Patient guide for Facemask Protraction with expander

A facemask — also known as a reverse pull headgear or protraction facemask — is an orthodontic appliance worn on the outside of the face that works in combination with an expander inside the mouth to guide the growth of the upper jaw forward. It is used to correct a specific type of bite problem called an underbite caused by an underdeveloped upper jaw — and it is most effective when used during periods of active growth in children and young adolescents. Here is your complete guide.

What is facemask protraction and why does my child need it?

The facemask works by applying a gentle but consistent forward and downward pulling force on the upper jaw — encouraging it to grow forward and catch up with the lower jaw. Inside the mouth, an expander is fitted to the upper teeth to provide the anchor points — small hooks on the expander attach to elastic bands that connect to the facemask worn outside.

Facemask protraction is used to treat:

• An underbite caused by an underdeveloped or recessed upper jaw

• A Class III skeletal relationship where the lower jaw protrudes relative to the upper

• Cases where early intervention during growth can avoid or reduce the need for jaw surgery later in life

The earlier this treatment is started during growth, the more effectively the upper jaw responds — which is why your orthodontist has recommended it now.

Wearing the facemask

• The facemask should be worn for the number of hours prescribed by your orthodontist — typically 16 hours per day, which for most patients means after school, during the evening, and throughout the night

• The more consistently it is worn, the more effectively the upper jaw responds to the treatment forces

• The elastics connecting the intraoral hooks to the facemask provide the active force — always ensure the elastics are attached correctly on both sides before wearing

• Change the elastics as instructed by your dentist - elastics lose their force over time and need to be replaced regularly to maintain effective treatment (at least once a day)

Getting used to the facemask

• The facemask will feel very unfamiliar and strange at first — this is completely normal and most patients adapt within 1–2 weeks

• There may be pressure across the upper lip, cheeks, and upper jaw when the facemask is worn — this is the treatment force working and is expected

• Some skin irritation where the forehead and chin pads rest against the face may occur initially — a small piece of soft padding or gauze can be placed under the pads for comfort if needed. Let your orthodontist know if irritation persists

• Sleeping with the facemask takes some adjustment — most patients find that after the first week it becomes part of their bedtime routine without issue

Wearing the elastics correctly

• Hook the elastics onto the intraoral hooks on the expander inside the mouth first — then attach to the facemask

• Ensure the elastics are attached symmetrically on both sides — uneven wear can cause asymmetric forces on the jaw

• The elastics should feel taut but not excessively tight — if they feel overly painful or the force seems excessive, contact your dentist

• Replace elastics with a fresh pair as instructed — keep a good supply at home and in your school bag

• If an elastic breaks during the night, replace it in the morning and continue wearing as normal

Oral hygiene during facemask treatment

• Brush and floss thoroughly twice a day as normal

• Pay particular attention to cleaning around the hooks and bands of the intraoral expander — food and plaque accumulate easily here

• Use an interdental brush to clean around the expander components

• Rinse with warm salt water after meals to keep the area clean

• Remove the facemask before eating — only the intraoral expander remains in the mouth during mealtimes

Caring for the facemask

• Wipe the facemask frame clean with a damp cloth regularly — particularly the chin and forehead pads where skin contact occurs

• Do not bend or adjust the frame yourself — if it feels uncomfortable or does not sit correctly, contact your dentist for an adjustment

• Store the facemask in its bag or box when not in use

• Bring the facemask to every orthodontic appointment

What to expect during treatment

• Treatment with a facemask typically continues for several months to over a year depending on the severity of the jaw discrepancy and the patient's growth response

• Your dentist will monitor progress at regular appointments and assess the jaw relationship and growth response

• As treatment progresses, you may notice gradual changes in the bite — the upper front teeth may begin to cover the lower front teeth more, and the profile may start to change

• Once the desired correction is achieved, the facemask is discontinued and a retainer or other appliance may be used to maintain the result during the remaining growth period

Signs to watch out for

Contact your dentist if you experience:

• Significant pain in the jaw joints or teeth that does not settle — some pressure and mild discomfort is expected, pain is not

• A hook or band on the intraoral expander becoming loose or broken

• The facemask frame bending or breaking

• Any concerns about the bite changing in an unexpected way

💡 Dr Watt's tip: I know the facemask can feel very daunting — especially for younger patients who are worried about what their friends might think. My advice is always to lean into the evening and nighttime hours as much as possible and make it part of the after-school routine. Most patients are surprised by how quickly they get used to it — and the results in terms of jaw growth and avoiding surgery later in life make every hour of wear absolutely worth it. You've got this! 😊