Treatment of phantom bite syndrome with milnacipran – a case series

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.