Headgear & Growth Binding - Our Call to Action

There is currently an alarming practice going on in the orthodontic industry that needs to be banned. That practice is the growth restriction of the maxilla and mandible on children and teens. There is ample evidence that this process is dangerous and can cause life-threatening and debilitating conditions, yet it continues to be taught and practiced today. The orthodontic community is divided into two camps, one that refuses to stop practicing growth restriction, and one that refuses to practice it. Children should not have to suffer because an industry is divided whereby one side is able to get away with life-destroying procedures. Rather, there should be laws that protect children from such procedures.

The reason we have no such laws is because we have accepted growth restriction on children’s jaws as normal orthodontic procedures, as they have been in practice for over a century.  However, is the restriction of the growth of a child’s jaws different from the restriction of any other body part?  Consider the following scenario:

You are visiting a doctor with your eleven-year-old child, and he says: “Ma’am, your child's feet are a too big and we need to restrict their growth. I'm going to use these little metal bands that are going to pull his toes against the backs of his ankles to restrict forward growth. The bands are spring-loaded, so the growth won’t be restricted too much. Then, when he's fifteen and his feet want to widen, we'll lock their width in fixed retainers so that his natural growth spurts will be stunted, preserving the good work we did.  This process will be highly controlled.”  How would you react in this scenario?

Most likely, you would be shocked at the proposition because it’s unheard of and is never done today.  You know intuitively that this would be an entirely destructive thing to do, because the soft and connective tissues in your child's feet would continue to grow despite the restriction placed on the bones. You would know that even if this process is "highly controlled," it is not natural, and thus if the tissues grew to their genetic size, the bones would not match up and that this would wreak havoc on the body.

Consider another scenario.  You are visiting a doctor with your eleven-year-old child, and he says, "Miss, your daughter's rib cage is a little bit too large and is disproportionate to her hips. We're going to put her in a metal corset with springs, which will prevent her rib cage from growing out too much. Once it's reached the size we're looking for when she's about fifteen, we'll strap it in a full metal cage so that it won't be able to widen due to natural growth spurts that will try to happen over the next couple of years. This process will be highly controlled…", again, you would be in shock. Like the example of the child with restricted feet, a restricted rib cage would concern you even more, for the heart, lungs, liver, stomach, digestive tract, kidneys, pancreas, and other systems need room to grow. You can only imagine the damage that this would do, and you would know from common sense that there would be no medical basis for this procedure. In fact, you know that it would be torture and would cause lifelong health problems.

You would be shocked in both scenarios, not just because foot binding is an ancient and harmful practice that was banned in China more than a hundred years ago, and not just because Victorian-era corsets disfigured and even killed many women.  You would be shocked because common sense tells you that the above procedures would be deadly.

However, if you go to an orthodontist today with your eleven year old, he may tell you, "Miss, you child's upper jaw has grown too much and we need to restrict its growth. I'm going to use these little metal arches that are going to pull his upper jaw against the back of his cervical spine to restrict its forward growth.  The arches are spring-loaded so the growth won’t be restricted too much. Then, when he's fifteen and his jaws wants to widen, we'll lock their width in fixed retainers so that his natural growth spurts will be stunted, preserving the good work we did.”  How would you react?

Do you think that restricting the natural growth of the maxilla is any different than restricting the natural growth of any other body part? 

Just as the rib cage holds vital organs, the maxilla supports the eyes, various glands, and most importantly, the upper airway and the tongue.  As the child's face grows, so does the airway. When the bones of the skull are restricted from their natural growth, do you think the soft tissues in the airway stop growing? Do you think the tongue stops growing? Or do they continue to grow, the same way vital organs would continue to grow in a metal-bound rib cage of a growing child? What do you think happens to the airway when the jaws of a growing child cannot widen naturally due to being bound in retainers? What do you think happens to the airway when the maxilla cannot grow forward to its genetically desired position? What do you think happens to the airway when the tongue continues to grow, yet no longer has a mouth long and wide enough to house it?

Today we know that a crowded and reduced airway causes sleep apnea, a debilitating and life-threatening condition that can remove ten to twenty years from a person's life expectancy, can increase their chances of cancer, stroke, type II diabetes, macular degeneration, depression, and host of other deadly problems. In fact, in 1986 a paper published by Dr. Allan Lowe out of the University of British Columbia’s Department of Orthodontics described a retruded maxilla as one of the tell-tale signs of sleep apnea. And since the 1940s many orthodontists have published research described a retruded maxilla as a tell-tale side effect of cervical headgear.

Aware of this, there are orthodontists who wouldn’t dare bind the growth of a child’s face in the name the airway.  Some have been asking their colleagues to stop doing this for decades and they are in the minority.  Despite these calls to stop, many orthodontists today continue to practice growth binding, not just with headgear but now with other newer appliances that achieve the same end.  Do you think that growth binding needs to be made into a criminal offense so that it is banned, and go the same way that foot binding went in China over a century ago?

Principle 2 of the United Nations Declaration of the Rights of the Child states that every child has the “special right to grow up and to develop physically and spiritually in a healthy and normal way”.  Do you think the practice of restricting the growth of a child’s jaws respects this principle?

How many more children need to suffer unnatural, dangerous and life-altering procedures at the hands of orthodontists who refuse to heed the calls of their peers?

If you are a politician, and you have a voice in government, now is the time to speak.

If you are a celebrity, and you have an audience, now is the time to use your influence.

If you are a lawmaker, now is the time to put in place a law that ends the barbaric practice of growth binding on children.

We are calling for an end to this practice.

