A subtle trap – occlusal dysesthesia

Introduction: Patients complaining of uncomfortable and unpleasant tooth contacts are encountered in the dental practice time and time again, as well as in the fields of physiotherapy, pain therapy, and psychotherapy. These tooth contacts are neither clinically identifiable as premature contacts nor associated with other disorders (e.g., of the periodontal tissues, dental pulp, masticatory muscles, or temporomandibular joint). It is not uncommon for patients to experience this perceived occlusal discomfort as a constant impairment of their oral or physical well-being. This is often accompanied by psychosocial problems. The cases discussed in this article often concern patients suffering from occlusal dysesthesia (OD), although a differential diagnosis must always be carried out to distinguish OD from occlusal disease. Methods: This article presents clinical features of occlusal dysesthesia that are relevant to everyday practice. These features are explained based on the current guideline "Occlusal Dysesthesia – Diagnostics and Management" published by the Association of the Scientific Medical Societies in Germany (AWMF) and by means of case examples. Psychopathological factors, neuro-plasticity, phantom phenomena, and changes to the transmission of proprioceptive stimuli and perception have been discussed as etiological factors of OD; however, the exact connections have not yet been extensively researched or fully understood. Invasive occlusal therapy is not advisable. The use of dental splints is also a controversial topic of discussion in the literature. Patient counselling and education about the nature of OD ("information therapy") that aims to explain and defocus is a recommended measure. Other therapeutic alternatives include cognitive behavioral therapy, specialist medical treatment of possible comorbid psychological factors, pharmacotherapy, and the prescription of physical activity. Conclusion: Despite professional therapy, treatment of affected patients is often unsuccessful. Keywords: false bite, lost bite, occlusal discomfort, occlusal disease, occlusal dysesthesia, occlusion