Case Study: The Cause of TMD, Headaches and Sleep Apnea

Part 1: Camryn’s Growth and Development

A note from Louisville dentist Dr. Tracey Hughes: Thank you for reading my blog. Something you should know— this is a professional, yet VERY personal journey of how I became so passionate about Physiologic Dentistry, treatment of TMD, headaches and sleep apnea using Orthopedic Guided Jaw Development: AGGA (Anterior Guided Growth Appliance) and ControlledArch Protractive Orthodontics.

Professionally: I began my post-graduate dental education at the Las Vegas Institute for Advanced Dental Studies (LVI) 10 years ago learning more complex, comprehensive, cosmetic dental treatments designing beautiful smiles and helping patients suffering from TMD (temporomandibular joint dysfunction). I earned my fellowship at LVI, and for almost 10 years, I’ve helped many people live a headache free lifestyles using the skills and techniques I learned at LVI. I am very proud to have been invited to be an instructor at the prestigious Las Vegas Institute just last year in 2017. Now I share my passion and knowledge with other aspiring dentists beginning their journey as physiologic dentists.

Personally: My continued dental education took me in a very specific direction for the last 7 years as my daughter began to struggle with headaches at the young age of 7.

It is very difficult to see your child suffer from pain. I was highly motivated—determined really, to gain the knowledge I needed to help my own child, which has resulted in my ability to help many other patients suffering from the same issues.

My blog is being written from the perspective of a TMJ specialist as well as a nurturing mother…mama bear of sorts, driven to help her daughter thrive pain-free. My #1 reason for learning the physiologic orthodontic techniques was to help my own children. Ben’s story is more focused on airway than TMD symptoms.  More about my 15-year-old son’s case coming soon in another blog.

Learning is a journey…it takes both a time and financial investment. It wasn’t until this last year, all the pieces of the knowledge puzzle finally fit together. I learned what TMD was and how to treat it early in this journey, but this year, I learned the true cause of headaches and TMD (a bad bite, caused by an underdeveloped midface), and my educational journey came around full circle.

Believe it or not—it’s all about allergies and the tongue! I invite you to read my page on Growth and Development, but I think an easier way to understand this is to read my daughter’s story…

Meet beautiful big, blue-eyed Camryn, now 14…18 months old in this picture.

What I didn’t know at this time, was her open mouth breathing habit would potentially cause her a lifetime of suffering…migraine headaches, TMD and even possibly obstructive sleep apnea as an adult. Parents (and grandparents) there are early signs of airway issues and the biggie is Open Mouth Breathing. Observe your child. If they don’t have their lips sealed, or don’t have clear nasal patency, they need help now! Call and schedule your child for a growth and development consultation with me at Boulder Valley Dental.

But why was her mouth always open? Why was she always “sick” with a cold once a month…watery eyes, runny nose, sneezing? We, as parents, just thought she had colds from germs at daycare.

This is the look of an allergic child.

Poor baby couldn’t breathe through her nose because of her enlarged adenoids (due to allergens, most commonly cow’s milk, gluten and environmental). If a child’s adenoids are enlarged, they will not be able to breathe normally through their nose which is the primary mode of breathing. If they cannot breathe through their nose, they will have to compensate by mouth breathing. Mouth breathing is a secondary “emergency” mode of breathing. Our bodies compensate for survival.

Because she was always snotty and unable to breathe through her nose during her early years, Camryn’s tongue has been positioned incorrectly, low in her mouth, thrusting forward to open her little airway to allow her to breathe. After all, Oxygen is the #1 most important thing our body requires. The tongue, one of the strongest muscles in the body, exerts way more force than orthodontic brackets and wires and can move teeth and cause the jaws to develop inadequately and this is what causes a cascade of negative effects into adulthood.


During Camryn’s development, I didn’t have a clear understanding of allergies, tongue position and the effect on facial development. Were there things I could have done for her sooner? Yes. Am I going to beat myself up that I didn’t gain the knowledge sooner? No. Spoiler alert…she is doing very well today, and I will share her treatment story in the next blog.

I am, however, very passionate about helping your child/children achieve maximum forward face and dental arch development while they are still growing at age 3-10 to prevent the problems my daughter and the many adults I see suffering from TMD and headaches. I will be writing future blogs on establishing the full genetic potential for growth in children very soon.

Starting during infancy, the tongue should be positioned high in the palate (roof of the mouth) to act as a natural palatal expander. Because her tongue was lower in her mouth and had a functional tongue thrust, her upper jaw and midface did not fully develop, causing a higher palate and narrow dental arch.


Interesting Fact: Did you know, excess sclera display (seeing the whites of the eyes below the beautiful blue iris) is a sign of incomplete development of the midface, a result of the tongue not being in its proper position during development due to mouth breathing? It sure is! The bones of the midface below the eyes support the soft tissue of the eyelids. If the midface is underdeveloped, there will be no support for the eyelids, and they will drop, causing excess display of the whites of the eyes.

Our first effort to improve Camryn’s airway was age 8; allergy testing (which came back a false negative) and finding an ENT who would remove her adenoids and tonsils to open her airway.

Little did we know, after being told at age 8 she had no allergies, only that her skin was a little sensitive to the testing, that she actually WAS allergic….to everything. (more on this later)

Tonsillectomy and adenoidectomy was the next step in Camryn’s airway health, but her tongue had already developed an abnormal posture and function which began altering her facial and nasomaxillary growth, in turn, affecting her lower jaw position. Because her tongue was not in the proper position, high in the roof of her mouth, her upper jaw did not fully develop. The lower jaw compensated, having to retrude back, compressing her TMJs causing headaches and TMD symptoms.

The muscles memory of the tongue is incredible. Camryn is 3 months post-tonsillectomy and adenoidectomy but look at her tongue position while she is sleeping. Her tongue was trained the first 8 years of her life to thrust forward to allow her to breathe properly.

Myofunctional therapy was necessary to retrain Camryn to find her correct resting tongue position, high in the roof of her mouth, and to correct her improper tongue thrust swallow. We are still working on correcting her abnormal swallow pattern today as well as lip taping during sleep to retrain her resting lip posture.

Age 10, headaches continue…

Camryn’s tongue thrust caused her front teeth to “buck” out, so she started conventional braces to pull them back. What I didn’t know, at that time, that conventional, retractive orthodontics would make the situation worse. Retracting the upper jaw with traditional braces, shoved her lower jaw back, even more, compressing her TMJs and causing contracted temporalis muscles in her head, worsening her headaches.   Look how retracted her front teeth were. Imagine what her lower jaw had to do to function behind the upper front teeth.

Look how conventional braces tipped her front teeth back, making less room for her tongue, forcing it back into her airway.

And look how contracted her neck muscles had become as a result of her retruded bite, which caused forward head posture. Conventional, retractive orthodontics vs. physiologic, protractive orthodontics.

Age 13…. Migraine headaches with nausea began.

This year I attended LVI’s F2O Forward Face and Controlled Arch Orthodontics courses when I learned about the maxilla, one of the most important bones in the entire body! Stay tuned for Camryn’s diagnostic physiologic work-up, physiologic orthodontic treatment plan and the beginning of her headache-free life.

Stay Tuned For Part Two

This post is part one of a multi-blog series. We will be posting periodic updates as Camryn progresses in her journey to a headache free life! If you have any questions, please feel free to contact our team at Boulder Valley Dental Center in Louisville, CO. To contact us, call 303-214-4009 or request an appointment online.