Shedding light on an enigmatic occlusal condition: hypothesis on the etiology of occlusal dysesthesia
Medical Hypotheses, cilt.210, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 210
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.mehy.2026.111945
- Dergi Adı: Medical Hypotheses
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE
- Anahtar Kelimeler: Malocclusion, Occlusal dysesthesia, Oral health-related quality of life, Phantom bite syndrome, Somatic symptom disorders, Thalamocortical dysrhythmia
- Ankara Yıldırım Beyazıt Üniversitesi Adresli: Hayır
Özet
Occlusal dysesthesia (OD) is a perplexing oral condition in which patients perceive disturbing occlusal contacts despite the absence of corresponding clinical abnormalities. The condition is often linked to significant psychological distress, yet its etiology remains elusive. Current therapeutic strategies, which are mainly conservative and psychotherapeutic in nature, frequently yield poor outcomes. Conventional theoretical frameworks have conceptualised OD as a psychogenic disorder or have drawn parallels with phantom phenomena, invoking the principles of neuroplasticity and maladaptive cortical encoding of occlusal input. However, these explanations have been unsuccessful in fully capturing the condition’s complexity or in offering consistently effective interventions. The present paper puts forth a novel hypothesis that posits thalamocortical dysrhythmia (TCD)—a well-documented mechanism in disorders such as tinnitus, neuropathic pain, and depression—as a potential underlying pathophysiology in OD. TCD emerges from dysfunction within thalamic gating and gain-control mechanisms, particularly involving the thalamic reticular nucleus (TRN), which regulates sensory processing and attentional filtering. Abnormal TRN activity may result in altered thalamocortical signalling, leading to distorted occlusal perception and heightened attentional salience. This model elucidates the persistent sensory disturbances characteristic of OD and its frequent comorbidity with psychological conditions. The integration of emerging evidence pertaining to the relationship between stress, mood disorders, and TRN dysfunction is a notable aspect of our hypothesis. The hypothesis may be tested via evaluated through electroencephalography, particularly by identifying theta–gamma coupling patterns that are indicative of TCD. If substantiated, this theoretical framework has the potential to transform the prevailing paradigm of understanding, diagnosis, and management of OD, transcending its current psychosomatic characterization and toward a more robust neurophysiological legitimacy. Ultimately, this could lead to the development of novel, targeted interventions that alleviate suffering in a patient population that has long been underserved by existing paradigms.