Occlusal Dysesthesia (Phantom Bite Syndrome): A Scoping Review

Background: Occlusal dysesthesia (OD), also known as phantom bite syndrome, is characterized by the subjective sensation of an uncomfortable or “wrong” bite despite the absence of objective occlusal pathology. This scoping review aimed to synthesize the current evidence on the epidemiology, etiology, clinical presentation, diagnosis, and management of OD. Methods: The PubMed, Google Scholar, Scopus, Web of Science, ScienceDirect, and Cochrane Library databases were systematically searched using the terms “phantom bite,” “occlusal dysesthesia,” “occlusal hyperawareness,” “occlusal hypervigilance,” “uncomfortable occlusion,” and “oral cenestopathy.” Studies were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (2020), and evidence quality was assessed using the Oxford Center for Evidence-Based Medicine levels of evidence. Results: A total of 20 studies were included (one systematic review, two clinical guidelines, two case-control studies, one retrospective cohort study, two retrospective case series, six case reports, four narrative reviews, one survey, and one theoretical article). OD predominantly affected middle-aged women, with symptom durations often exceeding several years. OD is increasingly believed to be caused by disorderly central sensory processing or maladaptive signal processing rather than by a primary occlusal abnormality, and high rates of psychiatric comorbidities have been reported. Current evidence supports conservative multidisciplinary management approaches, including patient education, cognitive behavioral therapy, and supportive pharmacotherapy and strongly advises against irreversible dental interventions. Conclusions: OD is a complex biopsychosocial condition requiring multidisciplinary care. The current low-quality evidence is primarily obtained from case reports and case series. Therefore, high-quality controlled trials are urgently required to establish evidence-based diagnostic criteria and treatment protocols.