Showing 10 reactions

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  • Kim Henry
    commented 2022-12-28 18:02:48 -0800
    Any “Call to Action” is a ridiculous waste of time as I have not encountered any ortho cases treated by headgear in over 15 years. It is just not used anymore.
  • D. Green
    commented 2022-12-28 14:01:25 -0800
    I agree with a lot of what you said here, but I’m curious if there’s any update on this? It would be interesting to read how your call of action panned out.

    Kind regards,
    Donald from The Pressure Washing Pros
  • Kim Henry
    commented 2022-01-29 18:37:43 -0800
    “I’m currently 17 and just got a an top jaw expander and I have an underbite. I might getting head gear to pull my top jaw forward.. could this result in the head gear affect??”

    Sorry, Meghan, but reverse headgear to cause forward growth of the maxilla never does anything past the age of 10 or so. It is unpredictable even with 6-year-olds, as no kid will wear this ugly contraption enough hours during the day to make a difference.
  • Real Holo-Widows of Culloden
    commented 2022-01-28 21:13:17 -0800
    This happened to me. My doctors gaslight me and pretend it never happened. This is why so many people distrust the medical system.
  • Kim Henry
    commented 2021-05-02 15:49:35 -0700

    You are right about both dentists and patients having limitations. Sometimes we may POTENTIATE the genetic growth of the mandible; other times we may fail. How much can we actually influence growth? It would take an identical twin study using different modalities on the twin pairs to know for sure.

    Many years ago I treated a mandibular-deficient 9-year old by maxillary expansion, to be followed by a second phase with Herbst appliance at puberty. What do you know? The mandible grew forward to form perfect profile and occlusion, and no second phase was even needed!

    On the other hand, I referred a very difficult 9-year old retrognath to the most skilled orthodontist I know. 1.5 years later, the teeth were straighter, but the mandible had not caught up to the maxilla ANY! Even with a second phase Herbst, this case could very well need surgery to finish.

    We are dealing with human beings with tremendous differences in growth potential- as well as secondary factors like breathing and tongue patterns.
  • Stephen Bray
    commented 2021-05-02 08:45:36 -0700
    Never say never, never say always. Everyone is different but concepts remain ‘true’. One concept is that facial growth is downwards and forward. Failure to do so may lead to aesthetic and functional compromise, Sleep Disordered Breathing and TMD symptoms. Inadvertent iatrogenic interference frequently results in suboptimal clinical results. Profitability due to ease of orthodontic treatment completion is of course morally inexcusable as is an unbalanced and ignorant treatment. No easy answer as we are still in our learning phase, however the most important issue (in my opinion) is to show insight into out own limitations both as individual clinicians and as a profession.
  • Kim Henry
    commented 2020-01-31 05:18:01 -0800
    Silly, silly silly! Would you argue that child deformities should not be corrected? Would you argue that there is not a hereditary basis for any cranial abnormalities, like overly long or short mandible? Human variation covers the whole smorgasbord of cranial deficiencies.

    Some kids inherits a tendency toward overly long mandibles; some short. Some kids, especially Asian ones, have maxillas deficient in length. Some kids, mainly dolichofacials, have narrow maxillas. All these genetic combinations can be influenced by environment, to be sure. It is our goal to potentiate optimum growth of a child and steer them to an attractive appearance. Sometimes this is impossible without orthognathic surgery.

    It is impossible to treat all cases without extraction. There is a limit to expansion that can be accomplished on the jaws. Saw a kid yesterday who had a maxilla overly expanded by some nitwit. Now his lower teeth don’t even fit, and cannot be made to fit even with mandibular surgery.
  • Jessica Gladstone
    commented 2017-06-25 07:45:36 -0700
    Actually sorry thinking about it some more and re-reading claiming powers site I reacted too quickly, I think expansion/oral posture is key but headgear pulling the maxilla forward would definitely be a good idea, sorry again!
  • Jessica Gladstone
    commented 2017-06-25 06:25:19 -0700
    Hi Meghan, if you check out john and mike mews orthotropics page on YouTube they go into detail about the cause of underbites etc, expanding the jaws is definitely a good thing but you have to change your tongue/oral posture and swallowing habits to address why you got the underbite in the first place (the tongue is supposed to sit in the top palate and not ‘hang’ in the lower jaw which then sits forward as the upper jaw drops back) – claiming power.com is also a good website to look at but I don’t think it talks about underbites as much. I think coming from an orthotropics point of view and expansion would be doing the right thing but Mike Mew was also doing forward pull headgears, I just haven’t looked into it that much so I couldn’t say. From a personal perspective, I had my retainer off from extractions and braces and now as my jaws have been expanding I’ve been getting more tongue space etc my jaws have been coming forward and up in a horizontal position and body postures been improving with it, for me, I think forward head pulling gear is trying to mimic what larger jaws with more/larger teeth would naturally achieve if that makes sense. Someone who’s done it might disagree with me and I do think that pulling the jaw forwards is a good idea but I’ve tried pulling my teeth forward and can tell it worked as I have more space at the back but it didn’t do anything more than that and only when my jaws have expanded have I felt themcome forward, posture improve etc – again just mimicking the effect of larger more forward jaws that are limited in how much expansion is possible as wasn’t addressed in developing younger years. I think if a way to regrow teeth was invented and you could replace your teeth with larger ones/add in missing ones that would be the way to go (my teeth grew in small as had no spaces between baby teeth for adult ones) Sorry for my rant, hope that helps :)
  • Meghan W
    commented 2017-05-02 20:42:21 -0700
    I’m currently 17 and just got a an top jaw expander and I have an underbite. I might getting head gear to pull my top jaw forward.. could this result in the head gear affect??

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