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CMD and TMD 

An estimated forty to sixty million Americans experience some degree of craniomandibular dysfunction (CMD) or temporomandibular disorder (TMD).  Many chronic sufferers are misdiagnosed with neuritis, neuralgia, tension headaches, or even label neurotic.  The simple fact is that your teeth must come together properly when you chew and swallow if you are not to stress the maze of muscles that connects your jaw to your skull to your spine. 

Dr. Trovato is a Fellow of the American Academy of Craniofacial Pain, exemplifying the extent of Dr. Trovato's studies, skills, and experience in the field of temporomandibular joint health. To earn a fellowship, Dr. Lou completed five years of course work, an extensive mini-residency, rigorous case presentations to a panel of Fellows, and a four-hour comprehensive written exam. Dr. Trovato has also completed many seminar and study hours in the unique field of Chirodontics (the marriage of chiropractic and dentistry).

With our extensive knowledge, we are able to diagnose, explain, and recommend palliative care and proper treatment.  We can review all options, but PLEASE NOTE: Meetinghouse Dental Care no longer treats CMD or TMD.  Due to the large amount of time and multiple appointments required to properly monitor and address CMD and TMD, we refer out to specialists who devote their entire practice to the care of these types of cases.  



People commonly refer to any CMD or TMD issues as "TMJ".  TMJ stands for temporomandibular joint.  Saying "I have TMJ" would be like saying "I have a knee".  Everyone has two TMJs.  Pain in the temporomandibular joint would be classified as TMD (temporomandibular disorder).  

The first important question that should be asked is WHERE exactly is the pain occurring?

CMD would be pain that is more generalized across the face and head, involving mostly the masseter and temporals muscles.  Patients would experience soreness, pain when chewing / grinding / clenching, and headaches.

TMD would be pain very specifically around the ear, radiating about one inch forward from the tragus.  Patients may hear clicks and pops and possibly locking of the jaw open or closed.

Of course, it is not uncommon to have a blend of symptoms and potential suffering from malfunction of both the muscles and the joint.




How do you know you have CMD/TMD? 

It's not always obvious.  CMD/TMD can generate symptoms in areas other than the jaw.  Do you suffer from migraines or headaches, pain or pressure behind the eyes, burning or tearing eyes, blurred vision, earaches, ringing or buzzing in ears, stuffiness in ears, loss of hearing, dizziness, chronic sinus problems, clicking or popping jaw joints, jaw locking, grinding, clenching, unusual wearing or cracking of teeth, jaw soreness on awakening, difficulty swallowing, facial pain, neck pain, shoulder pain, or numbness/tingling in the fingers? You may have a compromised bite.


Possible Causes of CMD / TMD

Muscle and joint issues are closely associated with chronic clenching and grinding which is usually related to a poor bite (malocclusion) or trauma.  Malocclusion is most commonly caused by retraction orthodontics.  If you had teeth (almost always four premolars) removed before braces, you are at higher risk for CMD and TMD.  Malocclusion can also be caused by crowded or overlapped teeth, poorly aligned teeth, extra or missing teeth, and irregularities of the jaw.  It may result from habits like thumb/finger sucking or from conditions like compromised skeletal structure, enlarged tonsils, forward head posture, and/or mouth breathing.  A bad bite may be the consequence of a single missing tooth, an improper detnal restoration, or ground down or broken back teeth.  Maybe you've tolerated syptolms for years, or maybe the onset of symptoms was sudden and intense, as after whiplash, a fall, or a blow to the face.  



Each CMD / TMD condition is unique and treated as such.

Because treatment is usually long and tedious, requiring full commitment on the part of the patient, Meetinghouse Dental Care typically recommends exploring treatment options only when experiencing pain, dysfunction, or quality of life issues.  We do not recommend treatment to fix a random click or pop.

Some conditions will benefit most from multidisciplinary treatment, and your treating dentist should work closely with your chiropractor, doctor, physical therapist, naturopath, or other practitioner.


Phase I of treatment requires finding a bite that positions the jaw in the proper placement for optimal functioning of the joint and relaxation of the muscles.  This is done by wearing a dental orthotic to establish a new occlusion.

Phase II of treatment involves finding a long term solution for creating the newly established proper bite to maintain long term optimal joint and muscle function. As your health improves, if you so choose, you may consider restorative options that will allow you to discontinue use of any appliance you may have worn during stabilization without sacrificing the comfort you've achieved.  Some acute pain (rather than chronic pain) guests and some youthful guests need no further attention to the bite.  Others may take advantage of rehabilitative dental care - implants, crowns, bridge, resin or ceramic rstorations, orthodontics, or a combination of the above - to reposition or restore teeth to hold the new, healthy bite.


Feel free to ask us for more information during your new patient exam or periodic exam.

For more information on CMD, visit the website of the American Academy of Craniofacial Pain at




I am a 72-year-old woman who has suffered from vertigo and TMD for the past 20 years.  Dr. Trovato fitted me with an appliance.  I wore it for several months.  To my amazement, I had no more veritgo, and the clicking in my jaw subsided.  Dr. Trovato made mys mile over then.  Now my teeth are positioned so I don't have to wear the appliance.  I am so very grateful to Dr. Trovato.  I feel like a new person!  The whole team has been so helpful and friendly.  I have no pain, I have a beautiful smile, and I feel like a sexy 72-year-old!" 
Marie, Southampton PA

What a pleasant experience!  I've been in pain for four months.  My own caring dentist sent me here, knowing the knowlede and experience Dr. Trovato has.  The pain of "being in pain" is gone, replaced with hope.  Dr. Trovato and staff are all so kind!  From the moment I opened the door and smelled what I though was something baking (cookies) to seeing the comfortable waiting room massage chairs and foot massager, i knew it was a caring office.  I was then greeted by name by each person on staff - WOW - I felt so speical.  I am leaving with hope and a fresh baked peanut butter cookie; what a great dental office.  May God bless this practice and all who owrk here. 
Carolina Dunleavy, Jamison PA

I have been trying to write and thank you since we saw you last week.  Barb, thank you for all the efforts you made in coordinating the appoinment with our airline travel, adn, Lou, thank you for allowing us to visit you on a Friday as well as all the time you spent with us for the CMD consult.  The consultation we had with you was fantastic, and I am so gratful to have found out about you.  I t has made all the difference having the acculiner assessments and your ideas.  You have a wonderful practice and staff.  Than you so much for allyour time and help.  It ahs made such adifference to me know how to proceed as wekll as being able to contribuite to Hamilton's health with the knowledge I now hoave.  Lou, you are an amazing dentist - and you and your wife, Barb, are such a great team. 
Engelda Clinton, Gloucestershire, England

Dr. Lou, you have done such a wonderful job with Melanie's functional orthopedic treatment.  Starting with our initial consultation,e valuation and planning, through the arch development treatment phase and now down to the final stage.  Dr. Lou, you are an innovator.  Your knowledge and skill saved us an unnecessary operation that others in the field suggested.  The Meetinghouse Dental Care team is incredible - meticulous, friendly, knowledgeable and caring.  They are like a second family to us!  Thank you for everything you've done.
Marianne Lawrence, Horsham PA