TABLE 2.

Situations when it is recommended that physical therapy practioners refer TMD patients to a dentist and appropriate treatment mechanisms.

Time Factor	Event	Treatment
Nocturnal	The patient awakes with TMD pain.	Improve sleep positions. Wear an occlusal orthotics at night. Prescribe medications that decrease electromyelographic (EMG) activity (e.g., amitriptyline (10 mg, 1–5 tabs 1–6 hours prior to bedtime), nortriptyline (10 mg, 1–5 tabs 0–3 hours prior to bedtime), or diazepam (5 mg, 1–2 tabs). Relaxation prior to sleep.
Daytime	The patient has symptoms associated with tooth-related pain such as: Pain occurs or intensifies upon drinking hot or cold beverages. Trobbing pain occurs spontaneously. Trobbing pain awakes him or her from sleep (there can be other causes for this symptom, e.g., neck pain).	Comprehensive dental examination and treatment.