Orthodontic Headgear: Types, Daily Wear Time, Side Effects, and Tips for Parents
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is orthodontic headgear?
Orthodontic headgear is a removable dental device that uses gentle pressure on a child's teeth and still-growing jaws to correct bad bites such as overjet, overbite and underbite. Most children wear it 12 to 14 hours a day, usually after school and overnight, for about six months to a few years, with regular orthodontist adjustments. [1]
What the research says
Cervical headgear does not consistently lengthen the face. A review of 18 studies with 1,094 children (average age 10.9) found no consistent increase in jaw angles or facial height compared with natural growth; the mandibular plane angle changed by only about 0.5°, a non-significant difference. Confidence in the evidence was low. (Hussain et al., European Journal of Orthodontics, 2024) [2]
Early headgear treatment may protect the front teeth. Within a review of 27 randomized trials (1,251 children), two trials compared early headgear with later treatment for prominent upper front teeth: the final bite was the same, but new front-tooth injuries fell from 37% (44 of 120) to 21% (24 of 117). The evidence was low quality. (Batista et al., Cochrane Database of Systematic Reviews, 2018) [3]
Facemask-type treatment improves underbite in children. A review of 29 randomized trials (1,169 children aged 5 to 13) found that non-surgical treatments, including the facemask, improved the bite by about 5 mm compared with no treatment right after treatment. In the one long-term facemask study, the gain shrank over 6 years, but treated children were judged less likely to need jaw surgery later. (Owens et al., Cochrane Database of Systematic Reviews, 2024) [4]
Key takeaways
Orthodontic headgear treats overjet, overbite and underbite by guiding a child's growing jaw bones into alignment. [1]
The three main types are cervical pull, high pull and reverse pull headgear. [1]
Most children need 12 to 14 hours of wear a day, and night wear matters most. [1]
Sore teeth at the start of treatment are common and usually ease with ice, soft foods and provider-approved pain medicine. [1]
Call the orthodontist if any part breaks, comes loose or causes serious discomfort. [1]
What is orthodontic headgear used for?
Orthodontic headgear is used to correct malocclusion, the dental term for a "bad bite," in which the upper and lower teeth do not line up properly when the mouth closes. [1]
A bad bite is more than a cosmetic issue. Over time, it can lead to dental problems, jaw problems, and even difficulty speaking and eating. It can also make a child feel self-conscious about their smile. [1]
Headgear corrects three specific bite problems:
Bite problem | What it looks like | Headgear type used |
Overjet ("buck teeth") | Upper front teeth stick out diagonally above the lower front teeth | Cervical pull or high pull |
Upper teeth overlap the lower teeth more than they should | Cervical pull or high pull | |
Lower teeth stick out beyond the upper teeth | Reverse pull |
Your child may need headgear on its own or together with braces to straighten the teeth. [1]
How does orthodontic headgear work?
Orthodontic headgear works by applying gentle, steady pressure to a child's teeth and jaws, which over time encourages the still-forming jaw bones to grow into alignment. [1]
That is why headgear is a treatment for growing children. The device does not force the jaw into place in one step. Instead, the orthodontist gradually adjusts the tension at follow-up visits, steering growth a little at a time. [1]
What are the types of orthodontic headgear?
The three main types of orthodontic headgear are cervical pull, high pull and reverse pull: the first two fix overjet and overbite, and the third fixes underbite. [1]
Cervical pull headgear
Cervical pull headgear uses a U-shaped wire called a facebow that attaches to the upper back teeth. The facebow connects to a strap that wraps around the back of the neck, and the strap provides gentle pressure that holds the upper jaw back. [1]
High pull headgear
High pull headgear has parts similar to cervical pull headgear and also fixes overjet and overbite. The difference is the straps: one rests on the back of the head and another goes over the top, encouraging the upper jaw to move back and up. [1]
Reverse pull headgear
Reverse pull headgear fixes an underbite by pulling the upper jaw forward. It uses a vertical frame in front of the face, held in place by a forehead pad and a chin cup. A wire mouthpiece that fits onto the upper back teeth extends from the frame and draws the upper jaw forward. [1]
Orthodontic headgear types at a glance
Type | Fixes | Strap or frame | Direction of pull |
Cervical pull | Overjet, overbite | One strap around the neck | Holds upper jaw back |
High pull | Overjet, overbite | Two straps: back and top of head | Upper jaw back and up |
Reverse pull | Underbite | Front frame with forehead pad and chin cup | Upper jaw forward |
Do kids still wear orthodontic headgear?
