Scant evidence available about epidemiology, aetiology and management of occlusal dysaesthesia


Occlusal dysaesthesia (phantom bite, occlusal neurosis, positive occlusal awareness and occlusal hyperawareness) has been defined as a persistent (more than 6 months) uncomfortable bite sensation, which does not relate to any physical alteration related to occlusion, pulp, periodontium, muscle or temporomandibular joint (TMJ) and causes significant functional impairment. Patients who complain  of occlusal dysaesthesia (OD) usually present with a long history of unsuccessful dental treatments. This paper aimed to review the epidemiology, aetiology and management approaches for OD.

The authors searched Medline (PubMed) and the Cochrane library databases abstracts from the International Association for Dental Research (IADR) and reference lists of identified articles. They included any case report or articles presenting aetiological hypothesis and management approaches for OD. Letters, editorials and those studies not related to OD were excluded. Studies were classified according the Oxford Centre for Evidence Based Medicine evidence levels. Study authors were contacted for missing data with incomplete data being excluded.

  • 13 full-text articles were included in the review
  • 37 occlusal dysaesthesia  patients were included (mean age 51.7 ± 10.6 yrs).
  • They were mainly women with a male/female ratio of 1:5.1
  • The average symptom duration was more than 6 years (avg:6.3± 7.5 yrs) with concomitant psychological disturbances (e.g. mood disorders, somatoform disorders, personality disorders).
  • Only four authors presented diagnostic criteria for occlusal dysaesthesia,
  • Treatment approaches included psychotherapy, cognitive ⁄ behaviour therapy, splint therapy and prescription of anti-depressants or antianxiety drugs.
  • The evidence level of management approaches were most expert opinions with single- or multiple-case report(s).

The authors concluded

 Future studies are necessary for a deeper understanding of the mechanisms behind the occlusal dysaesthesia symptoms, and consequently, for improvements in evidence-based management approaches.


It is useful to systematically summarise what is known about a given topic as this clarifies gaps in our knowledge. What is clear from this review is that our knowledge about OD is limited. While the review is helpful, it is disappointing that the authors did not present their own diagnostic inclusion criteria particularly as they have excluded some articles for meeting different diagnostic criteria and only four of the included authors studies diagnostic criteria.


Hara ES, Matsuka Y, Minakuchi H, Clark GT, Kuboki T. Occlusal dysesthesia: a qualitative systematic review of the epidemiology, aetiology and management. J Oral Rehabil. 2012 Aug;39(8):630-8. doi: 10.1111/j.1365-2842.2012.02300.x. Epub 2012 Apr 17. PubMed PMID: 22506934.




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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