I.  Patient interview
A )  Ask patient:  How many mornings per week do they awaken with NO DISCOMFORT?
1)  The typical appropriate candidate  will hesitate, and attempt to rationalize and/or justify their headaches, rather than answer the question directly.  They may attempt  to inform about when they get their worst  headaches.   They seem to rationalize any  other  headache.  There is nothing normal about awaking with any degree of headache, although having frequent or constant  background headache may *be* normal for most candidates.

II. Muscular Palpation
    A)  Standing behind the seated patient, the practitioner should press firmly with his index finger on the patient's forehead at the midline while asking the question: "How much does this hurt?"
1)  It should not be painful (although it may be tender or sore) as this is the control  for comparison.
B)  Palpate with an index finger the patient's temporal area.  Using a massaging motion, locate a fibrous band and press just as firmly on it as was done on the control.
1)  The typical appropriate candidate will report significant discomfort.
C)  If less-than-significant discomfort was reported, continue palpation and press firmly on another fibrous band. Areas that are painful to palpation may be only a few millimeters laterally to an area that was without discomfort.

III. Identifying the NTI candidate (any combination, or just one...)
Awakening with some degree of headache, face, neck or jaw discomfort is NOT unusual; Prior treatments have been less that successful at *preventing* the symptoms;  Temporalis palpation reveals a degree of discomfort; Typical presentations where an occlusal guard is indicated.

IV.  Modifying for vertical opening.
A)  In a right or left excursive movement, the cusp tips of the opposing canine teeth should not be able to occlude.  Modify the occlusal surface of the DE if necessary by either adding acrylic or removing enough plastic (maintaining the established occluding plane) so that there is  separation of the cusp tips in excursive.

1)  The question: "How much vertical opening should the device provide?" is often Asked. Typically, the cusp tips of the opposing canines show a degree of wear, that is, rarely are they as pointed as the day they erupted.  Therefore, it can be concluded that canine-to-canine occluding is not abnormal for the patient.  Although in some cases it may look like there is too much opening posteriorly when providing canine-to-canine  disclusion, it must be acknowledged that when canine teeth are occluded, there is no rest position, but an occlusal scheme which provides near maximal Temporalis contraction,  in an excursive position.
 
2)  Don't let the patient try to convince you that "they don't clench in that  position". The tooth wear is the evidence that they do, or will.  Allowing for canine occlusion as excursive is cause for failure
 
i)  Reducing the length of a canine may be acceptable, and in fact, more esthetically pleasing to maintain canine disclusion.
 
B)  Confirm that there is no posterior occluding in excursive movement.
 
1)  If for example, the palatal cusp of an upper molar occludes with an opposing lower molar in excursive movement  (however slight), this will cause the case to fail.  Either reduce the cusp tip (most preferable), or increase the height of the DE.