For dentists, PTs, and physicians who refer

Adult patients (18+) with one or more of the following presentations, in whom conservative management has been attempted or considered:

• Temporomandibular dysfunction (TMD) of muscular or mixed origin
• Chronic bruxism with documented dental wear or symptom burden
• Masseter hypertrophy secondary to chronic clenching
• Tension-type headache mapping to masseter and temporalis trigger points
• Stress-pattern awake clenching unresponsive to behavioral approaches

We do not treat: pediatric patients, patients with active joint pathology requiring surgical evaluation, patients with neuromuscular contraindications (myasthenia gravis, ALS, Lambert-Eaton), pregnant or breastfeeding patients, or patients seeking purely cosmetic injection.

We refer back when imaging suggests structural pathology, when red-flag headache features are present, or when the patient is better served by your continued management.

Evaluation

• 45-minute virtual or in-person consult
• Full medical, dental, sleep, and pain history
• Focused extraoral exam: TMJ palpation, masseter and temporalis palpation with tender-point mapping, range-of-motion measurements (max opening, lateral excursions), brief cranial nerve screen (V, VII, XII)
• Focused intraoral exam: occlusal class, parafunctional wear assessment, mucosal screening
• Baseline pain VAS, photographic documentation, and a written palpation map
• Imaging referred out when indicated (CBCT or panoramic) — no routine imaging

Indications for therapy

Treatment is offered when (a) the clinical picture is consistent with masseter/temporalis overuse driving the patient's chief complaint, (b) absolute contraindications are absent, and (c) the patient understands the off-label nature of the indication and provides written informed consent.

Injection protocol

• Product: onabotulinumtoxinA (Botox), reconstituted per manufacturer guidance, used within label dilution range
• Masseter: typically 20–30 units per side, 3–4 injection points per side, intramuscular, in the safe zone (anterior to the parotid, inferior to the zygomatic arch)
• Temporalis: typically 10–20 units per side when indicated for tension-type headache or temple referred pain, distributed across the muscle belly
• Total typical dose: 40–80 units per session, conservative-first; titrated upward over visits based on response, never to maximum tolerated dose
• Technique: 30G needle, slow injection, sterile prep, post-procedure ice, written aftercare instructions

Follow-up

• Two-week check-in (text or telehealth) — assess onset, side effects, early symptom change
• Twelve-week assessment (telehealth or in-person) — reassess pain VAS, palpation findings, decide on continuation or referral
• Standard interval thereafter: every 12–16 weeks if responsive; tapered or discontinued if not

What we won't do

• Treat without examining the patient first
• Provide cosmetic-only injection (out of scope for CA dentists)
• Treat at maximum tolerated dose
• Continue treatment in the absence of documented benefit
• Bill insurance (we are cash-pay)

Within five business days of each visit, you'll receive a brief, non-template-feeling consult note like the one below. PDF, secure email, or fax.

Templates are real but the notes aren't auto-generated. Each one is reviewed and signed before sending.

The fastest way to know whether to refer is to experience the protocol. We extend professional courtesy to referring providers, their spouses, and their clinical staff:

• Initial consult: complimentary
• First treatment: at cost (drug + supplies, no professional fee)
• Follow-up assessments: complimentary for the first cycle
• Subsequent treatments: at provider rate (~50% off standard)

The offer is real, the protocol you'll experience is the same one your patient will, and there's no expectation of referrals in return. If the visit convinces you, refer. If it doesn't, we'd rather know now.

The reason providers refer to a specialist is the confidence that the patient comes back. Here is what we commit to, in writing, with every patient you send us:

1. We provide a strictly limited scope of care. Therapeutic neuromodulator therapy for masticatory muscle conditions. Period. We do not provide comprehensive dental examinations, preventive care, prophylaxis, restorative dentistry, endodontics, prosthodontics, periodontal therapy, orthodontics, oral surgery, sleep appliances, fluoride therapy, sealants, or emergency dental care. We hold to this scope per California Business & Professions Code and Dental Board policy on therapeutic botulinum toxin within dental practice.
2. The patient remains your patient. We do not solicit, accept, or compete for the patient's general dental care. We do not market other dental services to referred patients. We explicitly tell every patient — verbally and in writing — that we are an adjunct to their general dentist, not a replacement, and that they should maintain their regular comprehensive recall with you.
3. We refer back for everything outside our scope. Anything we observe during the focused exam — caries, periodontal findings, suspicious mucosal lesion, occlusal concerns, restoration issues, suspected sleep-disordered breathing, joint pathology — gets noted in the chart and referred back to you in writing. We never treat outside scope, even when patients ask.
4. We document and communicate transparently. Within five business days of each visit, you receive a written chart note with findings, treatment, and recommendations specific to your continued care. We answer provider calls and texts directly. We make ourselves easy to co-manage with.
5. We will refuse a referral when appropriate. If a patient is better served by another provider — joint pathology requiring oral surgery, headache pattern requiring neurology, sleep-related airway issue requiring sleep medicine — we tell you and the patient directly, and we forward the referral. We don't keep patients we shouldn't be treating.
6. We do not perform cosmetic injection. Per California Dental Board policy, dentists may administer botulinum toxin for dental and functional purposes only. We do not offer glabella, forehead, periorbital, or any aesthetic-only injection. If a patient inquires, we refer them out.
7. If you ever feel a boundary has been crossed, tell us. Email [email protected] with the concern. We will respond within one business day and correct it that week. We hold this commitment because our practice depends on it.

This isn't marketing language. It is the operating model. Our practice is small and narrow on purpose; our value to patients and to the providers who refer them depends entirely on holding the boundary. If at any point you feel we are not, please tell us so we can correct it.

Three options, easiest to most formal:

• Tell the patient to inquire: send them to unclenchdental.com. They submit, we follow up with both of you.
• Email us with the referral: [email protected]. Patient name, DOB, what you'd like us to evaluate. We'll reach out and loop you on the chart note.
• Set up a referral relationship: email us if you'd like a brief intro call, a one-pager for your front desk, or a coffee. We're local in the South Bay.