No orthodontic article should be without the mention of the potential of irrevocable facial development,  pain and potential medical harm of reverse pull headgear.


Head gear. There are two kinds, one that brings the upper jaw forward. These are difficult to wear but often very beneficial and indicate a higher understanding by the practitioner using them since research indicates that most people suffer an under development of the upper jaw or, “lack of mid face development.”

Reverse pull headgear, using head or chin strap to prevent the forward growth of the upper (and therefore incidentally the lower) jaw are almost always to be avoided. I’ve seen irreversible pain, TMD, dysfunction and suffering and in some cases legal action against the dentist using them.

Like everything in life you can “never say never,” but generally traditional reverse pull headgear works against normal facial development and appears to have been instituted when orthodontics was considered purely mechanical by most orthodontists.

Reverse pull headgear goes against all determinants of normal growth and the practice should have been discontinued years ago, in my opinion.

If you have a dentist who wishes to use it, investigate it with several other dentists and consider changing your dentist or orthodontist if they are in disagreement with others and refuse to see both sides of the discussion – more than a legal case, it will likely save the child’s wellbeing.

I apologize if I sound belligerently against this, but I’ve seen destroy children’s faces too many times. I believe that most good orthodontists would be in agreement.

Reverse pull headgear was developed at a time when wholesale extractions of 4 premolars was the quickest, easiest and mot profitable way to “straighten teeth” for many.

Many good orthodontists may agree that this wholesale practice was wrong and yet some still perform this treatment which amounts to little more than “amputation.” Get a second opinion.

Other considerations with adult braces

Back to orthodontics for adults. There are times when a simple solution is appropriate and there are times when even surgery may be required in combination.

This may be quite reasonable and although a second opinion may not guarantee the opinion as right or wrong it may uncover other previously unexplored questions for you to have answered.

The cost of braces for adults

The cost of the various types of adult braces can vary considerably, depending on who is providing treatment and where in the country you are.

Orthodontic treatment can range in cost widely depending on what’s being done, who is doing it and where its being done. If you are planning on having orthodontic treatment you must do your due diligence and perhaps get a second opinion and estimate.

Can adult braces harm your teeth?

There is always the chance that any treatment may do harm – however if done with good planning, skill care and ability, treatment can have a wonderfully beneficial effect.

If braces are fitted or adjusted incorrectly, there is a chance that they can cause more problems with the teeth than they solve. Orthodontic treatment isn’t suitable for everyone and if performed poorly, can cause significant pain, injury and suffering, sometimes causing permanent damage.

Irreparable damage

Fixed braces moving teeth too quickly can damage the roots irrevocably which will never be seen until its too late. Instability due to straight teeth in a position of muscular imbalance requires permanent retention – failure to wear a retainer allows teeth to relapse and the problem becomes the lack of wear (patient’s fault) rather than tooth instability.

The orthodontic fraternity

The orthodontic fraternity is professionally and politically strong and legal action taken against orthodontists is difficult as much of the literature that “proves” orthodontic principles are written by orthodontists and as a consequence of this – the best advice is to proceed with caution and good consent.

Specialist orthodontists however are not always above the law and may be judged to a higher standard that a general practitioner due their perceived extra knowledge and training.

General practitioners providing orthodontic treatment may have varying degrees of training – this should be discussed prior to treatment.

Legal action against dentist who are not specialists is a different matter. Those general dentists treating children may be motivated differently than general practitioners treating adults.

Again this is a generalization and over simplification and each case must be considered on its own merit.

Temporomandibular pain

In conclusion it should be noted that orthodontics is NOT a treatment for jaw problems (TMD) alone.

In fact I have seen TMD caused by orthodontic treatment.

Orthodontics can certainly be an important part of the treatment of this disorder, (TMD) but orthodontics is by its very nature, irreversible.

TMD requires a stabilization phase where comfort and function are achieved for an adequate amount of time – before permanent treatment (if indicated and chosen) is performed.

Inadequate time to ensure success before proceeding with the next phase (usually due to a desire to “get on with it) may lead to difficult and expensive problems down the line.

Dr Stephen Bray 2020

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