Welcome to the Portland TMJ Clinic, where Dr. John Summer has been treating TMJ and bite problems for 35 years and sleep apnea for 15 years. This website contains over 250 pages of information 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. The content under the TMJ DISORDERS, TREATMENTS, 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 is extensively researched and footnoted. It employs medical and dental terms, but most of it can be understood by anyone who is willing to consult a dictionary.
Compared with other TMJ clinics in the world, we stand out for INNOVATION AND COMMUNICATION. Our innovations include the application of orthopedic principles to protect injured TMJs, a new understanding of the bite based on anthropology and joint physiology, the use of oral appliances to redirect bite forces to improve the pattern of adult facial growth, the use of bite alteration in posture treatment, a comprehensive explanation of the societal cause of TMJ and other disorders involving facial growth, and a new breakthrough in oral appliance treatment for sleep apnea. These innovations have led to a treatment success rate of nearly 100%. We explain the innovations, the techniques that have grown out of them, and comparisons with other treatment philosophies in detail on this website as part of our open communication policy. We also maintain an open channel for communication and consults with dentists and patients from all over the world through Skype and facetime.
Dr. Summer's particular field of clinical expertise is the orthopedic mechanics of the temporomandibular joints (TMJs). While many other TMJ dentists focus on the jaw muscles, we recognize that the state of tension in muscles depends on the health of the joints they surround. The TMJs often need to be treated before the surrounding jaw muscles will calm down and stop creating symptoms.
In acute TMJ disorders, we can usually provide immediate relief with chairside fabricated thermoplastic (not boil and bite) joint protective stabilization appliances, temporary pivots, and orthopedic modifications of existing appliances. Because we perform no time consuming general dentistry, we remain available to treat TMJ disorders on short notice. Because we have a complete in-house dental laboratory, we can alter appliances on the spot or make appliances overnight for people who are in severe pain or have traveled long distances for treatment.
In chronic TMJ disorders, instead of just managing the symptoms, we use orthopedic principles to eliminate the root cause of 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 and least expensive treatment that is likely to provide relief. We find that the vast majority of TMJ disorder patients only need the right type of night appliance and a stable natural bite to provide both short term and long term relief. The symptoms disappear and do not return.
An ORAL APPLIANCE specific to your particular condition, is usually provided for wear during sleep. If you have an inflamed TMJ, your oral appliance will be designed to prevent your lower jawbone ends (condyles) from accessing the chronically bruised retrodiskal area. If your symptoms are strictly muscular (myofascial), your oral appliance will be designed to either stretch out tight jaw muscles or rehabilitate chronically sore or weak jaw muscles. It may also be designed to reduce grinding or clenching (front flat bite plate), to protect the TMJs from grinding and clenching (joint protective appliances), to provide an improved exercise template for grinding and clenching (flat stabilization appliance), to try out a new bite (bite restoring appliance), to reduce impacts and strain from the bite (rubber bite cushion appliance), or to redirect the forces of grinding and clenching 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.
Our oral appliances have unique features. We avoid the excessive tightness of commercially made oral appliances by a laboratory block out process that creates a perfectly passive fit. We carve out a hollow for the tip of the tongue (tongue tip hollow) just behind the front teeth to allow ideal tongue posture. We use permanently stable impression material (PVS), normally only used for gold and porcelain crowns, to make a mold that stays accurate for years and thereby enables us to later repair or replace appliances, even through the mail.
THE NATURAL BITE may need modification, because a stable healthy natural bite is required for long term jaw system health. The bite has been the most misunderstood subject in dentistry and the source of great confusion in the treatment of TMJ disorders. A summary of the way bites are involved in TMJ disorders can be found in THE ROLE OF THE BITE under TMJ DISORDERS. A comprehensive analysis of the bite written in technical language with extensive footnotes can be found in the three OCCLUSION files under 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.
POSTURE is always involved in TMJ disorders, because the lower jawbone is an integral component of the head posture mechanism and head posture determines the way the spine aligns beneath the weight on top to maintain physical balance. The connection between jaw and body posture is summarized in THE ROLE OF BODY POSTURE under TMJ DISORDERS and explained in detail in technical language with extensive footnotes in OCCLUSION AND POSTURE under FOR DOCTORS.
We find that SUPPORTIVE TREATMENTS, such as physical therapy, massage, accupuncture, nutrition, counseling, hypnosis, biofeedback, exercise, stretches, etc. are often helpful but rarely necessary to relieve the symptoms. Patients who want additional 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 and other health care workers who specialize in full body care.
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 bring the lower jawbone forward and thereby create space for the tongue to shift forward away from the blockage, but they cannot actually hold the tongue forward. As a result, jaw protrusion appliances are never more than about 50% effective. For those who are not cured by jaw protrusion alone, we have developed and tested a new tongue holding device that can be added to the jaw protrusion appliance to hold the tongue forward together with the lower jawbone. If necessary, the same oral appliance can also carry a tongue rear depressor and a soft palate elevator. With the ability to clear the whole 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 the direction in which our faces grow and keep growing during adulthood in a way that has made us susceptible to 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." This statistical tendency to get better anyway occurs in any medical condition with symptoms that normally fluctuate over time, because 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