This website contains a surprising amount of actual content - hundreds of pages describing the cause and treatment of TMJ disorders as well as the forward head posture and airway problems (mouth breathing, snoring, and obstructive sleep apnea) which are commonly associated with them as products of a strained facial growth pattern maintained by an unstable or displaced bite table. Under TMJ DISORDERS are clinically relevant aspects of the underlying pathophysiology, the causal factors behind the symptom generating process, and the ways symptoms are commonly managed. Under TREATMENTS are descriptions of orthopedic treatments, along with their costs and rationales, and new perspectives on the role of glymphatic drainage in CRANIAL AND CRANIOSACRAL. Under FOR DOCTORS are more detailed descriptions of the cause and treatment, three long files explaining the misunderstood clinical aspects of bites, and new oral appliance treatments for snoring and obstructive sleep apnea under MULTILEVEL TREATMENT OF SLEEP APNEA. Under ETIOLOGY is a thorough explanation in 5 chapters of how bites work with the rest of the body in mammals and ancestral humans, how our bites have changed radically in the last couple of centuries due to the softening of our diet, and how this change has produced the backward jaw postures, forward head postures, craniofacial asymmetries and airway problems that have become endemic in modern populations. Only by understanding how we developed these problems can we learn how to solve, treat, and prevent them.
MANAGEMENT - For decades, dentists have not tried to prevent or cure TMJ disorders, because they have not been able to understand their root cause, so they "manage" the symptoms using physical therapy, exercises, stretches (myofascial release), medications, corticosteroid or trigger point injections, Botox, and simple oral appliances that provide a raised bite table. Without access to definitive treatment, many people have to suffer from chronic symptoms for decades.
MUSCLES - produce most of the symptoms, but muscles are responding organs. They rarely start problems. When a TMJ is inflamed or a bite is unstable, the jaw muscles automatically go into reflex protective guarding mode (hypervigilance). They hold increased background tension (tonus) at rest, and they function with decreased forces, like your leg muscles would act when walking on a swollen ankle or barefoot on gravel. The compression from the increased resting tonus in the muscles can prevent adequate resting circulation in the muscle tissues, causing waste products to accumulate in their capillary beds. Treatments that weaken the jaw muscles (such as Botox, trigger point injections, and esthetic orthodontics) can sometimes provide short-term relief of muscle symptoms by breaking up a symptom generating cycle in which one of the components is the forces used in nocturnal bruxism, but these treatments can also exacerbate the long-term problem by depriving the jaw muscles of the strength they need to regulate facial growth and power the natural mandibular advancement that is needed to maintain an adequate airway passage with age.
COMMON TMJ APPLIANCES - can relieve symptoms by providing a bite table tall enough to stretch tight muscles and stable enough to lower jaw muscle tonus; but these appliances lack the orthopedics necessary to address the root problem. Any oral appliance that interposes a layer of plastic between the teeth protects them from wear, but tooth wear is rarely the problem. An oral appliance that repositions the mandible can provide a crutch in the form of an improved platform for the mandible to rest on and exercise against; but, unless it also improves the facial growth pattern ultimately responsible for the strained platform, it can leave you dependent on the crutch.
ORAL ORTHOPEDIC APPLIANCES - can eliminate the symptoms on both a short-term and long-term basis by protecting the joints, rehabilitating the muscles, and redirecting forces of nocturnal bruxism to gradually accomplish the orthodontics that you need for an improved bite table. However, different types of oral orthopedic appliances are needed for different types of TMJ disorders. For example, an inflamed TMJ needs mechanical protection (the crutch), weak jaw muscles need a good exercise platform, tight jaw muscles need stretching, unstable bites need stabilizing, and strained bites need repositioning.
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 or if it is still happening. MRI is the only way to image the disk shape and location or the presence of inflammation. Dr. Summer has extensive experience with reading MRIs of the TMJs.
THE BITE - affects the core pathophysiology and the facial growth pattern responsible for it, because the bite functions orthopedically as a joint between the upper and lower jawbones. However, dentistry has never understood the central role that bites play in TMJ disorders and sleep apnea, because dental researchers have never seen the bite table as a joint, a postural component, or a regulator of facial growth. Without understanding the bite, most dental authorities simply warn dentists not to treat it. A goal of this website is to explain the bite and its role in these conditions so dentists can finally treat them effectively.
TMJ INFLAMMATION - is usually present in the initial stage, especially in young people. The inflammation must be treated before the muscles; because the resting tonus in muscles depends on the health of the joints they surround, and the TMJs (temporomandibular joints) are surrounded by the jaw muscles. TMJ disorders generally start with a dislocation of the articular disk from a TMJ, which leaves that TMJ without a cushion and therefore vulnerable to bruising by the condyle during the forceful clenching or grinding that affects everybody during sleep. Effective treatment at this "intracapsular" stage of a TMJ disorder requires wearing a TMJ protective oral appliance during sleep to stop the bruising for long enough to allow the damaged TMJ to fully heal, about two months. Then the same appliance can be converted orthopedically into a long-term use appliance that rehabilitates your muscles and improves your facial growth pattern so your problem never returns.
