The perils of “phantom bite syndrome” or “occlusal dysaesthesia”

Abstract

Occlusal dysaesthesia is a clinical disorder characterised by persistent occlusal discomfort in the absence of obvious occlusal discrepancies. Typically this is associated with significant emotional distress. This condition was first described by Marbach in 1976 as a subgroup of temporomandibular disorder patients, and he coined the phrase ‘phantom bite syndrome’. The term occlusal dysaesthesia was introduced in 1997 by Clark et al. and currently this is the most widely used term in the literature. In keeping with the psychiatric literature of the time Marbach suggested that these patients had a ‘mono-symptomatic hypochondriacal psychosis’. Recently the psychiatric hypothesis has been challenged and alternative explanations have been proposed. It is postulated that the condition might be an intraoral sensory disorder, which can occur: a) spontaneously; b) in conjunction with an underlying autoimmune disorder; or, c) with trigeminal neuropathic pain. Although our understanding of this condition has improved, it remains a real challenge for clinicians to recognise the symptoms and provide appropriate treatment. In the absence of controlled studies and agreed diagnostic criteria, the literature is largely based on descriptive reviews. This article describes the clinical characteristics, diagnosis, aetiology and some management strategies for this disorder. Two case studies are provided, which serve to illustrate both the diagnosis and management of this condition. Importantly, clinicians are advised that inadvertently providing further occlusal treatments can intensify the disorder.