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The paradoxes of phantom bite syndrome or occlusal dysaesthesia (‘dysesthesia’) Martin G Kelleher Lakshmi Rasaratnam Serpil Djemal Dental Update 2024 44:1, 707-709.
Authors
Martin GKelleher
Consultant and Specialist in Restorative Dentistry and Prosthodontics, King's College London Dental Institute, London SE5 9RW, UK
Phantom bite syndrome was first described by Marbach over 40 years ago as a mono-symptomatic hypochondriacal psychosis. He used the term to describe a prolonged syndrome in which patients report that their ‘bite is wrong’ or that ‘their dental occlusion is abnormal’ with this causing them great difficulties. This strong belief about ‘their bite’ being the source of their problems leads to them demanding, and subsequently getting, various types of dentistry carried out by multiple dentists and ‘specialists’. Sadly, even after exhaustive, painstaking, careful treatment, none of the dental treatments manages to solve their perceived ‘bite problems’. This is because they suffer from a psychiatric illness involving a delusion into which they continue to lack insight, in spite of the failures of often sophisticated dental treatments.1,2,3
In summary, dental practitioners, or other specialists, who suspect that they might be dealing with such a problem should refer these patients early on for specialist management by an appropriate specialist within the secondary care settings, preferably before they get trapped into the time-consuming quagmire of their management. A ‘Phantom Bite Questionnaire’, which is available to download free, might help.
CPD/Clinical Relevance: This article aims to provide professionals in various fields with guidelines on detecting, diagnosing and managing patients with Phantom Bite Syndrome (PBS). This is desirable in order to prevent extensive, or unnecessarily destructive, or unstable dental treatment being undertaken on such patients in a vain attempt to solve their problems with ‘dentistry’ when, in fact, these are really due to underlying mental health issues.
WARNING
Phantom bite patients are often highly resistant to being referred to psychiatrists as they lack insight into their behaviour. They often complain if even a gentle suggestion is made of a possible referral to a psychiatrist. They remain resolutely convinced that if they could only get someone competent enough to get their ‘bite right’ then all their problems would be solved.
Article
There are many difficult paradoxes in dentistry generally, but phantom bite syndrome is riddled with them. For instance, if a diagnosis of phantom bite syndrome, or occlusal dysaesthesia (dysesthesia), is suspected then the offer to refer the patient to an ‘occlusion specialist’ can, paradoxically, serve merely to confirm in patients' minds that there is something seriously wrong with them and that their perceived problems really are being caused by ‘their bite’. For other dentists, another paradox is that apparently technically excellent dentistry fails to satisfy these patients' demands about their bite and they then often become serial, time-consuming complainers. They often write very long letters (‘graphitis’) detailing their problems. These letters or emails sometimes include details of the ‘research’ that they have done frequently with the help of Professor Google to support their view that their various, sometimes bizarre, symptoms, often in remoter areas of their bodies, have all been caused by alleged imperfections in their occlusion or bite. They frequently have unusually long appointments, some unscheduled, in various vain attempts to ‘sort out their bite problems’. However, eventually that particular dental clinician's treatment is declared a failure. The phantom bite syndrome patient then moves on to other general dentists, sometimes one with a special interest in occlusion, or to consult with a dental specialist of some sort. Some complain to various ‘regulators’,4 or to administrators, or sometimes to an apparently omniscient lawyer about the previous dentist's, or the dental profession's, alleged incompetence in not getting their bite or their ‘occlusion’ quite right.
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