Children still wear orthodontic headgear today, although orthodontists use it less often than in the past and increasingly recommend alternatives when a child's bite allows it. [1]
Option | What it is | Best suited to |
Orthodontic headgear | External device worn on the head or face | Jaw position problems in growing children |
Removable plastic trays that fit over the teeth | Mild alignment problems | |
Herbst appliance | Device that repositions the jaws from inside the mouth | Children who need jaw correction and prefer a hidden device worn all the time |
Many children prefer an inside-the-mouth appliance because it stays hidden from classmates. Still, the right device depends on the bite, and the orthodontist is the best person to decide. [1]
How many hours a day should a child wear orthodontic headgear?
Most children need to wear orthodontic headgear for 12 to 14 hours every day, and total treatment can last from about six months to a few years. [1]
Consistency is everything. Even skipping a single day can roll back progress, so it helps to treat headgear like brushing teeth: part of the daily routine, without exceptions. [1]
A realistic schedule often looks like this:
Time of day | Headgear | Why |
School hours | Often off (if the orthodontist agrees) | Makes the routine easier for many children |
Straight after school | On | Starts building daily hours early |
Meals | Off | Protects the child and the device |
Overnight | On | Children's bones do most of their growing at night |
Your orthodontist may suggest starting with a few hours a day and building up gradually. Total treatment time depends on the bite and on how consistently the headgear is worn. [1]
What should you expect during orthodontic headgear treatment?
Orthodontic headgear treatment starts with a fitting visit, followed by regular check-ups where the orthodontist reviews the bite and adjusts the headgear's tension. [1]
At the first visit, you will get clear instructions on daily wear time and care. To keep your child and the device safe, the headgear should come off during: [1]
Eating
Drinking, unless your child uses a straw
Play or physical activity with a risk of falls or injury
Children can technically brush and floss with headgear on, but most find it easier to take it off first. [1]
What are the side effects of orthodontic headgear?
The main side effect of orthodontic headgear is soreness: teeth often feel sore at the start of treatment, and some jaw soreness or slightly loose teeth can occur as the bones grow and shift. [1]
Headgear is considered a safe and effective way to fix a bad bite, even though it can feel unpleasant at times. To ease the soreness: [1]
Comfort step | How to use it |
Ice pack | Apply to the sore part of the jaw |
Soft foods | Switch to soft meals until the pain improves |
Pain medicine | Ask your child's provider which options are safe |
It also helps to reassure your child that the pain will pass and that headgear is not forever. [1]
Some families worry that cervical headgear could make a child's face longer. A 2024 review of more than 1,000 children found no consistent increase in facial height compared with natural growth, although the evidence quality was low. [2]
How can parents help a child adjust to orthodontic headgear?
Parents help most by acknowledging how their child feels about headgear while reminding them that consistent daily wear is the fastest way to finish treatment. [1]
Wearing a visible dental device can feel embarrassing, and other children are not always kind. It is OK for your child to wish they did not need it. These steps can make the experience easier: [1]
Book the first appointment on a Friday if you can. A weekend gives your child time to adjust before school. Plan a day of things they enjoy.
Plan fun, low-key activities. Sports and rough play are off-limits with headgear on, so make games, movies and reading easy to reach.
Keep soft, tasty foods at home. Ice cream, smoothies and mac and cheese help on sore days.
Support better sleep. Sleeping in headgear takes practice, especially for stomach sleepers. Keep a set bedtime and a calm wind-down routine, and consider a supportive pillow for back sleeping.
When should you call the orthodontist about headgear?
You should call your child's orthodontist if any part of the headgear breaks or becomes loose, or if your child has serious discomfort. [1]
Headgear can only fix a bite when it is in good working condition and fitted properly, so problems should be checked rather than worked around. [1]
Orthodontic headgear at a glance
Question | Answer |
What it treats | Overjet, overbite and underbite |
Who wears it | Growing children whose jaws are still forming |
Main types | Cervical pull, high pull, reverse pull |
Daily wear | 12 to 14 hours, with night wear most important |
Treatment length | About 6 months to a few years |
Remove for | Eating, drinking (unless using a straw), sports and active play |
Common side effect | Soreness, mainly at the start |
Call the orthodontist | Broken or loose parts, serious discomfort |
Conclusion
Orthodontic headgear is a proven, safe way to guide a child's growing jaws and correct overjet, overbite or underbite. Its success depends less on the device and more on the routine: 12 to 14 hours of daily wear, especially overnight, with regular orthodontist adjustments.
