We have all been there…a patient attends complaining of the bite not being ‘quite right’ or the occlusion not feeling ‘balanced’ or the ‘same’ or ‘unnatural’. Patients may demand crowns or any type of elective treatment in order to resolve this ‘issue’. This can be quite daunting when the problem doesn’t seem to be apparent and the occlusal set-up seems to be within normal limits. This is even more acute in the current dento-legal climate.

Iceman famously clasping his teeth together in the locker room to Maverick as he stood in his towel.

Indeed if patients have elective invasive restorative treatment for the sole purpose of managing their ‘bite’ which may not resolve the ‘problem’ the issue may be compounded further as patients request further crowns or further restorations. Such patient presentation has been described as ‘Phantom bite syndrome’.

Some patients find it hard to understand what we aim for and how that relates to their own motivation for treatment.

Phantom bite may represent an obsessive compulsion by patients associated with their teeth-the ‘need’ for them to meet ‘perfectly’ OR for them to meet as they ‘used to’ prior to some required treatment they had received. In our fairly self obsessed world human organs used for smiling, speaking and eating are likely to rank very high on those areas of self awareness by our patients.

The first link below is a paper by Kelleher et al. on this intriguing condition, the second is a questionnaire that can be used to aide diagnosis.

In the authors own words…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. 

Link to Martin Kelleher’s paper on Phantom Bite

Phantom Bite Questionnaire by Martin Kelleher