Welcome to the Portland TMJ Clinic, where Dr. John Summer has been treating TMJ and bite conditions for 35 years. The two characteristics for which we stand out are INNOVATION AND COMMUNICATION. We have developed significant advancements in the understanding of these conditions, which has enabled us to greatly increase clinical success rates. 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 and rehabilitate jaw muscles, 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, and sleep apnea. Treatments are fully explained along with their rationales and costs. The content under the TMJ DISORDERS, SPECIFIC 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 employs medical and dental terms, but most of it can be understood by anyone who is willing to consult a dictionary.
In acute TMJ disorders, we can usually provide relief right away using a variety of temporary orthopedic measures, including temporary thermoplastic (not boil and bite) stabilization appliances and immediate pivots. Because we perform no general dentistry and we do not fill our work schedule with time consuming dental procedures, we remain available to treat TMJ disorders on short notice.
In chronic TMJ disorders, instead of just managing the acute symptoms that arise periodically, 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 correct 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.
Although we recognize that there are dozens of supportive treatments which are often helpful, we find them generally unnecessary, and we refer them out. 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.
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 either stretch out tight jaw muscles by providing a tall even bite table to grind against during sleep or to rehabilitate weak muscles by providing them a bite that forms an ideal exercise template. The oral appliance may also 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). Because all commercially made oral appliances are too thick and too tight, we make all our appliances in our in-house lab where Dr. Summer can be involved in all aspects of the design.
THE NATURAL BITE may need 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. A summary of the way bites are involved in TMJ disorders can be found in THE ROLE OF THE BITE under the drop down menu entitled TMJ DISORDERS. A comprehensive analysis of the bite written in technical language with extensive footnotes can be found in the three OCCLUSION files 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.
BODY POSTURE can sometimes be improved by even minute alterations of the bite. The lower jawbone is an integral part of the head posture mechanism, and lower jawbone posture should fit in with the postural tensions of the rest of the body. However, lower jawbone posture is also controlled by the bite. The connection between jaw position and body posture 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, which can create space for the tongue to shift forward, but cannot actually hold the tongue forward. As a result, in more than a hundred studies, the effectiveness rate of jaw protrusion appliances is always 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, headaches, crooked teeth, mouthbreathing, and even near-sightedness (myopia).
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." The 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 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