Overview of Orthodontic Headgear
- Headgear is commonly used to correct the bite of the patient.
- 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.
- Elastic bands are used to apply pressure to the bow or hooks.
- Other forms of headgear treat reverse overjets, encouraging forward growth of the upper jaw.
- Headgear needs to be worn between 12 and 23 hours each day to be effective.
- Orthodontic headgear consists of a facebow, head cap, and attachment components.
- The facebow is fitted with a metal arch onto headgear tubes attached to the molars.
- The headcap consists of straps fitting around the patient's head.
- The attachment component, such as rubber bands or elastics, joins the facebow and headcap to provide the force to move the upper teeth and jaw.
- Facemask or reverse-pull headgear is used to correct underbites.
- It pulls forward and assists the growth of the upper jaw.
- Facemasks or reverse-pull headgear needs to be worn between 12 and 23 hours per day.
- The appliance consists of a frame, chin cup, forehead pad, and mouth-yoke.
- The frame is adjusted to fit onto the patient's face and has hooks to attach elastics or springs into the patient's mouth.
- Headgear is typically worn for 12 to 18 months depending on the severity of the overbite.
- The prescribed daily wear time is between 14 and 16 hours a day.
- Soreness of teeth when chewing or touching is typical during headgear treatment.
- Younger patients tend to react sooner to soreness.
- Multiple appliances and accessories are used along with the headgear.
- Examples include power chains, coil springs, retainers, facemasks, lip bumpers, and palate expanders.
- These appliances work in combination with headgear to aid in treatment.
- Patients may wear a combination of these appliances at any given time.
- The use of these additional appliances depends on the specific needs of the patient.

Adverse Effects and Controversy
- Orthodontic headgear may flatten the face and prevent the chin from coming forward, pushing both the upper and lower jaw down and back, into the airway.
- It inhibits the natural growth of the jaws and can lead to a reduction in the SNA and ANB angles, which relate to the forward position of the maxilla and the mandible.
- Severe health symptoms, such as sleep apnea, breathing problems, and acute TMD, have been reported by formerly headgear-treated patients.
- Eye injuries have been reported, but can be minimised with the use of safety release straps and safety facebows.
- Teenagers prescribed orthodontic headgear often face social stigma and bullying due to wearing these appliances.

Decreased Usage and Alternative Methods
- The need for headgear in orthodontics and its application has somewhat decreased in recent years.
- Some orthodontists now use temporary implants (temporary anchorage devices) inside the patient's mouth to perform the same tooth movements.
- However, headgear is still widely used and remains a very effective appliance in orthodontics.
- Adults may sometimes be prescribed headgear, but this is less frequent than in younger patients.
- Soreness of teeth when chewing or when the teeth touch is typical, with adults experiencing soreness 12 to 24 hours later, and younger patients reacting sooner (e.g., 2 to 6 hours).

Safety Considerations and Solutions
- Eye injuries have been reported with orthodontic headgear, but the use of safety release straps and safety facebows can minimize these risks.
- Compliance with daytime wear of headgear can be difficult, leading to its mainly evening and sleep-time usage.
- The use of temporary implants as an alternative to headgear reduces the need for compliance and potential discomfort.
- The effectiveness of headgear as an appliance used by orthodontists today is still widely recognised.
- Social stigma and bullying are common challenges faced by teenagers prescribed orthodontic headgear.

Long-Term Effects on Airway and Facial Structure
- Orthodontic headgear can have long-term effects on the airway by inhibiting natural jaw growth and potentially reducing the size of a person's airway.
- It may flatten the face and prevent the forward position of the maxilla and mandible.
- Reduction in the SNA and ANB angles, which indicate the forward position of the jaws, can be observed in patients wearing headgear.
- These measurements are good indicators of the size of a person's airway.
- The controversy surrounding headgear intensified when formerly treated patients developed severe health symptoms, such as sleep apnea, breathing problems, and acute TMD.