This typically eases as the mouth adjusts. Modern headgear designs are also considerably more comfortable and less bulky than older versions, with softer straps and better-fitted bands.
If headgear is part of your child’s treatment plan at Davis & Goldberg Orthodontics, our team will walk you through the exact wear schedule and fitting adjustments needed to make it as comfortable and effective as possible — and we’ll always explain why headgear, rather than an alternative like an expander or TAD, is the right tool for your child’s specific bite.
Combining Headgear With Other Appliances
Headgear is rarely used entirely on its own. It’s most commonly paired with braces, since the braces handle individual tooth alignment while the headgear addresses the broader jaw relationship at the same time. In some treatment plans, headgear is used during an earlier stage to correct the skeletal discrepancy, with braces following once the jaw relationship has improved, similar to how a twin block or other functional appliance might be sequenced. Which combination and order makes sense depends on the severity of the jaw discrepancy and how much growth your child has left.
How Headgear Has Changed Over the Years
Headgear has a reputation from decades past as bulky and uncomfortable, but modern designs are considerably refined — lighter materials, better-padded straps, and more precisely fitted bands make today’s headgear noticeably easier to wear than what many parents might remember from their own childhood treatment. Combined with the fact that many cases now use expanders or TADs instead, headgear today tends to be reserved for, and better tolerated in, the specific situations where it’s genuinely the most effective tool.
How We Decide If Headgear Is the Right Call
Recommending headgear is never a default step — it comes after a careful look at exactly how a child’s upper and lower jaws relate to each other. At Davis & Goldberg Orthodontics, our orthodontists use digital X-rays to measure the jaw relationship precisely and compare it against normal growth ranges for a child’s age, which tells us not just whether there’s a discrepancy, but roughly how significant it is and how much growth potential remains to correct it. That data is what separates a case that genuinely benefits from headgear from one that could be managed just as effectively with an expander, a TAD, or braces alone.
Supporting Your Child Through Headgear Treatment
The biggest factor in how well headgear works is simple consistency, and that’s often more of a family effort than a clinical one. Building the wear schedule into an existing routine — putting it on right after homework or right before brushing teeth for bed — tends to work better than treating it as a separate task to remember. We also find that kids do better when they understand why they’re wearing it, so we make a point of explaining the goal in terms a child can grasp, not just handing a family an appliance and a schedule.
Frequently Asked Questions
Is headgear still commonly used today?
Less often than in the past, since expanders and temporary anchorage devices now address many of the same issues, but it’s still an effective and sometimes preferred option for certain significant jaw growth discrepancies in growing children.
What happens if my child doesn’t wear headgear as prescribed?
Because headgear works through steady, cumulative pressure, inconsistent wear significantly slows or stalls the jaw correction it’s meant to achieve, which can extend overall treatment time.
Can headgear be worn with clear aligners instead of braces?
Headgear is typically paired with braces or specific orthodontic bands rather than clear aligners, since it needs a secure attachment point on the back molars that aligner systems aren’t generally designed to provide.
At what age is headgear typically prescribed?
Most commonly between ages 8 and 12, while there’s still meaningful jaw growth left to guide.
Can headgear be avoided if we come in for an evaluation early enough?
Not always, since it depends on the specific type and severity of jaw discrepancy, but earlier evaluation generally means more treatment options are on the table, sometimes including alternatives like expanders or TADs instead of headgear.
Does headgear need to be worn during meals?
No — headgear is typically removed for eating, brushing, and any activity where it could get in the way or be damaged, then reinserted for the remainder of its prescribed daily wear time.
Can headgear cause any lasting marks or discomfort on the face?
Well-fitted, modern headgear shouldn’t leave lasting marks with proper use, though mild, temporary redness where straps rest against the skin can occur and typically resolves quickly once the appliance is removed for the day.
How long does a typical course of headgear treatment last?
It varies by case and how much jaw discrepancy needs correcting, but many headgear treatment courses run somewhere between six months and a couple of years, often followed or accompanied by braces to complete the overall plan.
Will my child need headgear again later if we stop treatment early?
Stopping before the jaw correction is complete can mean the improvement doesn’t fully hold, which is why sticking with the prescribed wear schedule and timeline matters as much as starting the appliance in the first place.
Is headgear painful to wear?
Most children describe it as an adjustment rather than pain — some mild soreness in the jaw or teeth is common in the first few days as the appliance begins applying pressure, similar to the feeling after a routine adjustment visit, and it typically eases as the mouth gets used to it.
Can headgear be adjusted at home if it feels too tight or too loose?
No — headgear tension should only be adjusted by your orthodontist, since the amount of force applied is calculated specifically for your child’s treatment plan. Contact our office if the fit ever feels noticeably different than usual.
Disclaimer: The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.