Welcome to the Portland TMJ Clinic, where Dr. John Summer has been providing non-surgical treatment of TMJ and bite disorders for 35 years and sleep apnea for 15 years. Unlike almost all other TMJ practices, we perform no general dentistry. Because we do not fill our work schedule with time consuming dental procedures, we remain available to treat TMJ disorders on short notice. We can usually see people in pain right away, and we often employ a number of temporary orthopedic interventions to provide quick relief.
The two qualities for which the Portland TMJ Clinic stands out are INNOVATION AND COMMUNICATION. We have developed significant advancements in the understanding of these conditions and their treatments. We explain these advancements and the rationale for all our treatments in detail on this website.
Our innovations include the application of orthopedic principles to protect injured TMJs, an understanding of the bite based on anthropology and joint physiology, a comprehensive explanation of the societal cause of these disorders, and a breakthrough in oral appliance treatment for sleep apnea.
This website contains over 250 pages of original and detailed information about TMJ disorders, the bite, facial growth, sleep apnea, and the etiology of all these problems. The content under the TMJ DISORDER, SPECIFIC TREATMENT, and SLEEP APNEA tabs is written in non-technical language so it can be understood by patients who are motivated to learn more about their condition, but it has not been "dumbed down" to make it more marketable. The content under the FOR DOCTORS and ETIOLOGY tabs describes the innovations, treatment rationales, and even treatment techniques in detail. Although it employs medical and dental terms, most of it can be understood by anyone who is willing to consult a dictionary.
Instead of just managing the acute symptoms that arise periodically in the natural course of a TMJ disorder, we use orthopedic principles to eliminate the root cause of the symptoms and attain a state of long term jaw system health that prevents them from returning. Each type of orthopedic treatment is explained along with its rationale and costs. To avoid overtreatment, we recommend the simplest and least expensive treatment that is likely to provide relief. Although we recognize that a large number and variety of medical treatments can be used to manage TMJ disorder symptoms under the banner of comprehensive care or multi-disciplinary care, we find that orthopedic treatment alone is sufficient to provide both short term and long term relief in almost all patients. The symptoms disappear and do not return.
An ORAL APPLIANCE , specific to your particular condition, is usually worn during sleep. If a TMJ is inflamed, the oral appliance is designed to control the movements of the lower jawbone to protect the bruised tissues. If the symptoms are strictly muscular (myofascial), the oral appliance is designed to rehabilitate tight jaw muscles by stretching them out or to rehabilitate weak jaw muscles by providing a bite surface that serves as an improved exercise template. The oral appliance worn during sleep may be designed to reduce grinding or clenching (front flat bite plate), to absorb the forces of grinding and clenching (stabilization appliance), or to redirect the forces of grinding and clenching to provide orthodontic and facial growth benefits (functional orthodontic appliance).
For OTHER SUPPORTIVE TREATMENTS, we count on the many local health care practitioners who specialize in using them. We don't directly treat the muscles, because there are so many physical therapists, chiropractors, massage therapists, and other health care workers who are very skilled in the direct treatment of muscles; and we leave holistic aspects of TMJ disorders to those naturopaths and other health care workers who specialize in full body care.
THE ROLE OF THE BITE
THE NATURAL BITE may also need some modification. A stable healthy natural bite is fundamental to jaw system health. A big portion of this website is devoted to explaining how the bite affects TMJ disorders, head posture, and facial growth. The bite has been the most misunderstood subject in dentistry and the source of great confusion in the treatment of TMJ disorders. The way bites are involved in TMJ disorders is explained for patients in THE ROLE OF THE BITE under the drop down menu entitled TMJ DISORDERS. A comprehensive analysis of the bite written in technical language for dentists with extensive footnotes can be found in the OCCLUSION papers under the drop down menu entitled FOR DOCTORS. The way the bite developed in our evolution and the way our bites have recently changed due to the softening of our diet is described in the ETIOLOGY chapters.
THE ROLE OF BODY POSTURE
The lower jawbone is an integral part of the head posture mechanism, yet lower jawbone posture is controlled by the bite, therefore adjusting the bite can have an important role in postural treatment. However jaw posture and body posture are rarely treated together, because their connection has not been understood by those in either field. The connection between the bite and the postural system is explained for patients in THE ROLE OF BODY POSTURE under the drop down menu entitled TMJ DISORDERS and in technical language with extensive footnotes in the file entitled OCCLUSION AND POSTURE under the drop down menu entitled FOR DOCTORS.
NEW MORE EFFECTIVE ORAL APPLIANCE TREATMENT FOR SLEEP APNEA
Sleep apnea occurs when people repeatedly choke on their tongues during sleep. Dentists make a variety of oral appliances to treat sleep apnea by bringing the lower jawbone forward. Such protrusion of the lower jawbone can create space for the tongue to shift forward, but it cannot actually hold the tongue forward. As a result, the effectiveness rate of jaw protrusion appliances never goes beyond about 50%.
To improve that rate, we have developed devices that can be added to a jaw protrusion appliance to hold the tongue forward with the lower jawbone and also to produce and maintain space for airway passage between the tongue rear and the soft palate. Our treatment protocol begins with a sophisticated jaw protrusion appliance, followed by a home sleep test to measure its effectiveness. If you still have sleep apnea, we add the tongue holding device and test again. If you still have sleep apnea, we also add a tongue rear depressor and a soft palate elevator to clear the only area of the pharynx that is still unprotected. Because it can protect the airway at all levels of the pharynx, such a multi-level approach is likely to become the key to predictable success in oral appliance treatment for sleep apnea just as multi-level treatment has become the key to predictable success in surgical treatment for sleep apnea. For more information click the SLEEP APNEA tab.
If you are interested in why these disorders have become so prevalent during the last century, under the ETIOLOGY tab you will find a long, well researched, and interesting story about how the softening of our diet due to industrialization of our food supply has changed our facial growth in a way that has made us susceptible to TMJ disorders, obstructive sleep apnea, forward head posture, and other related disorders. The information is written in technical language, because it needs to be understood by doctors and dentists and because the relationship between facial growth, the bite, and TMJ disorders is too complex to fully describe without using medical and dental terms.
This website is filled with content rather than patient testimonials, because content can help you understand your condition, while testimonials are just advertising. It's easy for almost any kind of health care worker to obtain moving and heartfelt testimonials to support almost any type of treatment; because placebo effects are especially powerful in conditions involving muscle resting postures and because there are always patients who improve from any treatment or even from no treatment due to a statistical factor called "regression to the mean." In any medical condition with symptoms that normally fluctuate over time, most people seek treatment when their symptoms are relatively severe and therefore likely to get better anyway just by returning to their average state. In addition, because even untreated TMJ disorders eventually resolve due to adaptation, the relief of symptoms caused by regression to the mean may feel like a permanent cure and therefore a resounding treatment success even if the treatment did not actually help at all.
PHONE: (503) 241-7353 FAX: (503) 525-2966