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Occlusal Dysesthesia – A Case Study

Author: Mina M. Faiek, DMD, MHA, FACD

Date: November 1, 2023

 

In this article, I discuss a condition called Occlusal Dysesthesia (aka Phantom Bite Syndrome). What it is and how we diagnose and treat it through a patient case study.

What Is  Occlusal Dysesthesia?

In The Journal Of Oral Rehabilitation’s clinical guideline, occlusal dysesthesia is described as “a condition in which tooth contacts that are not clinically identifiable as premature contacts nor associated with other disorders have been perpetually (i.e. for more than six months) perceived as disturbing or unpleasant.”

The root cause behind the condition is unknown, but it’s hypothesized that it occurs when a patient’s nervous system does not adapt to a new bite position or when jaw muscles become dysfunctional after restorations are placed. The patient perceives their bite has changed and develops a habit of checking it out numerous times a day. Every time the patient checks out their bite, they think it keeps changing.

Occlusal Dysesthesia is rare but every dentist will most likely come across a few cases during their career. When it does occur, it’s a frustrating situation for the dentist and a stressful and scary experience for the patient. The good news is occlusal dysesthesia is treatable and a favorable prognosis is typically achieved.

Case Study: “Adam”

Adam is a 37 year old man who recently arrived at our practice complaining that his bite hadn’t felt “right” since he had dental work. He explained that a few months before, his dentist filled cavities on four of his teeth in one visit.

When he went home, he felt pretty good – but when the anesthesia wore off, he immediately noticed that his bite felt off. So, the next day, Adam returned to his dentist, who adjusted his bite using a bur and a handpiece, and he instantly felt better.

However, a few days later, Adam’s bite was bothering him again. He went back to his dentist, who made a second adjustment. Then, a third adjustment. Each time, Adam’s bite would feel better right away, only to start bothering him a few days later. He was sure his dentist had “destroyed” his bite. So, off he went to a different dentist who adjusted his bite, but the same scenario occurred. In desperation, Adam saw yet another dentist. This one told him: “it’s all in your head.”

How We Diagnosed Adam’s Occlusal Dysesthesia

During his quest to “fix” his bite, Adam began experiencing some new symptoms: jaw pain, headaches, and sleep problems – which led him to us. During his first visit, I spent time with him in a private room, not in a dental chair. We discussed his dental history, medical history, his symptoms, and what he was going through in his life. I then took him to a treatment room and performed a thorough examination.

When I told him that his symptoms were not “all in his head”, that he didn’t have a TMD problem, and there was an explanation for what was wrong, Adam was visibly relieved. His condition, I explained, was occlusal dysesthesia, and it could be successfully treated.

How We Treated Adam’s Occlusal Dysesthesia

I explained that occlusal dysesthesia was likely causing his problems and described it in simple terms that he could understand. I then suggested that the best way for him to get better was simply to stop checking his bite throughout the day! At first, he was shocked that the treatment could be so straightforward, but he agreed to try to stop checking his bite. One month later, Adam’s jaw pain and headaches were gone, and his sleep returned to normal.

Patient education was what he needed.

Conclusion

Adam is a highly analytical and curious person who was willing to stop at nothing to find out what was wrong with his bite. His TMD-like symptoms led him to us. We were happy to give him the correct diagnosis and instructions on how to get better. However, other patients, particularly those with very high stress and anxiety levels when they arrive for care, may require medications, oral appliances, or cognitive behavioral therapy.

The takeaway here is this: if a patient keeps coming back for bite adjustments after restorative dentistry, occlusal dysesthesia should be kept in mind. Thank you for reading, and I welcome your thoughts.

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