The hardest part for most families is emotional, not medical. Open conversations, a realistic schedule and small comforts at home go a long way toward helping a child reach the day the headgear comes off for good.
Next step: If your child's orthodontist has recommended headgear, write down your questions about daily hours, treatment length and alternatives before the next visit. To learn more about the bite problems headgear treats, read our guides to overjet, overbite and underbite correction, and explore how a palate expander widens a narrow upper jaw.
FAQ
What is orthodontic headgear used for?
Orthodontic headgear is used to correct bad bites in growing children, specifically overjet, overbite and underbite. The device applies gentle pressure that guides the still-forming jaw bones into alignment over time. [1]
How many hours a day does a child need to wear headgear?
Most children need to wear orthodontic headgear for 12 to 14 hours a day. Night wear is especially important because children's bones do most of their growing during sleep. [1]
How long does orthodontic headgear treatment last?
Orthodontic headgear treatment can last from about six months to a few years. The exact length depends on the child's bite and on how consistently the headgear is worn each day. [1]
Can a child wear headgear to school?
Many children do not need to wear headgear at school, as long as the orthodontist agrees and the headgear goes back on as soon as they get home. Daily wear time and overnight wear matter more than daytime wear. [1]
Does orthodontic headgear hurt?
Orthodontic headgear often makes the teeth feel sore at the start of treatment, and some soreness or slightly loose teeth can occur as the jaws shift. Ice packs, soft foods and provider-approved pain medicine usually help. [1]
Can a child eat or play sports while wearing headgear?
Children should take orthodontic headgear off to eat, to drink (unless using a straw) and during sports or active play. Removing it protects both the child and the device from injury or damage. [1]
Are there alternatives to orthodontic headgear?
Alternatives to orthodontic headgear include clear aligners for mild alignment problems and the Herbst appliance, which repositions the jaws from inside the mouth. The best choice depends on the child's bite, so the orthodontist makes the final recommendation. [1]
When should I call the orthodontist about headgear?
Parents should call the orthodontist if any part of the headgear breaks or comes loose, or if the child has serious discomfort. Headgear must be working and fitted properly to correct the bite. [1]
What is the best age for orthodontic headgear?
Headgear works best while the jaws are still growing, usually in childhood before the growth spurt ends. Your orthodontist decides the right timing for your child.
How do you clean orthodontic headgear?
Wash the parts that go in the mouth with mild soap and water, and clean the straps and pads as your orthodontist explains. Keep the headgear in its case when it is not being worn.
Related Reading
Overjet (Buck Teeth): Symptoms, Causes, and Treatments explains upper front teeth that stick out and how they are corrected.
Overbite: Symptoms, Causes, and Management Strategies covers causes of a deep overbite and treatment options.
Underbite Correction: Symptoms, Causes, and Modern Treatment Options explains how an underbite is corrected in children and adults.
Orthodontics: Braces, Clear Aligners, Retainers, and What to Expect compares braces, aligners, retainers and other orthodontic appliances.
References
Cleveland Clinic. Orthodontic Headgear: Types & Uses. Cleveland Clinic. Last updated June 18, 2024. https://my.clevelandclinic.org/health/treatments/orthodontic-headgear
Hussain U, Shah AM, Rabi F, et al. Vertical effects of cervical headgear in growing patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod. 2024;46(1):cjad053. PMID 37866376. https://doi.org/10.1093/ejo/cjad053
Batista KB, Thiruvenkatachari B, Harrison JE, et al. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst Rev. 2018;3(3):CD003452. PMID 29534303. https://doi.org/10.1002/14651858.CD003452.pub4
Owens D, Watkinson S, Harrison JE, et al. Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database Syst Rev. 2024;4(4):CD003451. PMID 38597341. https://doi.org/10.1002/14651858.CD003451.pub3
Medical disclaimer
This article is for general education and does not replace advice from your child's orthodontist, dentist or doctor. Always follow the wear schedule and care instructions your child's orthodontist gives you.
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