Welcome to the Portland TMJ Clinic, where Dr. John Summer has been treating TMJ and bite conditions for 35 years. This website contains over 250 pages of information about TMJ disorders, the bite, facial growth, body posture, and sleep apnea. All treatments 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. We have developed significant advancements in the understanding of these conditions, and we explain them in detail on this website. They 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 breakthrough in oral appliance treatment for sleep apnea.
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 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 control the movements of the lower jawbone to protect it from chronic bruising due to nocturnal bruxism (clenching and grinding). If your symptoms are strictly muscular (myofascial), your oral appliance will be designed to either stretch out or rehabilitate and strengthen your jaw muscles. It may also be designed to reduce grinding or clenching (front flat bite plate), to absorb the forces of grinding and clenching (stabilization appliance), to provide an improved bite surface, to cushion the old bite surface, or to redirect the forces of nocturnal 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 design and fabrication.
A UNIQUE FABRICATION PROCESS allows us to make more comfortable and biocompatible appliances oral appliances. All commercially made oral appliances are too thick and too tight. The thickness negatively affects jaw position by crowding out the tongue from its normal resting posture, and the tightness causes jaw muscle tension by triggering neuromuscular reflexes. Eventually the tightness causes inadvertent tooth movement. To prevent these problems, we build our oral appliances with a hollow for the tongue just behind the front teeth, and we use a unique block-out process so the appliance fits passively on the teeth without any need for pre-heating in hot water.
SUPPORTIVE TREATMENTS, such as acupuncture, nutrition, counseling, hypnosis, biofeedback, etc. are often helpful but generally unnecessary. Patients who want them 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 those naturopaths and other health care workers who specialize in full body care.
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 the drop down menu 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 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.
POSTURAL TREATMENT is always involved in TMJ disorders, because the lower jawbone is an integral component of the head posture mechanism. In many TMJ disorder patients, the myofascial tensions of the head posture mechanism would prefer to hold the lower jawbone in one position while the bite programs lower jawbone posture to use a different position. As a result, small changes in the bite can sometimes provide significant relief of postural symptoms. The connection between jaw position and body posture is summarized in THE ROLE OF BODY POSTURE under the drop down menu TMJ DISORDERS and explained in detail in technical language with extensive footnotes in the file OCCLUSION AND POSTURE under the drop down menu 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 bring the lower jawbone forward and thereby create space for the tongue to shift forward, but they cannot actually hold the tongue forward. As a result, they are never more than about 50% effective, as shown in more than a hundred studies. When jaw protrusion is ineffective, we can add a new tongue holding device to hold the tongue forward together with the lower jawbone and thereby ensure clearance of the lower pharynx, followed by a home sleep test to measure its effectiveness. If holding the tongue and lower jawbone forward still does not fully eliminate the problem, we also add a tongue rear depressor and a soft palate elevator to clear the upper pharynx. 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 our facial growth in a way that has made us susceptible to TMJ disorders, obstructive sleep apnea, forward head posture, headaches, crooked teeth, several ear problems, 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 any health care worker to obtain moving and heartfelt testimonials; 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