Instead of the promotional information that fills most medical websites; this website contains a surprising amount of actual content - about 300 pages of original writing describing a new and comprehensive understanding of the pathophysiology of TMJ disorders and their involvement with bites, facial growth, obstructive sleep apnea, and forward head posture in a kind of unified field theory that explains all their connections.  This website also describes a whole set of orthopedic treatments based on that understanding of the root causes of these disorders, as well as the advantages and disadvantages of each treatment, and even its cost.  

ORTHOPEDIC TMJ TREATMENT

For decades, dentists have "managed" TMJ disorders using nightguards and "splints" that stretch tight jaw muscles by giving them a raised stabilized bite platform to rest on and exercise against.  These oral appliances often provide short-term relief of symptoms; because the muscles, on which the treatments are focused, are also directly responsible for most of the symptoms.  Similarly, Botox can provide short-term relief by breaking up the pain cycle that depends on muscle tightness.  However, the state of tension in muscles depends on the health of the joints they surround, and the TMJs (temporomandibular joints) are surrounded by the jaw muscles, so the TMJs need to be healthy before treatment of the jaw muscles can provide lasting relief. TMJ disorders generally start with a dislocation of the articular disk from a TMJ, which leaves that TMJ without a cushion and therefore especially vulnerable to bruising by the condyle during the forceful clenching or grinding that affects everybody during sleep.  The bruising produces inflammation, which triggers automatic protective guarding in the jaw muscles, much like walking on a swollen ankle triggers limping in the leg muscles.  Effective treatment requires first protecting the inflamed TMJ during sleep by preventing the condyle from accessing the bruised area for long enough to allow it to heal, usually about two months.  Then the jaw muscles can be rehabilitated using techniques that effectively treat muscles in other parts of the body.  

The type of oral orthopedic appliance you need depends on your TMJ condition and its roots in your facial growth pattern.  Your appliance may be designed to protect vulnerable TMJ tissues, provide an improved exercise template for rehabilitating the jaw muscles, reduce strain from the bite, reduce the forces used in nocturnal bruxism, or redirect those forces in a manner that provides orthodontic and long-term facial growth benefits.  Our complete in-house lab enables us to make temporary orthopedic appliances, modify existing appliances at a single appointment, or make rush appliances overnight for people who are in severe pain or have travelled far for treatment. 

At your first appointment, Dr. Summer will determine the root cause of your condition and explain your short-term and long-term treatment options.  Imaging is useful but rarely necessary.  X-rays can show that TMJ damage has occurred, but they cannot tell us when it occurred.  MRI is the only way to image the disk, the clinically most significant feature.  Dr. Summer published a study of recapturing TMJ articular disks with the leading authority on MRI of the TMJs, and he has extensive experience with reading and interpreting MRIs of the TMJs, but he finds them rarely necessary anymore.

BODY POSTURE is always involved in TMJ disorders, because the mandible is an integral component of the head posture mechanism, and the posture of the mandible is reflexively controlled by the location of its central bite platform.  If a displaced central bite platform prevents your mandible from resting in the middle of your face, your head cannot sit straight on the top of your spine, which places torque all along the length of your spine.  Backwardly displaced central bite platforms cause forward head posture, and laterally displaced displaced central bite platforms bite cause the head to tip toward the side of the displacement (described in THE ROLE OF POSTURE under the TMJ DISORDERS tab and in detail in BITES AND POSTURE under the FOR DOCTORS tab.  Displacements of head posture can also cause displacements of mandibular posture and bite platforms, but longitudinal studies show that the displaced mandibular posture usually comes first. 

