Instead of the promotional information that fills most medical websites; this website contains hundreds of pages describing a new and comprehensive understanding of the pathophysiology of TMJ disorders and their involvement with bites, obstructive sleep apnea, and forward head posture in a kind of unified field theory that explains how they are all connected as products of a strained facial growth pattern. The website also describes a whole set of orthopedic treatments that address the underlying pathophysiology, as well as their costs and comparisons with other treatments. Finally, the website describes significant new advances in oral appliance treatments for obstructive sleep apnea.
ORTHOPEDIC TMJ TREATMENT
For decades, dentists have "managed" TMJ disorders using physical therapy, medications, oral appliances such as nightguards and splints, and now Botox to treat the tight jaw muscles that always accompany them. These treatments often provide short-term relief; but they don't address the source of the muscle tightness.
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 of the TMJ produces inflammation, which triggers automatic protective guarding in the jaw muscles, much like walking on a swollen ankle triggers limping. There are many ways to treat the muscles, but 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. It 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 not when it occurred of if it has already fully healed and is no longer contributing to your symptoms. MRI is the only way to image the disk, the clinically most significant feature. Dr. Summer has extensive experience with reading MRIs of the TMJs.
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 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. Backwardly displaced central bite platforms cause forward head posture, and laterally displaced displaced central bite platforms cause the head to tip toward the side of the displacement (summarized in THE ROLE OF POSTURE under the TMJ DISORDERS tab and described in detail with footnotes in BITES AND POSTURE under the FOR DOCTORS tab.
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 the treatment of other musculoskeletal disorders. Some treat the muscles, either by mechanically stretching their fibers or flushing their capillary beds; while others work by supporting adaptive capacities that enable people to cope with the ongoing tissue damage and growth strains. Patients who want additional supportive treatments are referred to local practitioners with expertise in the treatment that is most likely to help them. With good orthopedic treatment, we find supportive treatments generally unnecessary, so we don't prescribe them unless the patient requests them; and we don't prescribe medications, because they make it difficult to monitor the effects of treatment that addresses the underlying problem.
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 increases the space in front of the tongue; 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 remarkably similar 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. A unique feature of two of the new sleep apnea treatments (the tongue holding device and the soft palate elevator) is that they can be used for denture wearers, who cannot tolerate mandibular advancement. The FDA study of denture wearers who have untreated obstructive sleep apnea will run from August 2024 until August 2025. Those who qualify for the study will receive free treatment along with before and after 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 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 has removed the jaw muscle forces that are needed to regulate craniofacial growth and thereby 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 - I don't include testimonials; because I consider them to be just advertising. They can even be purchased online. Also, even a genuine story from a real patient does not mean the treatment worked, because of a statistical factor called "regression to the mean." In conditions with symptoms that normally fluctuate over time, the symptoms are likely to regress (get better) shortly after patients begin any kind of 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 other words, something worked, but it could have been just time. 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.
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 $350 for rubber bite cushion appliances to $3500 for phase 1 multilevel sleep apnea treatment. The fees for each appliance are listed in 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 the extra doctor time required to 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