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Dentistry/Herbst Appliance vs. Head Gear vs. nothing


Hello Dr.Teig Our 11 years 11 months boy has severe over bite - the upper front teeth are too far from the lower front teeth by 6mm they call it class II and mandibular retrognathia. Different orthodontists offer different plans Herbst Appliance vs. head gear. Ideally we would like to do nothing since we know that there are side effects of both Herbst and Head Gear. On another hand everybody trying to scare us that if we do nothing there might be severe dental problems or potential surgeries in the future. Do you think side effects overweight potential benefits? What would you recommentd in this case?
Thank you very much

Alex - a severe over bite like you describe you son has can do much more than not allowing the teeth to look nice.  Children who have class 2 skeletal relationships very often develop gastrointestinal problems from not chewing the food properly.  Respiratory problems are also common in those with a significant class 2 jaw relationship.

Aligning the jaws properly is a very important factor in allowing normal facial growth and health.  Your son needs some treatment to correct the class 2.  I know this is not what your son to endure, but leaving it alone may make him suffer more in the long run,  If the orthodontists can encourage lower jaw growth then that should correct the situation.  Many do not fully get cured of the class 2 and surgical correction is necessary after puberty.

So orthodontics is not a bad approach, as long as the orthodontist does not create too much pressure on the jaw joints.  Enlarging the lower jaw is the best correction of the disparity of the jaws.  Orthodontics may not fully correct the problem and only tip your son's teeth without addressing the small lower jaw.  

As a surgeon, I have done quite a few class 2 jaw surgeries with great success.  My suggestion, besides the orthodontic evaluation you should have you son examined by an oral and maxillofacial surgeon.  I don't know where you live, but if you like, you can tell me where you live and I can provide a number of doctors who could evaluate your son.

Any additional questions, please feel free to contact me again.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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