This website contains a surprising amount of content - including a complete description of 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, we explain the clinically relevant aspects of the underlying pathophysiology, the many misconceptions that confuse treatment, and the causal factors behind the symptom generating process. Under TREATMENTS, we contrast the orthopedic treatments we offer with other treatments described in MANAGEMENT. The file entitled CRANIAL AND CRANIOSACRAL contains an updated explanation of the recently recognized role of glymphatic circulation in brain health, age related cognitive decline, and neurodegenerative diseases like Alzheimers and Parkinsons. Under FOR DOCTORS are more detailed descriptions of causes and treatments for TMJ disorders along with three long files explaining BITES and a detailed explanation of new oral appliance treatments for obstructive sleep apnea. Under ETIOLOGY is a thorough explanation in 5 chapters of how bites work with the rest of the body in mammals and humans and how the softening of our diet in the last couple of centuries has changed how our jaws and faces grow in a way that has made backward jaw posture, forward head posture and craniofacial asymmetry 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, but just to "manage" them using physical therapy, exercises, stretches (myofascial release), medications, corticosteroid or trigger point injections, Botox, and simple oral appliances that provide a taller and more stable bite table. Management is usually successful at getting people through the occasional exacerbations that are part of the natural course of most TMJ disorders, without addressing the cause of the problem.
COMMON TMJ APPLIANCES - are management tools. They can stretch tight muscles and provide temporary bite stability, but they 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 wear rarely causes TMJ disorders. Oral appliances that reposition the mandible can relieve symptoms by providing a crutch in the form of an improved platform for the mandible to rest on and exercise against while wearing the appliance; but, unless they also improve the facial growth pattern ultimately responsible for the strained platform, they 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. Different types of oral orthopedic appliances are needed for different types of TMJ disorders. For example, an inflamed TMJ needs protection (the crutch), weak jaw muscles need a good exercise platform, tight jaw muscles need stretching, unstable bites need stabilizing, and strained bites need adjusting or 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 in the past, but they cannot tell when it occurred or if it has already fully healed and is no longer causing symptoms. MRI is needed to image the disk shape and location and affirm the presence of inflammation. Dr. Summer has extensive experience with reading MRIs of the TMJs. Typically the cause of your face and neck pain or ear symptoms is either TMJ inflammation or chronic jaw muscle tightness (increased tonus).
TMJ INFLAMMATION - Most TMJ disorders undergo an inflammatory phase, usually shortly after the disk first became dislocated or went into the locking phase. The inflamation must be addressed before treating 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. 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, usually about two months. Then the appliance can be modified orthopedically to rehabilitate the muscles and improve the facial growth pattern so the problem never returns.
TIGHT JAW MUSCLES - can be caused by TMJ inflammation or by a displaced or unstable bite, which also 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 strained bite produces a strained jaw posture, and you won't know it.
BODY POSTURE - is always affected by a strained jaw posture, because the jaw is part of the neck. The rest of the body gets involved, because the mandible is part of the head posture mechanism, and the posture of the head determines how the body aligns beneath it to provide physical support 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, as explained in THE ROLE OF POSTURE under the TMJ DISORDERS tab, and in detail in BITES AND BODY POSTURE under the FOR DOCTORS tab.
TMJ ARTHRITIS - is a diagnosis which is based solely on X-ray and not an indication for treatment, because damaged TMJs heal with time and especially with age - even when the bones above and below them remain extremely misshapen. Wear-and-tear arthritis can reshape the bones of the TMJs with flattening, erosions, or ledges from adaptive remodeling; even when those TMJs have fully healed and are no longer symptomatic. If a TMJ is not inflamed (effusion on MRI), it is not the cause of your symptoms not an appropriate treatment target.
SUPPORTIVE TREATMENTS - such as physical therapy, myofunctional therapy, massage, accupuncture, chiropractic, 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 almost never prescribe medications, because they make it difficult to monitor the effects of orthopedic treatment.
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 their success rate is only 1/2 to 2/3; 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 they are just advertising. 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 - $300 depending on the amount of time required and whether or not the visit included a temporary oral orthotic device. 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, which are only involved as orthopedic tools for determining the bracing position and range of motion of the mandible. 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
HOURS: Mon - Thurs 9:00 - 5:00