TIGHT JAW MUSCLES - can by caused by TMJ inflammation, but they are most commonly caused by unstable or displaced bite platforms. If the bite platform does not provide a comfortable platform for the mandible to rest on and work against, the jaw muscles can never fully relax. Also, if the bite platform is displaced, it displaces the postural position for the mandible; because protective reflexes automatically program the jaw muscles to always hold the mandible in a resting posture just beneath its most stable bite platform, even if the jaw muscles have to strain to hold it there. In this manner, a displaced bite platform displaces mandibular posture.
ADAPTIVE TONGUES - often find a resting posture between the teeth to give the mandible a cushion which is more comfortable than a long row of jagged rocks that don't fit together perfectly or that force the mandible backward and/or to one side. When the bite forces the mandible backward, its front end rotates into the pharyngeal airway space, and the tongue (the guardian of the airway passage) shifts to find an adaptive position that maintains an adequate resting airway passage. It may reposition between the back teeth, leaving scalloped shapes in the sides of the tongue, or it may reposition between the front teeth and move them out of the way, producing an anterior open bite that prevents them from being able to touch or incise.
BODY POSTURE - is affected by jaw posture, because the mandible is an integral component of the head posture mechanism, and the posture of the head determines how the body aligns beneath it to provide physical support for the big weight on top in a resting postural stance. If a displaced bite table prevents your mandible from resting under the middle of your head, your head cannot rest straight on the top of your spine. Backwardly displaced bite tables cause backward jaw posture and forward head posture. Laterally displaced bite tables tip head posture toward the side of the displacement. Both mechanisms are explained in THE ROLE OF POSTURE under the TMJ DISORDERS tab, and in detail with footnotes in BITES AND BODY POSTURE under the FOR DOCTORS tab.
TMJ ARTHRITIS - is a diagnosis that is based on imaging and often used to sell unnecessary treatment of the joints, the TMJs. The diagnosis simply means that the bones at the TMJs no longer have the smooth rounded shapes of young healthy joints; but it does not reveal any need for treatment, because the damaged TMJs often heal by remodeling. Osteoarthritis is just wear-and-tear arthritis. Osteoarthritis of the TMJs results in a remodeling process that can leave the bones of the TMJs extremely misshapen after they have fully healed and become perfectly functional. For that reason, many older people have TMJs that show flattening, erosions, ledges, or other irregular shapes that resulted from adaptive remodeling some time in the past, which makes those TMJs fit the definition of arthritis; but that does not mean they need treatment. If a TMJ is no longer inflamed (effusion on MRI), it has healed; and the symptoms are myogenic, not arthrogenic. They are coming from the muscles, not the joints (the TMJs). Treatment aimed at the TMJs, (surgery or injections) is misdirected and inappropriate.
SUPPORTIVE TREATMENTS - such as physical therapy, myofunctional therapy, massage, accupuncture, chiropractic, improved nutrition, psychological counseling, biofeedback, exercise, muscle stretching (myofascial release), trigger point injections, and relaxation 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 them treat your muscles, and others increase your ability to adapt to the strain. We encourage patients who want to pursue these additional treatments to see the local practitioners with expertise in the treatment that is most likely to help them. We don't prescribe medications, because they make it difficult to evaluate the root problem or monitor the effects of orthopedic treatment on the root problem.
OBSTRUCTIVE SLEEP APNEA - is caused by choking on the tongue base and the distal end of the soft palate. Many dentists treat the problem with mandibular advancement appliances, but those appliances only solve the problem in 1/2 to 2/3 of the patients treated; because the mandible is only loosely attached to the tongue base and not at all attached to the soft palate. Also mandibular advancement appliances cannot be used in full denture patients. To solve these problems, Dr. Summer has developed three new devices that can be added to ineffective mandibular advancement appliances or denture base plates to also control the positions of the tongue base and soft palate. Two of the new devices have already been FDA cleared, and the third is undergoing its final clinical trial in full denture patients with untreated obstructive sleep apnea. At this point, the devices are only available locally. Next year they will all be marketed together in a kit of components that can be used by dental labs to add them to oral appliances as needed. The devices are described in detail in MULTILEVEL ORAL APPLIANCE TREATMENT OF SLEEP APNEA under the tab FOR DOCTORS.
TESTIMONIALS - are not included, because I consider them to be just advertising. They can be made up or 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 medical conditions that fluctuate, the symptoms are likely to diminish shortly after beginning 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 caused by regression to the mean may become a permanent cure and therefore a resounding treatment success, even if the treatment never addressed the condition.
FEES - Fees for exams are $100 - $400 depending on the amount of time required and whether or not the visit included a temporary oral orthotic device. Fees for consultations depend on the time required. Fees for oral appliances are included in the descriptions of various appliances. The fees have a range, because they require more time and effort in some cases.
Our evaluation and treatment for TMJ disorders and sleep apnea is considered medical rather than dental, because we treat the joints and muscles rather than the teeth. We are in network with Regence Blue Cross, but we can't guarantee coverage. Healthshare Care Oregon (OHP) covers the initial evaluation, but not treatment. We are out of network with most other insurance companies, but some of them cover benefits for out of network providers. We encourage our patients to contact their insurance company to inquire about benefits for non-surgical TMJ treatment, oral appliances, CPT code 21089. In some cases, we will provide a completed claim form for patients to submit to their insurance company.
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