Occlusal dysesthesia

Occlusal dysesthesia, or "phantom bite," is a form of Dysesthesia, characterized by the feeling of a biting sensation in the absence of any apparent damage to oral or maxillofacial structures or tissue, usually in patients that have undergone recent dental surgery.

Recent research
There are a number of hypotheses regarding the basis of occlusal dysesthesia. Some researchers believe the disorder is a psychological one, while others believe it to be a psychosomatic disorder. Joseph Marbach hypothesized that the symptoms were rooted in psychiatric disorders. Marbach suggested that occlusal dysesthesia would occur in patients with underlying psychological problems (such as schizophrenia) after having undergone dental treatment. More recently, two studies have found that occlusal dysesthesia is associated with somatoform disorders in which the patients obsess over the oral sensations.

Similarly, Marbach later proposed that occlusal dysesthesia may be caused by the brain “talking to itself,” causing abnormal oral sensations in the absence of external stimuli. According to this model, the symptoms of dysesthesia are catalyzed by dental “amputation,” for example the extraction of a tooth, whereby the brain loses the ability to distinguish between its memory of the bite and the actual, new bite. The patient, unable to recognize his or her own bite, becomes especially attentive to these perceived oral discrepancies. Finally and most recently, Greene and Gelb suggested that instead of having a psychological root, dysesthesia may be caused by a false signal being sent from the peripheral nervous system to the central nervous system. However, the reviewers note that no method exists for determining sensor nerve thresholds, and so sensory perception in the mouth is often measured by interdental thickness discrimination (ITD), or the ability to differentiate between the sizes of objects (thin blocks) placed between teeth. In one study, occlusal dysesthesia patients showed greater ability to differentiate these thicknesses than control, healthy individuals, but these differences were not statistically significant.