Herbst appliance for overbite

If your child has an overbite – where the top teeth protrude beyond the underdeveloped lower jaw – braces may not fully correct the problem. Most often, the child will need additional treatment to move the lower jaw forward, and that nearly always means an appliance.

In our office, we frequently recommend the Herbst appliance for this condition. This device eliminates the need for elastics or headgear. Instead, in most cases metal crowns are cemented over the upper and lower back teeth with tubes attached that stimulate the lower jaw bone to grow forward as they hold the upper jaw back.

Some parents are surprised that braces alone cannot correct their child’s overbite or other bite issues. Here are answers to some of our most frequently asked questions about the Herbst appliance:

When should my child start treatment for overbite?

Because your child will need a jaw adjustment as well as bite correction, the Herbst appliance is most effective at younger ages, while the jaw is still developing. These devices are infrequently used past the teenage years. Adults who seek this type of correction usually must undergo surgery.

If my child is OK with the way her teeth and profile look, why bother with orthodontic treatment?

Straight-appearing teeth doesn’t mean the bite is correct, and a bad bite is associated with a higher rate of cavities, gum disease and tooth loss. Taking care of these problems can be expensive. Treatment for overbite needs to begin before the time youngsters generally become concerned about their looks; once they’re self-conscious about a receding chin, it may be too late for non-surgical treatment. In addition, in correcting alignment, the Herbst appliance can improve speech clarity and temporomandibular joint disease (TMJ) and occasionally, in some patients, reduce sleep apnea.

How long will my child need to wear the Herbst appliance?

Normally, the appliance is worn for at least 12 months. Improvement in bite and appearance can usually be seen much sooner.

Is the Herbst appliance uncomfortable?

Your child may feel some pain initially, but over-the-counter medication in the correct doses should control it. Warm salt-water rinses can help both pain and healing. He will likely also find chewing and swallowing difficult at first, so soft foods – yogurt, mashed potatoes, macaroni and cheese, puddings – are best to eat for a couple of days. Your child should be able to return to normal eating in a short time, following his orthodontist’s few food restrictions.

Does the device require any special care?

The child should not let his fingers or tongue fuss with the appliance or try to move his jaw out of its new position. If slurred speech is a problem at first, reading aloud can help retrain the pronunciation. If a little rod on the appliance slips out of its sleeve, it is not hard for you or your child to put it back in place – we can demonstrate. Your child will need to brush more carefully because food can become trapped in the appliance – we recommend also using a water irrigator. Be sure to brush with fluoride each day, and call our office with any questions or concerns.

Don’t despair for your child when your orthodontist tells you she needs a Herbst appliance. The discomfort is minimal. The results will not only give her prettier teeth but a more perfect facial structure – and a healthier mouth for the rest of her life.

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