• Headgear is used to hold your upper jaw in place while your lower jaw grows enough to catch up. This can typically be done by wearing the headgear for 12 hours every day. We recommend you wear your headgear during the night, but if you miss a night, headgear can be worn during the day to make up for the night you missed.
  • Your headgear fits into the big tubes of your upper six-year molar (first molar) bands.
  • You may notice some temporary discomfort during the first few nights. This will go away if your headgear is worn faithfully. Generally, it takes 3-10 days to get used to and get over the soreness associated with your new headgear. If you miss even one night of wear, it is likely that you will have to repeat the 3-10 days of soreness all over again. Missing only one night (12 hours) of wear will wipe out the previous seven days of wear.
  • You may notice your upper six-year molars (first molars) are a little loose. This is normal. Use a pain reliever as needed for discomfort.
  • Handle your headgear with care, especially when inserting or removing it. Never, ever remove your headgear without first removing the neck strap.
  • If you notice the anchor band (on your first molar) in which the headgear fits is loose, please call us for an emergency appointment. Bring your headgear along so that we can re-fit it. Do not wear your headgear if the anchor bands are loose. If your anchor band comes completely off, please bring it with you to your emergency appointment.
  • If after getting used to your headgear, it suddenly feels like it doesn't fit, please call for an emergency appointment.

Please bring your headgear to each appointment so that we can adjust it.


  • This appliance is designed to expand (widen) your palate (upper jaw). With every turn, you may notice some slight pressure, which should subside rather quickly.
  • Do not turn any additional turns unless instructed by Dr. Fenderson.
  • Dr. Fenderson will tell you how many times you need to turn your appliance. This will be determined by the amount of expansion needed for your specific case. After expansion is complete, there is a stabilization period generally lasting six months from the last turn.
  • It is a good idea to turn your appliance at the same time every day to avoid forgetting a day and to lessen discomfort.
  • Always brush and rinse your appliance when you are brushing your teeth. Water picks are another helpful cleaning tool.
  • Avoid sticky, chewy foods as they tend to get stuck in your appliance.
  • During the first three days after your appliance is inserted, you may notice that your mouth is producing more saliva. As your mouth gets used to your new appliance, your salivary glands will stop producing so much saliva. This can take up to one month but usually only lasts 3-4 days.
  • More than likely, you will notice a gap forming between your two front teeth. This is normal and will eventually close on its own.
  • If you experience discomfort, you may take the same pain killer you use for a headache.


  • The lower lingual holding arch is designed to maintain the position of the lower molars as the baby teeth are lost.
  • The permanent teeth that will replace these baby teeth are much smaller. By preventing the molars from moving forward, we can gain up to 5 mm of space to relieve crowding of the lower teeth. If this space gain is not utilized, it can often mean that permanent teeth must be extracted in order to alleviate the crowding of the lower teeth.
  • The lower lingual holding arch is worn until all the permanent teeth have erupted.


  • The quad helix is used to expand your upper teeth. The bands on the back teeth are cemented into place. The wire on the inside of your teeth will gradually make your upper jaw wider, so that we can make more space for your upper teeth. It will be in place for approximately 4 to 6 months.
  • When you brush your teeth you should brush under and around the quad helix, floss and then rinse vigorously with water.
  • A mouth wash like Listerine or Scope will help also.
  • You should brush and rinse after every meal or snack. If this is not possible rinsing with water will help remove the food particles.
  • Avoid sticky, chewy foods as they tend to get stuck in your appliance.
  • If the quad helix should become loose you should call the office and have us re-cement it.
  • If the quad helix should become bent or distorted call the office.
  • Your tongue and cheeks could be irritated, use a warm salt water rinse, brush the top of the tongue, and use the wax on any sharp spots on the quad.
  • Sore teeth are normal for the first three to four days. Advil, Tylenol, or aspirin should be taken in the usual dose you use for headache.


  • The Nance holding appliance is placed to maintain the position of the upper molars.
  • This button uses the roof of the mouth as an anchor to hold back the molar teeth, thereby preventing them from drifting forward and maintaining valuable space.
  • This appliance will be worn until all the permanent teeth erupt.
Trans Palatal Appliance


Spacers are small elastics that fit snugly between certain teeth to move them slightly so bands can be placed around them later. Spacers can fall out on their own if enough space has already been created. To determine if it needs to be replaced, slip some dental floss between the teeth; if it gets stuck, that means the spacer hasn’t created enough room and needs to be replaced prior to your banding appointment.


One of the most common problems orthodontists treat is the discrepancy that occurs when the upper teeth protrude beyond the lower. Ordinarily, when we see a patient with the upper teeth protruding, we tend to think that the upper jaw and teeth are too far forward; but, more often than not, this condition is due to a small lower jaw that is further back than it should be. With these patients, we would like to encourage the lower jaw to catch up in growth, and braces like the Herbst appliance help this happen.

Even though the Herbst appliance prevents the lower jaw from moving backward, opening and closing movement still occur easily, and patients do not have any problems learning to chew their food with their lower jaw in this new position.

As with all kinds of braces, patients with Herbst appliances need to be careful about what they eat. For instance, cold foods such as ice slushes, Popsicles and ice will freeze the cement and make the brace loosen. Sticky foods such as caramels, bubble gum and candy suckers will pull the brace away from the teeth. Hard foods like crisp vegetables and hard candies will bend and loosen the Herbst appliance, too. So stay away from these foods during your orthodontic treatment.

Your Herbst appliance will be checked and adjusted at your appointments. If, sometimes between appointments, you develop some sore areas on the inside of your cheeks, please do not try to adjust the appliance yourself. Call for an appointment so that the necessary adjustments can be made.

Wearing a Herbst Appliance

At first, your mouth will feel unusually full and speaking will be awkward. But if you practice reading aloud, your ordinary speech will return quickly. You may also notice more saliva than normal, but this will decrease as you become accustomed to the appliance.


One of the many important advances in orthodontics has been the development of temporary anchorage devices, or TADs. Made of a bio-compatible titanium alloy, TADs are miniscrew anchors which are inserted into specific places in the mouth to be used as a fixed point from which teeth can move. Before TADs, orthodontists who wanted to move some teeth while keeping others still, or to achieve orthodontic movement in a mouth with missing teeth, had to rely on headgear for their fixed point. But TADs now provide an option for that fixed point that is smaller, more discrete, more efficient and requires significantly less work for the patient.

Temporary anchorage devices may not be recommended for everyone, and in fact, anchorage devices at all may not be needed in all cases. Contact us if you’d like to know more about TADs and how they can potentially prevent you from needing orthodontic headgear.