Yes, orthodontists still prescribe headgear, though far less often than they did a few decades ago. Modern alternatives have replaced headgear in many cases, but for certain jaw growth problems in children, headgear remains one of the most effective tools available. It works by applying external force to guide how the jaw bones grow, something braces alone cannot do.
Why Headgear Is Still Used
Braces, clear aligners, and other appliances that sit inside the mouth are great at moving individual teeth. What they can’t do on their own is change the size or position of the jaw bones themselves. That’s headgear’s specialty. It applies steady pressure from outside the mouth to slow down or redirect jaw growth while a child is still developing.
The conditions that still call for headgear are skeletal in nature, meaning the problem isn’t just crooked teeth but a mismatch in how the upper and lower jaws relate to each other. Orthodontists typically consider headgear for three situations: an overjet (sometimes called “buck teeth,” where the upper front teeth angle out far ahead of the lower teeth), a deep overbite (where the upper teeth overlap the lower teeth too much), and an underbite (where the lower jaw extends beyond the upper jaw). If the misalignment is mild and limited to the teeth, braces or aligners can usually handle it. When the jaw itself is the problem, headgear enters the conversation.
How It Works on Growing Bones
Headgear’s real power is that it can restrain or encourage jaw growth during childhood, producing changes that hold up over time. A long-term study published in The Angle Orthodontist tracked patients treated with high-pull headgear followed by standard braces and found that the headgear restricted forward growth of the upper jaw while the lower jaw continued to grow normally. This gradually closed the gap between the two jaws. Importantly, those skeletal changes remained stable years after treatment ended, with the jaw relationship actually continuing to improve during the retention period as the lower jaw kept growing forward.
This is why timing matters so much. Headgear is almost always prescribed for children and young adolescents whose bones are still actively growing, typically between ages 7 and 14. Once jaw growth slows in the late teens, headgear loses much of its effectiveness, and correcting a skeletal jaw discrepancy in an adult usually requires surgery instead.
Three Types for Different Problems
Not all headgear looks the same, because different jaw problems require force in different directions.
- Cervical pull headgear wraps around the back of the neck with a strap connected to the upper back molars by a U-shaped wire. It pulls the upper jaw backward to correct an overjet or overbite.
- High-pull headgear attaches to the top of the head instead of the neck and connects to the braces. It pulls upward and back, making it better suited for children whose faces are growing too much in a vertical direction alongside the overbite.
- Reverse-pull headgear (facemask) does the opposite. It has pads that rest on the forehead and chin, connected by a frame to the upper teeth, and it pulls the upper jaw forward to correct an underbite.
The Compliance Problem
The biggest drawback of headgear is that kids have to actually wear it, and most don’t wear it as much as prescribed. A study using sensors embedded in headgear devices to track real usage found that when patients were told to wear it 13 hours a day, they averaged only 6.7 hours, roughly 46% of what was recommended. About 85% of that wear time happened at night, with patients averaging just one hour of use during the day.
Younger children tended to be more cooperative, averaging 7.8 hours per day compared to 5.9 hours for kids over age 10. Compliance also drifted downward over time, starting a bit higher in the first month and gradually declining. These numbers help explain why orthodontists have been eager to find alternatives that don’t depend on a child remembering (or agreeing) to put something on their head every evening.
Modern Alternatives That Have Reduced Headgear Use
Several newer options now handle some of the jobs that once required headgear, which is why you see it prescribed much less frequently today.
Temporary anchorage devices, small screws placed directly into the jawbone, can serve as fixed anchor points inside the mouth. A randomized trial comparing palatal implants to headgear for reinforcing anchorage found the two methods equally effective, with nearly identical treatment outcomes and timelines. The key advantage is that implants work around the clock without any patient effort. Patients in the study accepted them readily, and some expressed reservations about headgear after learning about its drawbacks.
Fixed functional appliances, like spring-loaded devices cemented between the upper and lower teeth, can also correct certain bite problems without any removable components. A comparison study found that these devices, cervical headgear, and premolar extraction with braces were all effective at correcting the same type of bite problem, though each produced slightly different side effects on tooth position. All three approaches showed some relapse after one year of follow-up.
For mild alignment issues, clear aligners can sometimes manage what once might have been treated more aggressively. But none of these alternatives fully replaces headgear’s ability to physically restrain or redirect jaw bone growth in a growing child. When the skeletal discrepancy is significant, headgear (or in some cases, a facemask for underbites) still offers something the alternatives cannot easily replicate.
What Wearing Headgear Looks Like Today
If your child’s orthodontist recommends headgear, the typical prescription is somewhere around 12 to 14 hours per day, which in practice means wearing it from after school or dinner through the night until morning. Most kids wear it almost exclusively while sleeping and during evening hours at home. It is rarely worn to school.
Treatment duration varies depending on the severity of the jaw discrepancy and how consistently it’s worn, but headgear is generally used for several months to a couple of years alongside traditional braces. The headgear addresses the skeletal component of the problem while braces handle the alignment of individual teeth. Once the jaw relationship has improved enough, the headgear is discontinued and braces finish the job on their own.
Discomfort is common for the first few days as the teeth and jaw adjust to the pressure, but it typically fades as the patient gets used to it. The appliance hooks onto bands cemented around the back molars, so putting it on and taking it off is straightforward once a child gets the hang of it.