Headgear is most commonly used in orthodontics to guide jaw growth and move teeth in ways that braces alone cannot. It works by applying gentle, sustained pressure from outside the mouth to shift the position of the upper or lower jaw, correct bite problems, and create space in crowded dental arches. Most patients who wear orthodontic headgear are children between roughly 7 and 12 years old, when the jaw bones are still actively growing and most responsive to repositioning.
How Orthodontic Headgear Works
Braces move individual teeth within the jawbone. Headgear does something fundamentally different: it uses the back of the head or neck as an anchor point to apply force to the entire upper jaw or to specific molars. A metal wire (called a facebow) connects to bands cemented on the back molars, and elastic straps run from the facebow to a strap around the head or neck. This setup lets the orthodontist control the direction and intensity of force in ways that are impossible with brackets and wires alone.
The recommended force is typically around 100 grams per side for moving teeth, which produces roughly 1 millimeter of movement per month. For broader jaw correction, forces can be higher. The key is that the pressure must be consistent over many hours, which is why compliance matters so much.
Types of Orthodontic Headgear
Cervical-Pull Headgear
This is the most common type. A strap wraps around the back of the neck, pulling the upper molars and jaw backward. It’s used primarily for Class II malocclusions, where the upper jaw sits too far forward relative to the lower jaw. Cervical-pull headgear restricts the forward and downward growth of the upper jaw while allowing the lower jaw to grow normally, gradually correcting the overjet (the horizontal gap between upper and lower front teeth).
One important side effect: cervical-pull headgear tends to push the upper molars slightly downward as it pulls them back. This opens the bite vertically and causes the lower jaw to rotate slightly backward. For children with already long, narrow face shapes, this vertical change can worsen their profile. Orthodontists typically avoid cervical-pull headgear for these patients and opt for a high-pull design instead, where the strap attaches to the top of the head rather than the neck, directing force more upward and minimizing that downward molar movement.
A bonus effect of cervical-pull headgear is slight expansion of the upper arch. The inner bow of the facebow is typically widened by 8 to 10 millimeters, which gently spreads the upper teeth outward and helps with alignment.
Reverse-Pull Headgear (Facemask)
This type does the opposite. Instead of holding the upper jaw back, it pulls it forward. It’s used for Class III malocclusions, where the upper jaw is underdeveloped relative to the lower jaw, giving the appearance of an underbite. The device rests against the forehead and chin, and elastic bands hook from the facemask to the upper teeth, pulling the midface forward over months of wear.
The angle of the elastic bands matters. When the pull is directed more horizontally, the upper jaw moves forward with minimal downward shift. When the pull is angled more steeply, the jaw moves both forward and downward. Orthodontists adjust the position of the attachment point on the facemask to fine-tune these movements based on each patient’s facial structure.
Why Age Matters
Headgear is far more effective in children than in teens or adults because it relies on bones that are still growing. Research published in the European Journal of Orthodontics found that starting cervical-pull headgear treatment between ages 7.5 and 11.5 produced lasting results, but timing within that window made a meaningful difference.
Children who began treatment earlier (around 7 to 8) gained more total arch length, achieved stable results faster, and maintained those gains better into adulthood compared to children who started later (around 10 to 11). One reason: in younger children, the permanent second molars haven’t fully developed yet, so there’s less resistance to moving the first molars backward. Boys who started early benefited the most in terms of lower arch length gains, while girls who started later benefited the least.
By the mid-teen years, jaw growth slows significantly, and headgear becomes less capable of reshaping bone. At that point, orthodontists may turn to surgical options or other appliances for severe bite problems.
What Wearing Headgear Looks Like
Most children need to wear headgear for 12 to 14 hours per day. In practice, this means putting it on after school and wearing it through the night. Nighttime wear is especially important because children’s bones do most of their growing during sleep. Treatment duration varies, but many children wear headgear for one to two years alongside braces.
The experience is uncomfortable at first. The molars may ache for the first few days as they adjust to the pressure, similar to the soreness after getting braces tightened. The straps can irritate the skin behind the ears or on the neck. Most children adapt within a week or two. The biggest challenge is consistency: skipping hours reduces the cumulative force on the jaw, and teeth can drift back between sessions if wear time drops too low.
Risks and Side Effects
The most studied risk of any prolonged orthodontic force, including headgear, is root resorption, where the tips of tooth roots gradually shorten. Several factors increase this risk: longer treatment duration, higher force levels, teeth with thin or severely curved roots, a history of dental trauma, and individual genetic variation. Certain gene patterns related to bone remodeling have been linked to higher rates of root shortening after orthodontic treatment.
For most patients, root resorption from headgear is minor and causes no long-term problems. Severe cases are rare and typically associated with excessive force or unusually long treatment timelines. Orthodontists monitor root length with periodic X-rays during treatment.
Modern Alternatives to Headgear
Headgear use has declined over the past two decades, largely because of temporary anchorage devices, or TADs. These are tiny titanium screws placed directly into the jawbone inside the mouth, providing a fixed anchor point that eliminates the need for external straps and headgear altogether.
TADs can accomplish many of the same tooth movements that headgear provides, including pushing molars backward, closing gaps, and correcting bite alignment. They’re particularly useful for older teens and adults whose jaw growth is complete, making traditional headgear ineffective. They also remove the compliance problem entirely since they’re fixed in place and working around the clock. Placement is quick and done under local anesthesia, and the screws are removed once treatment is finished.
That said, TADs don’t fully replace headgear for every situation. When the goal is to redirect jaw growth in a young child rather than simply move teeth, headgear still offers something TADs cannot: orthopedic force on the growing skeleton itself.
Headgear Beyond Orthodontics
The term “headgear” also appears in other medical contexts. CPAP headgear is the strap system that holds a mask in place for people with sleep apnea. These come in several configurations: nasal pillow masks that fit at the nostrils, nasal masks that cover the entire nose, full-face masks covering both the nose and mouth, and hybrid masks that deliver air through the mouth. The headgear straps keep the mask sealed against the face so the air pressure device can hold the airway open during sleep. Proper sizing is critical for both comfort and effectiveness, and sizes vary across styles and brands.
Protective headgear is also used for people with epilepsy or other conditions that carry a risk of falls and head injury. These are lightweight helmets designed to cushion impact during seizures, distinct from both orthodontic and CPAP headgear in purpose and design.