When a child’s upper jaw grows too far behind the lower jaw, the effects can show up long before adult teeth arrive. Parents may notice an underbite, a flattened profile, or a bite that never quite lines up the way it should. Left alone through the growing years, these skeletal patterns tend to become more pronounced rather than less, sometimes requiring surgery once growth is complete.
At our Jeffersonville practice, we treat this exact concern with facemask therapy, a growth modification approach designed to work with a child’s remaining growth rather than against it. We built our early intervention program around catching these patterns while a child’s jaw is still developing, since acting early can change the entire trajectory of treatment. We recommend an initial evaluation around age seven, when the first signs of a developing skeletal mismatch tend to appear.
What Facemask Therapy Actually Does
A facemask, sometimes called reverse-pull headgear, is an appliance worn outside the mouth that connects to a device inside it, typically an expander attached to the upper back teeth. Gentle, steady forward pressure is applied to the upper jaw through elastic bands, encouraging it to grow forward and align more evenly with the lower jaw.
This is different from an appliance that simply straightens teeth. Facemask therapy targets the underlying bone structure, which is why timing matters so much. A child’s facial bones respond to this kind of guided pressure while they are still actively growing. Once that growth window closes, achieving the same skeletal correction may require jaw surgery instead of an appliance worn at home.
Why We Often Pair It With Expansion
Many children who benefit from facemask therapy also have a narrow upper jaw, which is why we frequently combine it with an appliance from our palatal expander program. Widening the upper arch first creates more room and can make the forward-pulling force of the facemask more effective. The two appliances work in sequence, not competition, each addressing a different dimension of the same underlying skeletal pattern.
A study published through the National Institutes of Health evaluated rapid palatal expansion paired with facemask therapy in growing children with this type of jaw discrepancy and found that most patients showed meaningful improvement in the relationship between the upper and lower jaw. That research reinforces what we see in our own patients: combining these two appliances at the right age can meaningfully change how the jaw develops.
Recognizing the Signs Early
Parents are not expected to diagnose a skeletal jaw discrepancy on their own, but a few signs are worth watching for between ages six and nine.
- An underbite, where the lower teeth sit in front of the upper teeth when the mouth is closed
- A flattened or concave appearance to the midface when viewed from the side
- Difficulty biting into foods like sandwiches or apples
- A family history of jaw misalignment, since this pattern often runs in families
If any of these sound familiar, an early evaluation through our pediatric orthodontic evaluation program can confirm whether growth modification is appropriate before the growth window narrows.
What Treatment Looks Like Day to Day
Most children wear the facemask for 12 to 14 hours daily, often overnight and during quiet time at home, for several months to a year depending on the severity of the discrepancy. It takes some adjustment, but children tend to settle into the routine quickly once they get used to the feel of the appliance.
Throughout treatment, we monitor growth closely and adjust the approach as needed. Because facemask therapy is one piece of a broader early intervention strategy, we often coordinate it with other interceptive treatment options depending on what else is developing in a child’s bite. In some cases, addressing airway function alongside jaw growth makes a meaningful difference, which is part of why our airway-focused orthodontics program often works hand in hand with growth modification for children who need both.
Meet Dr. Heather McCullum
Dr. Heather McCullum brings 15 years of orthodontic experience to our Jeffersonville practice, with particular expertise in airway-focused orthodontics and early intervention. A Southern Indiana native, she returned home after training and practicing in Illinois and Kentucky to open a practice built around personalized, small-town care for patients of every age. She graduated as valedictorian from the University of Louisville School of Dentistry and was recognized with the American Association of Orthodontists Award for her academic and clinical work.
We built our practice around catching skeletal jaw patterns like this while treatment can still work with a child’s natural growth. If you have noticed any of the signs above, or simply want a professional opinion on your child’s bite, reach out through our contact form to schedule an evaluation with Dr. McCullum.
