In 1997, Clark et al proposed an alternative term: “Occlusal dysesthesia”. However, Marbach’s evocative illustrations are useful for clinicians to visualize better the phenomenon. Earlier, Posselt had mentioned this unusual sensation as a hyperawareness named “positive occlusal sense” in his textbook from 1960, saying “after occlusal grinding or adjustment, some person with a nervous predisposition may become too conscious of their own occlusion”. The term was originally inspired by phantom limb pain, because it was suggested that what occurred after dental treatment in patients with hypochondriacal or severe personality disorder resembles the “ego defense” or “denial of loss” mechanism in postamputation patients. This phenomenon, named “phantom bite syndrome” (PBS), was firstly described by Marbach in 1976 with a report of two female cases. However, apart from these ordinary cases, there are some cases where patients present with non-verifiable occlusal discrepancies with strict demands for bite correction. Subsequently, dentists will perform some occlusal adjustments or provide a specific therapy, if on examination they observed any abnormal intercuspation or contact patterns. Most of the time, these typical complaints are due to reasons such as new crown delivery, dental restorations, orthodontic treatment and temporal mandibular joint dysfunction. In this review, we have discussed the critical role of enhancing dental professionals’ awareness of this phenomenon and suggested a comprehensive approach for PBS, provided by a multidisciplinary team of dentists, psychiatrists and exclusive psychotherapists.Ī general dentist might come across many patients with disturbing or uncomfortable bite sensations in their daily practice. Nevertheless, the treatment approach has been solely based on incomplete knowledge of etiology, in which none of the proposed theories are fully explained in all the available cases. Despite the lack of official classification and guidelines, many authors agreed on the existence of a PBS “consistent pattern” that clinicians should be made aware. Since Marbach reported the first two cases in 1976, there have been dozens of published cases regarding this phenomenon, but only a few original studies were conducted. In general, patients with PBS are quite rare but distinguishable if ever encountered. Subsequently, it takes a toll on their quality of life causing, career disruption, financial loss and suicidal thoughts.

Such erroneous and unshakable belief of a “wrong bite” might impel patients to visit multiple dental clinics to meet their requirements to their satisfaction. © 2012 Wiley Periodicals, Inc.Phantom bite syndrome (PBS), also called occlusal dysesthesia, is characterized by persistent non-verifiable occlusal discrepancies. Botulinum toxin is a safe and effective treatment for this life altering and difficult to treat first bite syndrome.

Many treatments for first bite syndrome have been attempted including: dietary modification, pharmacological treatments, and surgical treatments. The third patient had significant decrease in pain at 4-month follow-up.

Two of 3 patients experienced complete relief of symptoms for 4 to 6 months. Three patients with first bite syndrome were injected with 75 units of botulinum toxin into affected parotid glands, focusing on areas of greatest first bite pain. This study presents 3 cases of first bite syndrome treated with botulinum toxin and a review of the current literature on available treatment modalities for first bite syndrome. It can have a significant effect on both the quality of life and physical health of affected patients. First bite syndrome is an unexpected yet relatively common complication of surgeries involving the parapharyngeal space.

First bite syndrome cure