Children who have an under-bite need special attention, which is why they wear a reverse pull headgear for up to 18 hours a day, even when they are sleeping. Dr. Menachem Roth of Carvalho and Roth Orthodontics in Newton Centre, Marlborough and Northborough, Massachusetts explains here what the benefits are of this intricate device.
An orthodontic facemask is also known as a reverse pull headgear. It is used to correct a Class Three malocclusion, which is more commonly known as an under-bite. What this means is that the upper front teeth are behind the lower front teeth. This can be caused by either a skeletal discrepancy, growth discrepancy between upper and lower jaws, or a dental discrepancy, where the upper and lower teeth are angled incorrectly, causing the underbite to form.
The reverse pull headgear is more often used for growing patients. It is most effective when used between the ages of about six to 10 or 11 years old. It works to bring the pull the upper jaw forward, increasing its size and also restricting the growth of the lower jaw. Essentially, it attempts to normalize the relationship between the upper and lower jaw.
The reverse pull headgear is usually worn at least 12 hours a day for about six to 18 months, depending on the severity of the discrepancy, and the goal of the treatment. It does not look like a typical headgear, however. It has three components:
- The first goes inside the mouth and attached to the molars.
- The second component is extraoral. It has a pad on the forehead and a pad on the chin, with a bar connecting them.
- The third is where the piece inside the mouth and outside the mouth are connected with elastic. Those elastics create the force needed to pull the upper jaw forward.
Typically we ask patients to wear their reverse headgear at home. They don’t have to wear it at school, although they should wear it at night, and whenever they are home. If they have a sleepover or friends coming over they do not have to wear it, but then they should wear it the rest of the day, and on the weekend when they are just sitting at home. It should not be worn during physical activity (when they have rough and tumble sports, for example).
Patients should keep in mind that the sole purpose of wearing a reverse headgear is to normalize the size of the jaws so they are even. It will not do anything to straighten teeth. Usually we do this first, follow up with a course of braces immediately following, or perhaps when the child gets a bit older. That varies based on what the malocclusion is.
The information in the article is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.
