Briggs' recent reflection on complaints associated with occlusal dysesthesia/phantom bite contained many points with which we strongly empathised.1 His narrative highlights how easily clinicians and patients can become locked into a purely mechanical ‘bite-fixing' framework, despite persistent symptoms that remain disproportionate to clinical findings (Fig. 1).

Fig. 1
figure 1

Panoramic radiograph obtained at the first visit of a 57-year-old woman with occlusal discomfort lasting for more than 30 years, who had consulted numerous dental clinics and university hospitals without symptom relief. She had undergone extensive full-mouth prosthetic rehabilitation with a changed vertical dimension of occlusion, and her clinical presentation could hardly be explained by any condition other than phantom bite syndrome/occlusal dysesthesia (PBS/OD)

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A large retrospective study by Baek et al. provides timely epidemiological context.2 Among 1,323 consecutive new adult patients in a university prosthodontic service, 47 (3.6%) presented with occlusion-focused discomfort without explanatory dental pathology, operationally defined as occlusal dysesthesia.2 Importantly, around 70% attributed symptom onset to prior prosthodontic treatment.2 A prevalence of 3.6% is not negligible; it represents a clinically relevant subgroup that many prosthodontists will encounter, and it strengthens the case for early recognition and consistent, conservative management from the first consultation.

This aligns with guidance that occlusal dysesthesia exists independently of the occlusion and is best understood as maladaptive central signal processing.3 Accordingly, repeated irreversible occlusal adjustments are unlikely to resolve symptoms and may reinforce attentional fixation and help-seeking behaviour. Our previous BDJ letter described a pattern of persistent, non-verifiable ‘wrong bite' sensations, extensive prior dental interventions and substantial impairment in daily life.4 Evidence consistent with central involvement has also been reported, including changes in regional cerebral blood flow following successful pharmacological treatment in a case report.5

Taken together, Briggs' personal account and Baek et al.'s data argue for a pragmatic shift: explanation that validates distress while avoiding endorsement of a mechanical defect, a reversible approach when any intervention is unavoidable, defocusing strategies, and timely collaboration with psychosomatic dentistry and/or mental health services.3,4

Finally, progress will require accumulation of clinical data. When prosthodontic treatment is necessary, definitive intervention should follow symptom stabilisation; any occlusal changes should be introduced reversibly (splints or provisionals) and stepped up cautiously.3,4 Neuromodulators, started at low dose with gradual titration in liaison with psychosomatic/medical colleagues, may reduce sensory amplification and distress and support conservative care.5 Multicentre, standardised recording of triggers, symptom descriptors, comorbidity and outcomes would help move this field from anecdote and controversy to evidence.