Guiding Lower Jaw Growth

Braces and Invisalign are not the only ways that orthodontists improve the smiles of their patients. Several different orthodontic appliances are used to help correct various issues, such as malocclusions (bad bites) and jaws that are too narrow.

To help educate our patients, Burke & Redford Orthodontists has been providing information about the different orthodontic appliances that may be used during a patient’s treatment. This article focuses on the Herbst appliance.

Problems Corrected with the Herbst Appliance

The Herbst appliance is most often used to correct moderate or severe overbites, which is when the lower teeth set excessively behind the upper teeth. Although minor overbites can sometimes be corrected with braces, often the cause is an underdeveloped lower jaw. The Herbst appliance is used to move the lower jaw forward to create a better bite. By moving the jaw forward, the source of the overbite is eliminated.

Because modification of the jaw is most effective when the jaw is still developing and growing, the Herbst appliance is usually used on patients between the ages of 9 and 14. Once the device is removed, additional orthodontic treatment (such as braces or Invisalign clear aligners) is usually needed to finalize bite correction and align teeth.

Addressing bite and jaw issues at younger ages has many advantages—such as improved jaw function, a more balanced facial appearance, and healthier teeth and gums. If the problems corrected by the appliance are left untreated, patients often experience problems with speaking, chewing, and swallowing.

The Herbst appliance is rarely used on older patients. Instead, treatment for adult patients to correct a jaw size mismatch may involve jaw surgery, which can be expensive, painful, and has a lengthy recovery period.

In addition to correcting an overbite and bringing the lower jaw into the correct position, the Herbst appliance may also help improve clarity of speech, improve chewing function, and improve facial balance.

Herbst Appliance Description and History

Named after its inventor Emil Herbst, the Herbst appliance is a fixed brace that holds the lower jaw forward. The appliance consists of metal rings (crowns) that are cemented to the upper and lower back molars. These crowns slide over the molar teeth and no drilling or alteration of the teeth is required. Two telescopic attachments (called jigs) are then inserted. These attachments bring the lower jaw forward.

When patients are wearing the Herbst appliance, patients can move their jaws forward and sideways with free range of motion. However, the lower jaw is prevented from moving backward. Patients can fully open their mouth, which allows for normal speech, chewing, and eating. The device is typically worn for 6-8 months. However, this may vary depending on a patient’s needs.

In the past, orthodontists commonly used headgear to treat severe overbites. However, headgear was bulky, difficult to wear, and removable. This meant that headgear relied on patient

compliance to achieve results. Because headgear had to be worn 12 to 16 hours a day and was uncomfortable and unattractive, many patients didn’t wear it enough to achieve the best outcomes.

Because the Herbst appliance is fixed in place, it requires no effort from the patient. Plus, the device is working 24 hours a day to modify growth—thereby shortening treatment time. In addition, the appliance is much more discreet than headgear—usually only visible when patients laugh or speak.

Although there are Herbst clones on the market and similar appliances, research has shown that the original Herbst appliance is the most effective device and typically outperforms the alternatives.

Expectations and Adjustment Period

Patients will need a full week to get used to wearing the Herbst appliance. At first, the device will feel a bit bulky in the mouth. Also, patients report that their bite initially feels different. Chewing may also temporarily be affected. However, most patients adjust relatively quickly.

Here are some common issues to expect during the adjustment period, along with some solutions.

• Muscle Tenderness. A patient’s jaw muscles may be sore and tender at first. This will go away once the patient adapts to the appliance. Using over-the-counter medications (such as ibuprofen or acetaminophen) will help reduce any pain. Also, a diet of soft food for the first few days will help make the transition period more comfortable. Some choices include yogurt, applesauce, mashed potatoes, macaroni and cheese, puddings, and smoothies.
• Tissue Irritation. The metal parts of the appliance may irritate the cheeks and gums. Although these areas will “toughen up” over time, orthodontic wax can help in the interim. Rinsing with salt water is also helpful (1/2 teaspoon of salt mixed with 8 ounces of warm water). If patients don’t care for the taste of salt water, an alcohol-free oral rinse can also be used.
• Speech and Swallowing Issues. A patient’s speech might sound a little funny at first, and they may have excessive saliva for the first few days. Although this will correct itself in time, patients can speed things along by speaking or reading out loud as often as possible.

The best orthodontist like Dr. Redford or Dr. Burke will closely monitor the appliance, which will be worn until the necessary amount of bite correction is achieved. Depending on the patient, the device may need to be activated (tightened) every couple months. This involves putting small pieces of tubing on the appliance’s arms (jigs).

Cleaning and Maintenance

Although the appliance requires very little maintenance, there are some rules to follow.

• Don’t eat sticky and chewy foods that can damage the appliance.
• Use caution when eating hard or crunchy foods.
• Avoid drinking carbonated beverages that can wash out the cement.
• Refrain from playing with the appliance with fingers or the tongue as this may move it from its proper place.

If the cemented part of the appliance becomes loose or dislodged, contact our orthodontist office immediately. After the appliance is attached, patients will be shown how to fix minor issues that may arise.

While wearing the Herbst appliance, patients should follow a strict oral hygiene routine, which involves daily brushing, flossing, and rinsing with a fluoride rinse. Patients should pay particular attention when cleaning areas that are next to the gums.

If you have questions or concerns about the Herbst appliance or any other orthodontic appliance, contact Burke & Redford Orthodontists at (951) 699-8011 or fill out the contact form on our website.