For providers · Resource 01
Clinical indication sheet
A one-page reference for evaluating whether a patient is appropriate for referral to unclench dental — Dr. Jennifer Nguyen, DMD, FAGD, MPH · Redondo Beach, CA · concierge therapeutic botulinum toxin for TMD, bruxism, and orofacial pain.
✓ Refer when the patient has
- Chronic morning jaw stiffness or soreness
- Tension-type headaches mapping to temples + cheek
- Documented sleep bruxism with dental wear
- Awake/stress-pattern clenching unresponsive to behavior change
- Masseter hypertrophy with functional symptoms
- Repeated nightguard wear-through or breakage
- Tenderness on palpation of masseter / temporalis
- TMD with a muscular component (with or without joint findings)
- Patients exhausted by conservative care that hasn't moved the needle
× Refer elsewhere when
Send to OMFS / oral surgery
- Suspected joint pathology (degeneration, disc displacement with bone changes)
- Acute lock with no resolution
- Trauma history requiring imaging
- Tumor / cyst suspicion
Send to neurology
- Migraine with aura, cluster, or other primary headache
- Red flag: thunderclap, post-trauma, fever, new in >50
- Focal neurological signs
- Suspected medication-overuse headache
Send to sleep medicine
- Suspected obstructive sleep apnea
- Witnessed apneas with excessive daytime sleepiness
- Bruxism in the context of clear airway disease
Manage in your practice
- Acute dental pain or infection
- Restorative needs (occlusal adjustment, repair, crowns)
- Pediatric bruxism
- Patient who hasn't tried conservative measures
⚠ Absolute contraindications
- Myasthenia gravis
- Lambert-Eaton syndrome
- ALS
- Hypersensitivity to onabotulinumtoxinA or human albumin
- Active infection at injection site
- Pregnancy or breastfeeding
- Patient under 18
Relative: aminoglycoside antibiotic use, immunosuppressants, bleeding disorders, active autoimmune disease.
→ What we offer
- 45-min virtual consult before in-person treatment
- Concierge in-home, in-office, or hotel visits across the South Bay (home base Redondo Beach; minutes from LAX)
- Conservative dosing (40–80 units typical first session), titrated over visits
- Chart note returned to you within 5 business days
- Scope-limited: we do not provide comprehensive dental, restorative, or emergency care
- Patient remains your patient; we refer back for everything outside our scope
Refer or ask a question
Dr. Jennifer Nguyen, DMD, FAGD, MPH
Founder · unclench dental
Redondo Beach, CA
For clinical use. Therapeutic botulinum toxin for TMD, bruxism, masseter hypertrophy, and tension-type headache is considered off-label by the FDA. Suitability is determined per-patient on consultation. Last updated June 2026.