SUPPORTIVE TREATMENTS such as physical therapy, massage, accupuncture, chiropractic, nutrition, counseling, hypnosis, biofeedback, exercise, and stretching are often helpful in the treatment of TMJ disorders for the same reasons they are often helpful in treatment of other musculoskeletal disorders.  Some treat the muscles either by mechanically stretching their fibers or flushing their capillary beds, while the others work by supporting adaptive capacities.  Patients who want such additional supportive treatments are referred to local practitioners with expertise in the treatment that is most likely to help them.  We don't routinely refer for supportive treatments unless the patient requests them, because we find that orthopedic treatment alone almost always provides sufficient relief.  We don't prescribe medications, because they make it difficult to monitor the effects of treatment.  

OBSTRUCTIVE SLEEP APNEA - is caused by choking on the tongue base, but currently dentists only treat it with oral appliances that advance the mandible (lower jawbone).  Advancing the mandible creates space for the tongue to rest in a more forward position; but it cannot pull the tongue forward into the space created, because the tongue is only attached to the mandible by muscles, which lose tonus during sleep.  As a result, mandibular advancement appliances only eliminate the problem in about half of the patients, as shown by a remarkable similarity of results in hundreds of studies.  For the other half, Dr. Summer has developed new devices that can be added to their ineffective mandibular advancement appliances in order to also control the positions of the tongue base and soft palate, the tissues that form the actual obstruction.  Two of the devices (the high push Herbst and the soft palate elevator, which together comprise phase 1 treatment) have already been approved by the FDA.  Two other devices, (the tongue holding device and the tongue base titraters) are in the FDA review process, expected to be completed during 2024.  The products will all be marketed together in 2025.

The earlier FDA study of the tongue holding devices involved dentate patients who had already undergone mandibular advancement.  The 2024 FDA study will involve only edentulous (no teeth) patients.  They will receive free denture base plates with soft tissue control devices and evaluation by multi-night home sleep testing.  

THE BIG PICTURE (SOCIETAL CAUSE)  

If you are interested in why TMJ disorders, sleep apnea, and forward head posture have become such significant health problems in modern societies, under the ETIOLOGY tab you will find a long story which details in 5 chapters how our upper and lower jawbones were designed to deal with almost any type and degree of functional forces, but they were never equipped to deal with a lack of functional forces.  The recent softening of our diet due to processed foods; along with parallel synergistic influences from allergies, asthma, muscle hypodevelopment, and sedentary life styles; has radically changed the direction in which our jaws and faces grow and keep growing during adulthood in a way that has made us especially susceptible to these problems.  

TESTIMONIALS  - After 40 years of treating patients, I could include many testimonials, but I don't do that out of principle; because I consider testimonials on websites to be just a form of advertising.  Even the wording that comes from real patients, rather than from advertising consultants, is meaningless because of a statistical factor called "regression to the mean."  In any condition with symptoms that normally fluctuate over time, the symptoms are likely to regress (get better) shortly after patients begin treatment; because patients usually seek treatment at the time when their symptoms are relatively severe and therefore likely to get better soon anyway, just by returning to their average state.  In addition, because TMJ disorders eventually resolve on their own, the relief of symptoms caused by regression to the mean may become a permanent cure and therefore a resounding treatment success, even if the treatment did not actually address the condition.  If you have an experience to share, write a Google review online.  In this unregulated field, the only way patients can get reliable information is by talking to each other.    

FEES -  for exams are $100 - $350 depending on the amount of time required and whether or not the visit included a temporary oral orthotic device.  Fees for appliances range from $250 for rubber bite cushion appliances to $3500 for phase 1 multilevel sleep apnea treatment.  The fees for each appliance are listed at the back of the paper describing that appliance.  In people with dental problems that complicate appliance fabrication, such as missing teeth or implants, the fee may be increased for time required for Dr. Summer to personally fabricate the appliance.

 

CONTACT INFO   

PHONE: (503) 241-7353                     FAX: (503) 525-2966 

EMAIL: theThis email address is being protected from spambots. You need JavaScript enabled to view it.    PHYSICAL ADDRESS:  833 SW 11th Ave. Suite 810  Portland  OR   97205