Correcting Underbites in Kids: How an Orthodontic Facemask for Kids Works | CDC Dental Bangkok, Thailand

 

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Authored by Dr. Pitipat Tunksook
MSc in Orthodontics, Mahidol University

Parents researching "correcting underbites in kids" or those noticing their child has a protruding chin often worry that the condition will worsen and eventually require jaw surgery. Fortunately, for families seeking expert dental care in Bangkok, Thailand, one of the most effective appliances orthodontists use to correct this issue is the Facemask (also known as reverse pull headgear), a specialized device designed to gently guide the upper jaw forward as the child grows.

What is an Orthodontic Facemask (Reverse Pull Headgear) for Kids?

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An orthodontic Facemask, commonly referred to in dentistry as reverse pull headgear, is a removable, extraoral appliance (worn outside the mouth). It is designed to pull the upper jawbone (maxilla) and upper teeth forward. This treatment is highly effective for correcting underbites in kids with an underdeveloped or slow-growing upper jaw (maxillary deficiency), which is a leading cause of the condition.

Components of a Facemask

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It consists of 4 main parts:

1. Forehead pad
2. Chin cup
3. Metal framework with hooks for elastics
4. Intraoral device, such as an RPE (Rapid Palatal Expander) attached to the upper teeth

How Does Reverse Pull Headgear Work?

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When rubber bands are attached from the device inside the mouth to the Facemask framework, they generate a gentle pulling force of about 300–600 grams per side. This creates the following effects:

The primary results include:

• Encouraging the upper jaw to move forward
• Rotating the lower jaw slightly downward and backward
• Moving the upper teeth outward and the lower teeth inward, effectively correcting the crossbite

What is an RPE? Why Must It Be Used with a Facemask?

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In many cases, orthodontists will use an RPE (Rapid Palatal Expander) in conjunction with the reverse pull headgear to help the upper jaw respond better to the pulling force.

The RPE is a fixed appliance bonded to the upper teeth. Its main functions are to:

• Widen the upper jaw
• Loosen the bony sutures in the palate
• Make it much easier for the Facemask to draw the upper jaw forward

While the RPE does not directly fix the bite on its own, it is a crucial preparatory step that allows the orthodontic facemask for kids to work at maximum efficiency.

Can Reverse Pull Headgear Really Fix an "Underbite"?

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The short answer is yes, it is highly effective, depending on the child's age and the severity of their skeletal structure.

Case study from Dr. Pitipat Tangsuk (License No. 17030), published with patient consent.
Please note that treatment results vary from person to person.

Will My Child Be Teased? Facemasks Are Worn at Home, So Don't Worry!

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Many parents worry that wearing reverse pull headgear will lead to teasing at school or make their child feel self-conscious. The good news is that this appliance is designed to be worn entirely at home.

• The child only wears the device in the evening and while sleeping.
• They do not need to wear it to school.
• No one will see it, so it won't impact their daily routine.
• They can play sports and socialize completely normally.

Parents do not need to worry about bullying or teasing. Because the Facemask stays at home, it is a safe and psychologically friendly treatment option for young children.

At What Age is Facemask Treatment Most Effective?

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• During the early mixed dentition stage, typically ages 8–10 years old.
• This window provides the best possible skeletal correction.
• It should be worn for 12–14 hours a day (only at home) for a duration of 6–12 months.

Is Facemask Treatment Worth It?

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Clinical evidence clearly shows that:

• It reduces the eventual need for corrective jaw surgery by 30%.
• Approximately 67% of patients successfully maintain a normal bite (occlusion) in the long term.

Is There a Risk of Relapse?

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• Relapse occurs in about 25–33% of cases, usually in children whose lower jaw has strong genetic growth potential.
• Children in this category may require further surgical evaluation once they are fully grown.

Who is a Good Candidate for a Facemask?

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Highly suitable for:

• Children with an underbite or protruding chin caused by an underdeveloped upper jaw.
• Children aged 8–10 years old.
• Patients who still have significant bone growth ahead of them.

Not suitable for:

• Children with exceptionally long facial structures.
• Children with severe genetic overgrowth of the lower jaw.

Cost of Facemask Treatment in Bangkok, Thailand

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At CDC Dental in Bangkok, Thailand, orthodontic treatment with a Facemask is priced at 20,000 THB (this includes the Facemask appliance for 12,000 THB and the RPE appliance for 8,000 THB). This is considered part of Phase 1 Pediatric Orthodontics. The complete cost breakdown is as follows:

1. Consultation + X-rays + Treatment Planning – 3,000 THB
   Includes professional clinical photography, dental impressions, or 3D digital scanning for precise analysis.
2. Pre-Orthodontic Dental Clearance
   Any necessary fillings, scaling, or cavity treatments (costs vary depending on the patient's oral health).
3. Facemask Appliance – 20,000 THB
   Plus a clinical adjustment fee every 1–2 months of 1,000 THB per visit.
4. Retainers after completing Phase 1 – 2,000–3,000 THB
   To maintain the corrected position of the teeth after the appliance is removed.
5. Phase 2 Orthodontics (once all permanent teeth have erupted)
   Patients can choose traditional metal braces or clear aligners. Find more details here.

Does Your Child Need an Orthodontic Facemask? Book a Free Consultation!

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If your child has an underbite or a protruding chin,
you can schedule a complimentary evaluation with our specialized orthodontists at CDC Dental.
Our specialists are available daily to provide thorough and professional assessments.

References

• Mandall N, Cousley R, DiBiase A, Dyer F, Littlewood S, Mattick R, Nute SJ, Doherty B, Stivaros N, McDowall R, Shargill I, Worthington HV. Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial. J Orthod. 2016 Sep;43(3):164-75.