THE EDITOR'S CORNER
Part-time wearing of conventional headgear is not the correct way to use this appliance. Yet, relatively few orthodontists are prescribing full-time wear of extraoral appliances. The majority are prescribing ten to fourteen hours of home wear per day. Indeed, in many parts of the country the extraoral appliance is known as the "night appliance". This is done not because it is thought to be the correct way to use these appliances, but as an expedient because we lack the confidence to ask for more.
I believe that if full-time headgear wearing were instituted countrywide--if just about all orthodontists who prescribe the appliance were to prescribe it full-time--that the desired correction would be accomplished in a fraction of the time and that we would then be serving our patients' needs and not their desires and their vanities. The fact is that we do not apply this easement to any other force system.
The reasons that most orthodontists prescribe part-time wearing of headgear are that much of the time a satisfactory result can be obtained even though it may be over a prolonged period of time; the amount of chair time needed for headgear treatment is not so great that time is a large factor; we are afraid if we insist on full-time wearing that we will lose the patient; and, possibly most of all, it is hard to ask our patients to do something that others in the area are not doing.
All of these points would be satisfied by universal full-time wearing. Economic pressure in terms of cases lost would be minimal if almost everyone were doing it. There would be little fear that a patient would leave you for someone else in town who did not insist on full-time. In any event, the net loss would probably be more than counterbalanced by the speed of treatment. Also, for those patients who would not accept this treatment, you could elect not to start the case, or start at a later age, or some other form of treatment might be substituted. That should be the expedient, rather than part-time wearing of headgear.
Full Time Better
In reply to the argument that part-time wearing often succeeds and that the increased treatment time is not a factor in light of the small amount of chair time involved, one could say that in any procedure less time is better than more; that you have less time to wear out the patient; that some orthodontists do not use this appliance at all because of the prolonged treatment time and the problem of patient cooperation over that long period of time; with a prolonged treatment period, the effective time for tooth movement and/or growth could pass; if headgear wearing is associated with a full-banded technique for mandibular anchorage preparation or preservation or an ACCO technique, you are depending on headgear to counteract an undesirable reaction and you are far better off knowing that you have better cooperation on the headgear.
The chances of obtaining better cooperation with headgear lie with full-time wear because there is more pressure to wear the appliance during the day when the patient is under surveillance at school, at home, among his peers many of whom also will be wearing the headgear. Curiously, the indefinite hours of cooperation would be the sleeping time as they are now; but, even with night cheating (which goes on now anyway), there would be more wearing time logged by full-time wearing than is presently true with conscientious night-time wearing.
Most parents would approve and, once full-time wearing was standard practice, most patients would also go along. No one inquires whether he can wear a plaster cast on a broken leg just at night because it is awkward, uncomfortable, or of poor appearance. The lack of commitment to this useful appliance is, in the first place, on our part.
Changeover Date
In order to make this commitment, there would have to come a day when a preponderant number of orthodontists who use headgear would say to every headgear patient old and new, "From now on, the method of wearing this appliance is going to be full-time for all patients".
Orthodontist Poll
The most important part of such a changeover would have to be the confidence on the part of every orthodontist that just about every other orthodontist was going to go along. If the entire specialty or an extremely substantial part were in agreement that full-time wearing of headgear was the method of choice and that they would institute that regime if virtually everyone else did, all that would be needed would be for some agency to administer a pledge campaign. Every orthodontist of record would be polled to solicit his written pledge that, if some chosen percentage of those polled (say 85%) agreed, then when that percentage was achieved, it would be announced and this would confirm a date (say 3 months hence) on which the conversion would occur. The names of those in agreement could be published.
The time between agreement and enactment could be used for an education program relating the benefits of the change and the fact that this would be specialty-wide. It also could be used to confirm with your orthodontic neighbors by personal contact that they were in on the agreement.
JCO is willing to take the initiative in conducting the headgear pledge if there is enough reader response to indicate broad interest in the idea. Let us know how you feel about this and possibly together we can make a significant change in an important treatment procedure.
Just as an initial indicator, if you are interested in this idea, snip off the "Yes" on the corner of this page, slip it into an envelope and mail to the Editor, Journal of Clinical Orthodontics, 230 Hilton Avenue, Hempstead, N.Y. 11550. 
