Orthodontic headgear
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Orthodontic headgear is a type of orthodontic appliance attached to dental braces that aids in correcting severe bite problems.
[edit] Need for treatment and concurrent corrections
The most common treatment headgear is used for is correcting anteroposterior discrepancies - for instance the top teeth being too far forward relative to the lower teeth ("increased overjet", also known as a malocclusion) The headgear is attached to the braces via metal hooks or a facebow and is anchored from the back of the head or neck with straps or a head-cap. In some situations both are used. Elastic bands are then used to apply pressure to the bow or hooks. Its purpose is to slow-down or stop the upper jaw from growing, hence preventing or correcting an overjet. For more details and photographs, see Headgear - Orthodontic.
Other forms of headgear treat reverse overjets (where 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.
The headgear can also be used to make more space for teeth to come in. The headgear is then attached to the molars (via molar headgear bands & 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 usually go along with their 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.
[edit] Forms of headgear
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There is a great possibility that patients will be outfitted with more than one headgear at the same time, which essentially forms a double headgear. While the headgear is still on, a face mask may also be added. These appliances can also be wired on with coil springs so they are permanent.
Patients with headgear will need to have a thick metal wire fixed at the back of the teeth for several years, along with elastic bands.
As another part of their headgear, patients must also wear full bands. These take the place of brackets. In full bands, the band wraps around the entire tooth, which encases the tooth in metal. Full bands then have a bracket on top of the metal band. These bands come as a standard with headgear of any kind, and are more painful than small brackets. They are also tightened every week instead of every three to four weeks, as with small brackets. They take longer to work than small brackets. The amount of chair time also dramatically increases with these type of braces. They can take over an hour to put on.
You can not kiss with these type of braces as the brackets get locked very easily. They may cut your lips, and the results of the treatment often take longer to obtain when wearing full bands.The reason that these brackets are used is that they are the only brackets strong enough that when attached to teeth can serve as anchorage. When wearing high pull or double headgear, patients must have frequent haircuts because the hair is pushed down by the large number of head straps. This pushes the hair up at odd angles all over the head, causing further humiliation.
Headgear needs to be worn approximately 18 to 24 hrs each day to be effective at all in correcting the overbite, usually anywhere from 12 to 120 months depending on the severity of the overbite and how much a patient is growing.
A typical scenario with headgear treatment is a case where some teeth are extracted, and front teeth are being retracted (pulled backward). When extraction spaces are being closed, the teeth behind the extraction space slide forward if not held in-place by headgear. In some situations, to maintain the bite, the orthodontist will need prescribe a headgear at the end of the treatment for another twelve month period.
Full headgear is the most commonly used, though double headgear is common as well. With straps and J-hooks for connection into the patients mouth, it is typically worn 16 to 24 hours a day depending on treatment plan. The headgear serves to hold teeth back (maintain anchorage). Orthodontists will want those patients to wear the headgear as much as they can once fitted. Realistically this might only be 14 hours per day, with catch over weekends. 24 hours will be required. Compliance is essential, and if not followed exactly it will be wired on for twice as long as originally thought.
The orthodontic headgear will usually consist of three major components:
Face bow: firstly the face-bow (or J-Hooks), which fits with a metal arch onto headgear tubes attached to the rear upper and lower molars. This face bow then extends out of the mouth and around the face. Both upper and lower face-bows may be used. J-Hooks are different in that they hook into the patients mouth and attach directly to the brace (see photo for example of J-Hooks). Head-cap: the second part consists of a head-cap, which consists of a number of straps fitting around the head. This is then attached with elastic bands or springs to the face-bow. Additional straps and safety attachments will be used to ensure comfort and safety (see photo). Attachment: the third and final component (typically rubber bands, elastic or springs) joins the face bow or J-Hooks and the head cap together, providing the force to move the teeth backwards. In some cases it will be required to wear both an upper and lower face-bow or j-hooks, however your orthodontist will provide you with all the information required.
Soreness of teeth when chewing, or when the teeth touch, is typical. teenagers usually feel the soreness to 2/3 hours later, but younger patients tend to react sooner, (e.g., 1 to 1 1/2 hours). The headgear is one of the most useful appliance available to the orthodontist, but many patients find it difficult to comply with daytime wear, so it is often wired in. A similar appliance is the reverse-pull headgear or orthodontic facemask, which pulls the patients teeth forward (rather than back, as in this case). This type of headgear uses orthodontic elastics (rubberbands) to pull the top jaw, while also stunting the growth of the bottom jaw. The reverse-pull headgear should be worn for at least 20 hours a day, depending on the age and growth rate of the patient.
[edit] Complications and Risks
There are many complications and issues of having orthodontic headgear. The first and foremost is being subject to mocking and teasing every day while in headgear. This can be especially hard on children in school.
Headgear will most likely cause difficulties performing usual daily tasks such as eating, sleeping, talking and brushing, especially for those who have permanently-attached headgear. Talking becomes very hard and creates a heavy lisp.
There is also a heavy increase in saliva, which causes uncontrollable drooling. When permanently attached, headgear cannot be removed and must be worn 24 hours a day. This is very embarrassing for children, and most of the patients of headgear are of school age.
The need for headgear (also see Headgear - Orthodontic) as a useful appliance for orthodontists and its use has increased greatly as less and less orthodontists use temporary implants ("temporary anchorage devices") inside the patients mouth, to perform the same tooth movements.
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