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Occlusal dysesthesia
Temporomandibular Disorders Occlusal dysesthesia Background.—Occlusal dysesthesia (OD) is characterized by feeling one’s bite is altered in the absence of obvious occlusal discrepancy. The disorder is usually associated with emotional distress and often occurs after a dental procedure has been done. Because of the discomfort, patients undergo dental treatments and occlusal adjustments seeking to return to the ‘‘correct bite.’’ The epidemiology, taxonomy, etiology/pathophysiology, symptoms, and treatment of OD were documented. Methods.—A literature search of PubMed yielded 22 articles that were reviewed for information. Eighteen came from the original search; four were added from the references in the studies. Epidemiology.—Data are not available on the prevalence and incidence of OD, but it is considered a rare condition. OD may be more common in female subjects, but this is not reported in all studies. Patient age varies widely, but the onset of the symptoms occurs around age 45 years. Symptoms last a mean of 6 years. Over 70% of the patients studied reported symptoms developed after a dental intervention. Taxonomy, Etiology, and Pathophysiology.—OD does not have an official classification, but several hypotheses have been developed to explain its etiology and pathophysiology. Among the psychopathologic etiology hypotheses are the monosymptomatic hypochondriacal psychosis theory, the body dysmorphic disorder, and a theory that a somatoform disorder accompanies one of these two disorders. In the neuromatrix theory, a patient is believed to have a self-knowledge of his or her dental occlusion, or occlusal neurosignature, which includes the feeling of each occlusal contact. When dental treatments modify the bite, OD can develop in susceptible patients, so that they do not recognize the new occlusal contacts as their own bite. Altered dental proprioception has been proposed as an explanation of OD, but does not appear to be supported by the evidence. Symptoms and Diagnosis.—The main symptom and major focus of patients with OD is discomfort with the bite. Usually emotion distress accompanies this symptom. Often patients undergo numerous dental procedures to relieve the symptom but achieve no relief. Among the comorbid conditions with OD are temporomandibular disorder (TMD), tooth clenching, depression, obsessive compulsive tendencies, and somatoform disorder. Dental
treatment generally precedes the onset of the major symptom. Various criteria have been proposed for the diagnosis of OD. Among those shared by the studies evaluated were discomfort with the occlusion, acknowledgment of the emotional stress associated with the uncomfortable bite, undergoing numerous dental procedures without satisfaction, and the absence of identifiable occlusal abnormalities or other pathologic conditions that would explain the sensation of altered bite. Symptoms should be present for at least 6 months. Often the occlusal discrepancy reported is disproportional to the situation. Treatments.—Four major categories of treatment have been identified. All are based on expert opinion and case reports, since none of the studies reviewed included a control group. Positive results were scarce. Patient education is important to make the patient aware that nothing organic is wrong, but the sensation results from an altered perception or interpretation of normal occlusal contacts. Tooth contacts change constantly, so the feeling of having uncomfortable contacts is not abnormal. Psychologic therapy is delivered via individual sessions using cognitive behavioral techniques. It should accompany education of the patient and focus on distracting the attention from the teeth. Splints may be used along with education and cognitive behavioral therapy to help the patient divert his or her attention from the tooth contact. Having an appliance placed on the teeth will change the perception of tooth contact. However, the clinician should monitor the patient’s progress to ensure that the attention on the tooth contact is not increased rather than decreased. Pharmacotherapy uses medications that affect the central nervous system. The goal is to stabilize the patient’s mood, relieve anxiety, and minimize the compulsion to focus on tooth contact. One treatment approach that should never be used is the performance of dental procedures of any type to achieve even contacts between the teeth. Usually this approach fails to improve the symptoms and patients could become even more focused on the occlusion.
Volume 61
Issue 3
2016
e79
Discussion.—OD cannot be improved with dental interventions. In fact, the result may be the opposite—making the patient feel more strongly that something is wrong with his or her tooth contacts. Other approaches are designed to inform, distract, and minimize the focus on tooth occlusion for patients.
Clinical Significance.—If the patient believes a dental procedure caused the tooth contacts to change, it makes sense that performing more dental procedures will be counterproductive. Engaging the patient in a process of
e80
Dental Abstracts
education, distraction, and anxiety reduction should prove to be a better approach—although it appears that none of the management approaches for this disorder carry a high rate of success.
Melis M, Zawawi KH: Occlusal dysesthesia: A topical narrative review. J Oral Rehabil 42:779-785. 2015 Reprints available from M Melis, Private Practice, Via Roma 130 09047 Selargius, Cagliari, Italy; e-mail: [email protected]
treatment generally precedes the onset of the major symptom. Various criteria have been proposed for the diagnosis of OD. Among those shared by the studies evaluated were discomfort with the occlusion, acknowledgment of the emotional stress associated with the uncomfortable bite, undergoing numerous dental procedures without satisfaction, and the absence of identifiable occlusal abnormalities or other pathologic conditions that would explain the sensation of altered bite. Symptoms should be present for at least 6 months. Often the occlusal discrepancy reported is disproportional to the situation. Treatments.—Four major categories of treatment have been identified. All are based on expert opinion and case reports, since none of the studies reviewed included a control group. Positive results were scarce. Patient education is important to make the patient aware that nothing organic is wrong, but the sensation results from an altered perception or interpretation of normal occlusal contacts. Tooth contacts change constantly, so the feeling of having uncomfortable contacts is not abnormal. Psychologic therapy is delivered via individual sessions using cognitive behavioral techniques. It should accompany education of the patient and focus on distracting the attention from the teeth. Splints may be used along with education and cognitive behavioral therapy to help the patient divert his or her attention from the tooth contact. Having an appliance placed on the teeth will change the perception of tooth contact. However, the clinician should monitor the patient’s progress to ensure that the attention on the tooth contact is not increased rather than decreased. Pharmacotherapy uses medications that affect the central nervous system. The goal is to stabilize the patient’s mood, relieve anxiety, and minimize the compulsion to focus on tooth contact. One treatment approach that should never be used is the performance of dental procedures of any type to achieve even contacts between the teeth. Usually this approach fails to improve the symptoms and patients could become even more focused on the occlusion.
Volume 61
Issue 3
2016
e79
Discussion.—OD cannot be improved with dental interventions. In fact, the result may be the opposite—making the patient feel more strongly that something is wrong with his or her tooth contacts. Other approaches are designed to inform, distract, and minimize the focus on tooth occlusion for patients.
Clinical Significance.—If the patient believes a dental procedure caused the tooth contacts to change, it makes sense that performing more dental procedures will be counterproductive. Engaging the patient in a process of
e80
Dental Abstracts
education, distraction, and anxiety reduction should prove to be a better approach—although it appears that none of the management approaches for this disorder carry a high rate of success.
Melis M, Zawawi KH: Occlusal dysesthesia: A topical narrative review. J Oral Rehabil 42:779-785. 2015 Reprints available from M Melis, Private Practice, Via Roma 130 09047 Selargius, Cagliari, Italy; e-mail: [email protected]