Orthodontic headgear is a type of orthodontic appliance attached to the patient's head with a neck strap or a number of straps around the head. The device typically transfers the force to the teeth via a facebow or J hooks to the patients dental braces or a palatal expander that aids in correcting more severe bite problems or is used in retention of the teeth and jaws of the patient.
Headgear is most commonly used to correct anteroposterior discrepancies. The headgear attaches to the braces via metal hooks or a facebow. Straps or a head cap anchor the headgear to the back of the head or neck. In some situations, both are used. Elastic bands are used to apply pressure to the bow or hooks. Its purpose is to slow or stop the upper jaw from growing, thereby preventing or correcting an overjet.
Other forms of headgear treat reverse overjets, in which the top jaw is not forward enough. It is similar to a facemask, also attached to braces, and encourages forward growth of the upper jaw.
Headgear can also be used to make more space for teeth to come in. In this instance the headgear is attached to the molars, via molar headgear bands and tubes, and helps to draw these molars backwards in the mouth, opening up space for the front teeth to be moved back using braces and bands. Multiple appliances and accessories are typically used along with the headgear, such as: power chains, coil springs, twin blocks, plates or retainers, facemasks, a headgear helmet (a headgear helmet is a cervical headgear with a cap that covers the entire head), lip bumpers, palate expanders, elastics, bionaters, Herbst appliances, Wilson appliances, other headgear, hybrid twinblocks, positioner retainers, and jasper jumpers. Many patients wear a combination of, or all of these appliances at any given time in their treatment. 
Headgear needs to be worn between 12–22 hours each day to be effective in correcting the overbite, typically for 12 to 18 months depending on the severity of the overbite, how much it is worn and what growth stage the patient is in. Typically however the prescribed daily wear time will be between 14 and 16 hours a day. 
Orthodontic headgear will usually consist of three major components:
Soreness of teeth when chewing or when the teeth touch is typical. Patients usually feel the soreness to 2 to 3 hours later, but younger patients tend to react sooner, (e.g., 1 to 1 1⁄2 hours). The headgear application is one of the most useful appliances available to the orthodontist when looking to correct a Class II malocclusion.
Facemask or reverse-pull headgear is an orthodontic appliance typically used in growing patients to correct underbites (technically termed Class-III orthodontic problems) by pulling forward and assisting the growth of the upper jaw (maxilla), allowing it to catch up to the size of the lower jaw (mandible). Facemasks or reverse-pull headgear needs to be worn between 12 and 22 hours per day, but typically 14 to 16 hours a day is effective in correcting the underbite. Overall wear time is usually anywhere from 12 to 18 months depending on the severity of the bite and how much a patient's jaws and bones are growing over this time.
The appliance normally consists of a frame or a center bars that are strapped to the patient's head during a fitting appointment. The frame has a section which is positioned in front of the patient's mouth, which allows for the attachment of elastic or rubber bands directly into the mouth area. These elastics are then hooked onto the patient's braces (brackets and bands) or appliance fitted in his or her mouth. This creates a forward pulling force to pull the upper jaw forward.
The orthodontic facemask typically consists of three major components:
In some cases surgery is required in conjunction with a facemask or reverse-pull headgear. Many parents and doctors recommend using early intervention (ages 7 to 13) by using a facemask to avoid costly and painful surgical procedures later.
The appliance is very effective in correcting Class III orthodontic problems in younger or adolescent patients that are still growing. Initially, it can be difficult for children to wear a mask or headgear, however most doctors and parents agree that children and adolescence adapt quickly to such changes and requirements. Parents should be aware that their child is often better-off wearing a facemask or headgear to avoid later surgery and the patient, friends and school peers normally get used to the new appliance after just a few weeks of wear. 
The orthodontic profession has constantly struggled with the improvement of anchorage of both inter and intra oral appliances. In some treatment plans, the use of a full headcap or orthodontic helmet device was recommended.
The advantages of this application is that the anchorage of the intra oral face bows (in this case the patient has both an upper and lower facebow fitted) is significantly improved using such cap or helmet.
Other appliances and devices, such as a full rigid helmet headgear, have been designed and patented to fit onto the patient's head and provide a stable platform from which the orthodontist can attach various elastic bands, springs, metal facebows directly into the patient's mouth.
Researchers have studied the long term effects of orthodontic headgear have found that it may flatten the face and prevent the chin from coming forward, pushing both the upper and lower jaw down and back, into the airway. In more technical terms, it inhibits the natural growth of the jaws and lead to a reduction in the SNA and ANB angles, which relate to the forward position of the maxilla and the mandible, and good indicators of the size of a person's airway.
In some cases, eye injuries have been reported, which is minimized with the use of safety release straps and safety facebows.
Teenagers prescribed orthodontic headgear often face social stigma and bullying due to their detracting appearance.
The need for headgear in orthodontics and its application by practitioners has somewhat decreased in recent years as some orthodontists use temporary implants (i.e., temporary anchorage devices) inside the patient's mouth to perform the same tooth movements however the headgear is still widely used and a very effective appliance used by orthodontists today. Soreness of teeth when chewing, or when the teeth touch, is typical. Adults usually feel the soreness 12 to 24 hours later, but younger patients tend to react sooner, (e.g., 2 to 6 hours). Adults are sometimes prescribed headgear but this is less frequent. The headgear is one of the most useful appliances available to the orthodontist, but many patients find it difficult to comply with daytime wear, so it is mainly worn in the evenings and when sleeping. A similar appliance is the reverse-pull headgear or orthodontic facemask, which pulls the patients teeth forward (rather than back, as in this case). 
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