Face Mask

What is an Underbite (Class III Malocclusion)?

Before diving into the specifics of the face mask appliance, it’s important to understand the underlying condition it aims to treat. Underbites occur when the lower teeth and jaw protrude beyond the upper teeth and jaw, resulting in a misaligned bite. This misalignment can lead to a variety of dental and functional issues, such as:

• Difficulty chewing and biting.
• Speech problems.
• Increased risk of tooth wear and damage.
• Facial asymmetry or an unbalanced appearance.

This condition is often referred to as Class III malocclusion, which indicates that the lower jaw (mandible) is too far forward in relation to the upper jaw (maxilla). An underbite may occur due to genetic factors, abnormal jaw development, or environmental factors like thumb sucking during childhood.

When left untreated, underbites can lead to more severe dental complications, such as tooth misalignment, joint issues, and problems with facial aesthetics. This is why early intervention with orthodontic appliances, such as the face mask, is essential for creating a functional, aesthetically pleasing smile.

What is a Face Mask in Orthodontics?

A face mask (or reverse pull headgear) is an orthodontic appliance used to correct Class III malocclusion or underbites. The appliance works by applying gentle pressure to the upper jaw, encouraging it to grow in the correct direction. It is particularly effective in growing patients, as their bones are still developing, allowing for the jaw to be influenced by external forces like the face mask.

The face mask consists of several components:

• The face mask frame: This part fits around the face and attaches to the upper jaw through brackets or bands placed on the teeth.
• Elastic straps: These are connected to the face mask frame, which pulls the upper jaw forward to align it with the lower jaw.
• Headgear: The headgear component of the face mask typically includes a forehead strap that helps secure the appliance while applying the necessary force.

The face mask is worn primarily at night, but it can also be used during the day for more intensive correction. The constant, gentle force applied by the face mask helps correct the alignment of the upper jaw, bringing it forward to match the position of the lower jaw.

How Does a Face Mask Work?

The face mask works by leveraging growth modification to guide the upper jaw (maxilla) into a more forward position in relation to the lower jaw (mandible). It is typically most effective in growing children and adolescents whose bones are still developing. When a patient’s upper jaw is underdeveloped compared to the lower jaw, the face mask appliance can stimulate the growth of the upper jaw, gradually improving the alignment and function of the bite.

Here’s a step-by-step explanation of how the face mask works:

• Placement of the Appliance: The face mask is securely attached to the patient’s upper teeth using orthodontic brackets or bands. Elastic straps are then connected to the face mask frame, which is positioned around the patient’s face.
• Gentle Force Application: Once the appliance is in place, the elastic straps apply gentle forward pressure on the upper jaw. This force encourages the upper jaw to grow forward to match the size and position of the lower jaw.
• Jaw Growth and Realignment: Over time, the applied force helps the upper jaw to grow in the right direction, correcting the underbite. The length of treatment with the face mask depends on the severity of the underbite, the patient’s age, and how consistently the appliance is worn.
• Bone Remodeling: The forces exerted by the face mask help the bones of the upper jaw remodel in a way that shifts the jaw forward, improving bite alignment. As the upper jaw moves forward, the teeth gradually realign into a more functional and aesthetic position.
• Improved Bite and Aesthetics: As treatment progresses, the relationship between the upper and lower jaw improves, resulting in a more harmonious bite. The patient’s facial appearance may also become more balanced, with the upper and lower jaws aligned more symmetrically.

When is a Face Mask Used?

The face mask is most commonly used to treat Class III malocclusion, or underbites, where the lower jaw protrudes forward of the upper jaw. It is typically recommended for growing patients, as their bones are still developing, allowing for more effective jaw modification.

Some indications for using a face mask include:

• Underbite due to a small upper jaw (maxillary deficiency): When the upper jaw is not growing properly, the lower jaw may appear to protrude. The face mask helps bring the upper jaw forward to restore a balanced bite.
• Premature closure of the bite: In some cases, early bite closure may occur, resulting in an improper bite. The face mask can correct this by stimulating the upper jaw’s forward growth.
• Severe overgrowth of the lower jaw (mandibular excess): When the lower jaw is excessively forward, the face mask can help correct this misalignment by encouraging proper growth of the upper jaw.

The face mask is particularly effective when used during early stages of jaw growth, as it can guide the bone development in a favorable direction. However, it may also be used in more moderate cases of Class III malocclusion in patients with ongoing growth potential.

Benefits of Using a Face Mask in Orthodontics

The face mask appliance offers several significant benefits for patients with underbites:

• Non-Surgical Correction: One of the key advantages of using a face mask is that it can correct underbites without the need for invasive surgery. This is especially valuable for children and adolescents who are still growing.
• Improves Facial Aesthetics: By realigning the jaws, the face mask can help improve facial symmetry and appearance, leading to a more balanced profile.
• Prevents Future Dental Problems: Correcting the bite early can prevent issues like tooth wear, gum recession, jaw pain, and difficulty chewing.
• Convenient Treatment: The face mask is generally worn at night, which makes it less disruptive to daily activities. It can also be used during the day for more intensive treatment.
• Effective for Growing Patients: The face mask is most effective in children and adolescents who have active growth, as it harnesses the body’s natural growth processes to correct jaw misalignment.

What to Expect During Treatment with a Face Mask

If your child or adolescent is undergoing treatment with a face mask, here’s what you can expect:

Initial Fitting:

During the first visit, Dr. Ceceilia M. Markham, DMD, will take impressions of the patient’s teeth and create a custom face mask appliance. The appliance will be fitted and adjusted for comfort.

Wearing Schedule:

The face mask is typically worn for about 12–14 hours each day, often during sleep. In more severe cases, it may need to be worn for longer periods during the day as well.

Monitoring Progress:

Throughout the treatment process, regular follow-up appointments will be scheduled to monitor progress and make any necessary adjustments to the appliance.

Discomfort and Adjustments:

Some discomfort may occur when the face mask is first worn or after adjustments, but this should be temporary. Dr. Markham will provide guidance on how to manage any discomfort.

Duration of Treatment:

The length of treatment with a face mask depends on the severity of the underbite and the patient’s age. Treatment may take several months to a year or more.

Conclusion: Correcting Underbites with a Face Mask Appliance

The face mask appliance is an essential tool in orthodontics, particularly for correcting Class III malocclusion or underbites. By applying gentle, continuous pressure to the upper jaw, the face mask encourages its forward growth to align with the lower jaw, improving bite function, aesthetics, and overall oral health.

Dr. Ceceilia M. Markham, DMD, in Warrington, PA, offers personalized treatment with the face mask appliance to help patients achieve a balanced, functional bite and a more harmonious facial appearance. If you or your child are experiencing an underbite, contact Dr. Markham’s office today to schedule a consultation and learn more about how the face mask appliance can help correct the bite and improve oral health.