The Herbst appliance is a functional orthodontic device designed to influence jaw growth and correct a person’s bite. It consists of a custom-fabricated metal framework of surgical-grade stainless steel anchored to the first permanent molars in the upper and lower jaws. Connecting these anchor points are telescoping mechanisms that run along the outside of the teeth, linking the top and bottom jaws. This setup is fixed in place by an orthodontist and is not removable by the patient.
How the Herbst Appliance Works
The primary purpose of the Herbst appliance is to correct a specific type of bite problem known as a Class II malocclusion. This condition is characterized by a significant overbite, where the lower jaw is positioned too far back. The appliance functions by holding the lower jaw in a more forward, corrected position. The telescoping arms allow for opening and closing but guide the jaw to a designated forward spot when closed.
This constant, gentle pressure encourages the lower jaw to grow into this new, more aligned position. The appliance is most effective when used in growing patients, typically adolescents between 9 and 14, as it capitalizes on their natural growth spurts. By working with the body’s development, the device helps achieve a skeletal correction of the jaw’s position, rather than just tipping the teeth. The force also applies some backward pressure to the upper jaw, contributing to the overall bite correction.
Adjusting to the Appliance
The first week of wearing the Herbst appliance is an adjustment period. It is normal to experience some muscle tenderness in the jaw and general soreness in the teeth as the mouth adapts to the new forward posture. This discomfort is mild and can be managed with over-the-counter pain relievers, as approved by a doctor. A diet of soft foods during this initial phase can also help minimize pressure.
Eating will feel different, and it is best to avoid hard, sticky, or chewy foods that could damage the appliance, like hard candies, nuts, and sticky caramels. It is advisable to cut all food into small, bite-sized pieces to make chewing easier. This prevents putting excessive force on the metal arms and connection points.
Speaking may feel awkward at first, and some people develop a temporary lisp or have difficulty with certain sounds. This is a common experience as the tongue learns to navigate around the new hardware in the mouth. With practice, such as reading aloud daily, speech returns to normal within one to two weeks.
The metal components of the appliance can sometimes irritate the soft tissues of the cheeks and tongue, potentially causing sores. This is particularly common in the first couple of weeks as the mouth “toughens up.” Orthodontic wax is a useful tool to manage this; a small piece can be warmed and pressed over any part of the appliance that is causing irritation. Rinsing with warm salt water can also help soothe any sore spots that develop.
Care and Maintenance
Meticulous oral hygiene is necessary while wearing the Herbst appliance. Food particles and plaque have more places to hide, so brushing thoroughly after every meal is important. Care should be taken to clean around all parts of the device, including the metal crowns, telescoping rods, and where the appliance meets the gumline.
Specialized tools can make cleaning more effective. An interdental brush or a water flosser can be helpful for removing food debris from hard-to-reach areas around the appliance framework. Using a fluoride mouth rinse daily provides an extra layer of protection against cavities.
If a part of the appliance, such as a rod or screw, becomes loose or breaks, it is important to contact the orthodontist’s office immediately. They can provide specific instructions and schedule a repair appointment. Attempting to fix the appliance at home is not recommended, as this could cause further damage. Prompt professional repair is the best course of action.
Treatment Timeline and Expected Results
The Herbst appliance is worn for about 9 to 12 months. The exact duration can vary depending on the severity of the initial bite problem and the individual patient’s growth response. During this time, the orthodontist will make periodic adjustments, sometimes adding small “shims” to the telescoping arms to advance the lower jaw further.
This phase of treatment is often considered “Phase 1” of a more comprehensive orthodontic plan. Its primary goal is to correct the underlying jaw discrepancy. After the Herbst appliance is removed, “Phase 2” of treatment begins. This second phase almost always involves braces on both the upper and lower teeth to straighten them and refine the bite.
The final outcome of this two-phase approach is a corrected bite and improved jaw function. By aligning the jaws, the treatment can also lead to a more balanced facial profile. Patients are left with a healthier and more stable bite, having addressed both the skeletal and dental components.