Phantom bite syndrome: Revelation from clinically focused review

Table 1 Clinical characteristics of phantom bite syndrome

	Clinical characteristics
1	Preoccupation with their dental occlusion and an enormous belief that their dental occlusion was abnormal
2	A long history of repeated dental surgery treatment failures with persistent requests for the occlusal treatment that they are convinced they need
3	A relatively high intelligence and socioeconomic status enabled them to undergo endless costly and time consuming dental treatments
4	Despite repeated failures of dental surgery, persist in seeking bite correction from a succession of dentists
5	A strong resistance to referral to psychiatrists and stick to dental procedures
6	A favorable attitude to dentists at first, gradually blaming them for the exacerbated symptoms, finally dropping out with disappointment
7	A tendency to use dental jargon
8	Bringing to the appointment pieces of evidence to prove occlusal discrepancies (radiographs, study cast, temporary crowns, mouthpieces, etc.)

Table 2 Summary of frequent complaints observed in patients with phantom bite syndrome and proposed terminologies

Terminologies
Phantom bite syndrome
Occlusal dysesthesia
Occlusal hyperawareness
Occlusal hypervigilance
Occlusal neurosis
Positive occlusal sense
Persistent uncomfortable occlusion
Frequent complaints
Abnormal/uncomfortable bite
My bite is off/too high
My jaws are not biting correctly
Jaw looseness and weak bite
Uneven dental bite
Feel uneasy with the bite
I try maneuver to position the bite correctly
I don’t know where my teeth belong anymore
Lack of familiarity with my own bite

Table 3 Summary of medications used in phantom bite syndrome’s management

Classification	Drug’s name	Period of follow-up	Side effects	Treatment outcome	Mechanism	Level of evidences	Ref.
D2 blocker	PimozideHaloperidol	No report	No report	No report	Prescribed as a treatment for monosymptomatic hypochondriacal psychosis	Expert’s opinion	Marbach[2], 1978
D2 partial agonist	Aripiprazole	Average 59 d from initial administration to clinical improved day	Drowsiness, constipation, weight gain, nausea, diarrhea, staggering, dizziness, malaise, irritation, headache	37% improved; 40.7% no change, 22.3% discontinued	Unspecified	Retrospective study, n = 27	Watanabe et al[8], 2015
Anticonvulsant	Clonazepam	No report	No report	No report	Reduce anxiety and increase tolerance to the symptom	Expert’s opinion	Clark et al[23], 2005
Tricyclic antidepressant (TCA)	Dothiepin	Unspecified	Unspecified	Generally recovered	Prescribed as a treatment for somatic symptom disorder	Single case report	Wong and Tsang[12], 1991
	Amitriptyline	390 d	No	Significant improvement	Unspecified	Single case report	Umezaki et al[16], 2013
		Average 75 d from initial administration to clinical improved day	Drowsiness, constipation, weight gain, nausea, dry mouth, malaise	44.8% improved; 41.3% no change, 13.9% discontinued	Unspecified	Retrospective study, n = 29	Watanabe et al[8], 2015
	Paroxetine	No report	Drowsiness	1/3 improved; 2/3 no change	Unspecified	Retrospective study, n = 3	Watanabe et al[8], 2015
Serotonin-norepinephrine reuptake inhibitor		Average 152 d from initial administration to clinical improved day	Drowsiness, constipation, nausea, dysuria, pollakiuria, staggering, dizziness, malaise	4/7 improved; 3/7 no change	Unspecified	Retrospective study, n = 7	Watanabe et al[8], 2015
	Duloxetine	Average 28 d from initial administration to clinical improved day	Drowsiness, constipation, nausea, decreased appetite	3/7 improved; 4/7 no change	Unspecified	Retrospective study, n = 7	Watanabe et al[8], 2015
		5 mo	No report	Symptom improved	No report	Single case report	Bhatia et al[39], 2013
	Escitalopram	Average 18 d from initial administration to clinical improved day	Drowsiness, staggering, dizziness, malaise	3/4 improved; 1/4 discontinued	Unspecified	Retrospective study, n = 4	Watanabe et al[8], 2015
Selective serotonin reuptake inhibitor	Sertraline	Average 79 d from initial administration to clinical improved day	Drowsiness, constipation, nausea, edema, dry mouth, decreased appetite	7/9 improved; 2/9 no change	Unspecified	Retrospective study, n = 7	Watanabe et al[8], 2015
	Fluvoxamine	Average 24 d from initial administration to clinical improved day	Drowsiness	2/4 improved; 2/4 no change	Unspecified	Retrospective study, n = 4	Watanabe et al[8], 2015
Noradrenergic and specific serotonergic antidepressant	Mirtazapine	Average 59 d from initial administration to clinical improved day	Drowsiness, constipation, weight gain, nausea, staggering	42.9% improved; 47.6% no change, 9.5% discontinued	Unspecified	Retrospective study, n = 21	Watanabe et al[8], 2015
Combination of TCA and D2 partial agonist	Amitriptyline; Aripiprazole	41 mo	Staggering	Remarkable improve	Altered biochemical abnormalities related to neurotransmitter and higher brain connectivity dysfunction, especially dopaminergic system	Single case report	Umezaki et al[16], 2013
Combination of TCA, benzodiazepine and D2 blocker	Amitriptyline; Lorazepam; Sulpiride	Average 99.8 d for hospitalization and 3.8 yr from discharge	Weight gain, Liver dysfunction, hyperprolactinaemia	15/16 improved	Altered biochemical abnormalities related to neurotransmitter	Retrospective study of inpatients, n = 16	Toyofuku[32], 2000
Combination of D2 blocker and benzodiazepine	Sulpiride; Flunitrazepam	10 mo	No report	Symptom improved	Unspecified	Single case report	Nakamura[40], 1996