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 3 new mechanisms that Dr.Summer invented and developed (now in FDA review) to add to ineffective mandibular advancement appliances or denture base plates (for people without natural teeth) to address the root causes of obstructive sleep apnea by preventing the tongue and soft palate from dropping back into the pharynx. Such a comprehensive approach could soon make oral appliances a first line treatment 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 cause most of the pain. These treatments often provide short-term relief; but they don't address the source of the problem. 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 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. There are many ways to treat the muscles, but effective treatment requires first protecting the inflamed TMJ by wearing a joint protective oral appliance that prevents the condyle from accessing the bruised area when clenching or grinding during sleep. The nightly wear is continued for long enough to allow the damaged TMJ to fully heal, usually about two months. Then the jaw muscles can be rehabilitated using techniques that effectively treat muscles in other parts of the body; and the long term effect of your facial growth on your airway, posture, and teeth can be addressed.
The vast majority of TMJ disorder patients only need to wear the type of oral orthopedic appliance during sleep, when all facial growth occurs and when your jaw undergoes its big nightly workout. Your appliance may be designed to protect bruised TMJs, provide an improved exercise template for rehabilitating the jaw muscles, orthodontically shift your teeth to relieve strain between the jawbones, reduce the forces used in nocturnal bruxism, or redirect those forces in a manner that provides orthodontic and long-term facial growth benefits.
We allow plenty of time for each patient. At your first appointment, Dr. Summer will evaluate your facial growth pattern, 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, or if that TMJ 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 posture system, 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 under 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 central bite platforms cause tipped head posture, as 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 of these approaches treat the muscles, either by stretching them or flushing their capillary beds; while others work by increasing the ability of your body to adapt to the strain. While supportive treatments help most people with tight jaw muscles, they are rarely necessary when good orthopedic treatment is provided. Patients who want to amend their orthopedic treatment with additional supportive treatments are referred to local practitioners with expertise in the treatment that is most likely to help them. We don't prescribe medications, because they are not a good solution to the problem, and they make it difficult to monitor the effects of orthopedic treatment.
OBSTRUCTIVE SLEEP APNEA - is caused by choking on the tongue base with contributions from soft tissues like the distal end of the soft palate. Dentists make oral appliances that treat it by advancing the mandible (lower jawbone), but they are only effective in half of the patients treated, because the mandible is only loosely attached to the tongue base and soft tissues that produce the actual obstruction. Also mandibular advancement appliances cannot be used by denture wearers, because their gums cannot tolerate the pressures required. Therefore, for those who cannot tolerate CPAP and those for whom mandibular advancement is ineffective or impossible, Dr. Summer has developed new devices that can be added to ineffective mandibular advancement appliances or denture base plates in order to also control the positions of the tongue base and soft palate. The soft palate elevator is a silicone rubber bulb on the end of a thin flexible arm that extends backward from the appliance to raise the center of the soft palate to draw its distal end upward and forward away from the obstruction. The tongue holding device grasps the tongue between tongue gripping surfaces comprised of thousands of tiny forward-slanted bristles (tongue velcro) to prevent it from dropping back into the pharynx. Their grip is so effective that they can hold the tongue all night with very little compressive force and no discomfort. Adjustment mechanisms added to the upper tongue gripping surface can also pry the tongue base gradually further forward off the pharyngeal wall in small stepwise increments as patients get used to them. These new devices are summarized under the SLEEP APNEA tab and described in detail in MULTILEVEL ORAL APPLIANCE TREATMENT OF SLEEP APNEA under the tab FOR DOCTORS.
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 the recent softening of our diet due to processed foods has removed the jaw muscle forces that regulate craniofacial growth and thereby changed the direction in which our jaws and faces grow 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 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 fluctuate over time, the symptoms are likely to diminish 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 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 - While some dentists charge exhorbitant fees for TMJ work, (locally some dentists charge $10,000 -$12,000) we keep our fees reasonable, because we love this work. 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 oral appliances range from $350 for rubber bite cushion appliances to $3500 for multilevel sleep apnea treatment. The fees for various appliances are summarized in ORTHOPEDIC TREATMENTS under the TREATMENTS tab. 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