Treatment of phantom bite syndrome with milnacipran ? a case series

Abstract

Phantom bite syndrome is characterized by an uncomfortable sensation mainly affecting corrected dentition in which no abnormality is clinically detectable. Despite repeated failures of dental surgery, sufferers persist in seeking bite correction from a succession of dentists. The etiology-pathogenesis of phantom bite is unknown but some consider the syndrome to be a psychosomatic disorder. Seven patients with this syndrome were treated with the serotonin and norepinephrine reuptake inhibitor milnacipran for 4 weeks. One patient withdrew after 2 weeks because he was feeling "well". At the end of the study, 5 of the 6 patients completing the study reported significant improvements, with a mean decrease in occlusal discomfort of 55.3%, as indicated by a visual analogue scale. This result appeared to be independent of any antidepressant effect. Only minor and transient side-effects were observed. It is suggested that milnacipran may be a helpful treatment for phantom bite but this needs to be confirmed by further and longer term studies.

Psychiatric comorbidities and psychopharmacological outcomes of phantom bite syndrome

“…Previous reports describe cases in which amitriptyline [20][21][22][23][24], milnacipran [19] and duloxetine [25] were effective, but little is known about aripiprazole [21], and mirtazapine. We found that aripiprazole and mirtazapine may be as effective as amitriptyline for PBS.…”

“…Thorough clinical examinations were performed by at least three dentists, including prosthodontic and orthodontic specialists, to exclude occlusal discrepancies and temporomandibular joint disorders. Previously reported clinical characteristics and criteria were also considered for definitive diagnosis [12,26], Amitriptyline was prescribed as the first choice for psychopharmacological management based previous reports [19][20][21][22][23][24][25]. Other antidepressants or antipsychotic drugs were added or switched consensually according to weekly clinical assessments of symptom severity, quality of life, and adverse reactions.…”

“…The management of PBS includes referral for psychological evaluation [1,5,6] and avoiding occlusal adjustment [3,11,12]. Antipsychotic drugs [1,3,6,11,12] and antidepressants [19][20][21][22][23][24][25] have been reported to be effective, but pharmacological evidence from clinical studies is lacking.…”

Pain and persistent occlusal awareness

“…4,7,12 Phantom sensations may result owing to neuronal reorganization of adjacent regions of the thalamus into the deaf-ferented regions, which can lead the patient to report sensations of tooth awareness and pain. Thus, even after a change in or a loss of occlusal input, the central brain regions representing occlusal proprioception remain functional and unchanged.…”

“…7,9,13-18 Although the relationship among somatic preoccupation, chronic pain and occlusal disharmony rarely has been addressed, the results of a 2007 study showed that 35 (66 percent) of 53 patients with subjective occlusal-related problems also had a comorbid mental disorder. 9 …”