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 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 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, 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. We explain these innovations and everythig else we do and the reasons we do it all in detail on this website.
IMPROVED ORAL APPLIANCE TREATMENT FOR SLEEP APNEA
Obstructive sleep apnea (OSA) is caused by choking on the back of the tongue repeatedly during sleep. Many dentists treat the problem with oral appliances that advance (protrude) the lower jawbone. Jaw protrusion can create space for the tongue to rest in a more forward position; but it 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 are never more than about 50% effective at eliminating OSA. Dr. Summer has developed a tongue holding device (THD) that can be added to jaw protrusion appliances in order to hold the entire tongue forward in a comfortably protrusive position together with the lower jawbone. The body and base of tongue are held between thousands of plastic bristles that are all slanted forward like directional Velcro. Their grip is so effective that the tongue can be held in any position desired all night without discomfort, and it cannot be pulled out of the THD until the mouth is opened wide enough to release it. The tongue doesn't need to be held way forward, it just needs to be prevented from dropping too far back.
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 muscles are surrounded by the TMJs, and these joints (the TMJs) often need to be treated before treatment of the surrounding jaw muscles can provide lasting relief.
In ACUTE TMJ disorders, we can usually 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. 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, 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 treatment that is likely to provide relief. Most people only need the right type of oral appliance to wear during sleep and a stable natural bite to provide both short term and long term relief. The symptoms disappear and do not return.
Unlike most TMJ clinics, we make different oral appliances for different conditions. If you have an inflamed TMJ, the 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), the appliance will be designed to either stretch out tight jaw muscles or rehabilitate chronically sore or weak jaw muscles. The appliance 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 (hard plastic or metal 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.
UNIQUE FEATURES of our oral appliances include passive fit, minimal thickness, a dedicated space for proper tongue posture, and permanently accurate vinylpolysiloxane impressions. We avoid the excessive tightness of commercially made oral appliances by employing a unique laboratory block out process that creates a perfectly passive fit and leaves the teeth in their rest positions. We make appliances no thicker than necessary, because we can easily fix them if you break them. We carve out a space for the tip of the tongue just behind the front teeth to encourage normal tongue posture. Our use of permanently stable impression materials, designed for use in gold and porcelain crowns, 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 a fundamental requirement 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 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. The important and generally unrecognized 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.
SUPPORTIVE TREATMENTS, such as physical therapy, massage, accupuncture, nutrition, counseling, hypnosis, biofeedback, exercise, stretches, etc. are often helpful in the treatment of TMJ disorders as well as in overall health; but we find that they are rarely necessary to eliminate the problem, especially in the mid and long term. 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 and other health care workers who specialize in full body care.
MEDICATIONS are also generally unnecessary for treatment. By masking the symptoms, they can make it more difficult to determine the source of the problem, which is our focus. They are primarily only useful for diagnostic purposes. For example, if your symptoms are strictly muscular, an anti-inflammatory will not help much; and if your symptoms are strictly caused by joint inflammation, a muscle relaxer will not help much.
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 more space for the tongue, but they cannot actually hold the tongue forward so they are never more than about 50% effective. For sleep apnea patients 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 entire body of the tongue forward together with the lower jawbone. If necessary, it can also carry 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. More information can be found under the SLEEP APNEA tab, and even more can be found in MULTILEVEL TREATMENT under FOR DOCTORS.
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." 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