Welcome to the Portland TMJ Clinic, where Dr. John Summer has been researching and treating TMJ and bite problems for 35 years and sleep apnea for 15 years. This website contains hundreds of pages of original writing about TMJ disorders, the bite, facial growth, body posture, and sleep apnea. All the treatments we offer are fully explained along with their rationales and costs. Most of the content is written in non-technical language, but it has not been "dumbed down" to make it more marketable. The extensively researched content under the FOR DOCTORS tab is for anyone who wants a more detailed explanation of any of these topics and is willing to consult a medical dictionary to learn a few key words.
Compared with other TMJ clinics, we stand out for INNOVATION AND COMMUNICATION. Our innovations include the application of orthopedic principles to protect injured TMJs, an understanding of the bite based on anthropology and joint physiology, the use of bite alteration as a tool in posture treatment, a comprehensive explanation of the societal cause of TMJ and other disorders involving facial growth, and a significant improvement in oral appliance treatment for sleep apnea. Our communications include explaining these innovations and everything else we do in detail on this website as well as offering consultations worldwide through telephone, skype, facetime, and email.
IMPROVED ORAL APPLIANCE TREATMENT FOR SLEEP APNEA
Obstructive sleep apnea (OSA) is caused by choking on the base of the tongue repeatedly during sleep. Many dentists treat the problem with oral appliances that advance (protrude) the lower jawbone. These jaw protrusion appliances can create space for the tongue to rest in a more forward position; but they cannot move the tongue forward, because the tongue and lower jawbone are only attached by muscles, which lose their tonus during sleep. As a result, even extreme lower jawbone protrusion often cannot prevent the tongue from falling back and obstructing the airway, and jaw protrusion appliances only eliminate the problem in half of the patients.
For the other half, Dr. Summer has developed a tongue holding device (THD) that can be added to jaw protrusion appliances in order to hold the tongue forward together with the lower jawbone. The tongue is grasped between upper and lower tongue gripping surfaces, each containing thousands of plastic bristles that are all slanted forward like directional Velcro, so they can hold the tongue in any position desired all night without discomfort. In most cases, the tongue doesn't need to be held way forward, it just needs to be prevented from dropping too far back. The same oral appliance that holds the tongue and lower jawbone forward can also carry an adjustable tongue base controller and a soft palate elevator. This 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.The use of this technology is described further under the SLEEP APNEA tab and in greater detail in MULTILEVEL ORAL APPLIANCE TREATMENT under the FOR DOCTORS tab.
ORTHOPEDIC TMJ TREATMENT
While most treatments for TMJ conditions focus on the jaw muscles, the state of tension in muscles depends on the health of the joints they surround. The jaw joints (the TMJs) are surrounded by the jaw muscles, so the TMJs often need to be treated before treatment of the surrounding jaw muscles can provide lasting relief. TMJ disorders generally start with dislocation of an articular disk from inside a TMJ, leaving the involved TMJ without a cushion and especially vulnerable to damage during the forceful clenching or grinding that affects everybody during sleep. To stop the damage, we protect dislocated TMJs with oral appliances that are orthopedically designed to prevent the lower jawbone from accessing the chronically bruised area all night long. After the TMJs are restored to health, the jaw muscles are easy to treat.
In ACUTE TMJ disorders, we can provide immediate relief with chairside fabricated temporary thermoplastic (not boil and bite) joint protective stabilization appliances, temporary front flat plate appliances, and orthopedic modifications such as adding pivots to existing appliances. Because we perform no time consuming general dentistry, we remain available to treat TMJ disorders on short notice.
In CHRONIC TMJ disorders, we focus on the root cause of the problem in order to eliminate the symptoms and attain a state of jaw system health that prevents them from returning. To avoid overtreatment, we begin (and usually end) with the simplest treatment that is likely to provide relief. Most people only need the right type of oral appliance to wear during sleep when nocturnal bruxism stresses the jaw system and a stable unstrained natural bite for normal daytime use in order to provide both short term and long term relief.
The type of oral appliance you will receive depends on your TMJ condition. It may be designed to protect the TMJs from bruxism (joint protective appliances), to provide an improved exercise template for bruxism (flat stabilization appliance), to reduce the forces used in bruxism (front flat bite plate), to try out a new bite (plastic or metal bite restoring appliance), to reduce impacts and strain from the bite (rubber bite cushion appliance), or to redirect the forces of bruxism in a manner that provides orthodontic and facial growth benefits (functional orthodontic appliance). Our in house lab enables Dr. Summer to be involved in all aspects of the appliance design and fabrication, to have appliances made quickly for people who are in pain or have traveled far, and to avoid the excessive thickness and tightness of appliances made by commercial labs.
THE NATURAL BITE may need modification, because a stable unstrained natural bite is a fundamental requirement for long term jaw system health, however the bite is by far the most misunderstood subject in dentistry. The way bites are involved in TMJ disorders is summarized in THE ROLE OF THE BITE under the TMJ DISORDERS tab and explained in detail with extensive footnotes in the three OCCLUSION files under the FOR DOCTORS tab. The way the bite developed in our evolution and the way it has changed due to the recent softening of our diet is described in the ETIOLOGY chapters.
POSTURE is always involved in TMJ disorders, because the lower jawbone is an integral component of the head posture mechanism; yet the lower jawbone is the only postural component that is routinely ignored in the treatment of postural disorders, because its role has not been understood. The important and generally unrecognized connection between jaw and body posture is summarized in THE ROLE OF BODY POSTURE under the TMJ DISORDERS tab and explained in detail in technical language with extensive footnotes in OCCLUSION AND POSTURE under the FOR DOCTORS tab.
SUPPORTIVE TREATMENTS such as physical therapy, massage, accupuncture, nutrition, counseling, hypnosis, biofeedback, exercise, stretches, etc. are often helpful in the treatment of TMJ disorders for the same reasons they are often helpful in treatment of other musculoskeletal disorders. Patients who want supportive treatment are referred to local practitioners with expertise in the treatment that is most likely to help 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 treating muscles; and we leave holistic aspects of TMJ disorders to naturopaths, chiropractors, and other health care workers who specialize in full body care. We use medications primarily just for diagnostic purposes, because we find they are rarely needed for treatment. For example, if your symptoms are a result of muscle tightness, muscle relaxation will help, but an anti-inflammatory will not help much; and if your symptoms are a result of ongoing joint (TMJ) damage, an anti-inflammatory drug will provide short term relief, but a muscle relaxer will not help much.
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, interesting, and not yet fully edited story about how the softening of our diet due to industrialization of our food supply has changed the direction in which our faces grow and keep growing during adulthood in a way that has made us susceptible to a number of health problems including TMJ disorders, obstructive sleep apnea, forward head posture, headaches, crooked teeth, and mouthbreathing.
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 any health care worker to obtain moving and heartfelt testimonials to support almost any 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 shortly after the treatment 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