When canine cusp tips are just missing each other, is there still plenty of freeway space?  If so, that's not good... the opposite condyle mayh still be excessively translated.  (example)

> She then saw the oral surgeon for evaluation of the joints and he said she had bone spurs/calcium 
> deposits in the right side where she has the pain and sometimes numbness/dysesthesia.

Is her maximum opening (without pain) less than 25mm?  
That's about when some good translation happens and how real primary joint conditions present themselves. (In fact, everybody you see in your office is supposed to have their degree of painless opening checked.  Pain at  25 mm or more is a sign of a joint condition). When she moves excursively to the left, that right joint is really translated...and if she clenches on the NTI (who doesn't?), then her joint will hurt worse.

> Is it possible that she "needs" her musculature to reposition the condyle to avoid this area? 

Looks to me like you might have a "primary joint condition" on your hands.
Zero strain on the joint happens when there is bilateral posterior occlusal contact.  Miminal joint strain happens with an NTI as long as vertical opening has not initiated translation, especially with a "true" primary joint condition.  The vertical opening that her canines force you to create may make the NTI contraindicated here. You'd have to either reduce the canine cusp tip height (start with the
lowers) or simply not use an NTI on this patient...

> But yet she also says that WITH the NTI she gets muscle tension/pain in her neck and shoulders.  Any 
> tips??

If the opening is too much for the joint condition she has, then a reflexive/protective activity would be muscle tension (it's the attempt to stablize the area).

I had a great talk with a good friend of mine about this exact scenario just yesterday.  Our conclusion (even for NTI Masters): Why expose yourself to the risk at the onset?  See what the O.S. has in
mind, first.  You can try a little hero-dontics (reducing canines, etc.) later.

-Jim

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