Sir, a 50-year-old female was referred to our hospital department, following a six-month history of right-sided facial discomfort and complaining that her bite felt 'wrong', which had 'driven her crazy' and 'driven her to tears'. Her GDP had placed a ceramic crown on tooth 36 and adjusted it multiple times, with no improvement. Intraorally the ceramic crown appeared sound, had light occlusal contacts in intercuspal position and was not in occlusion on lateral excursions. After examination and appropriate investigations, a diagnosis was made of occlusal hypervigilance, which is an anxiety-related disorder. Sufferers have heightened attention to their occlusion and become 'exquisitely sensitive about the way their teeth meet'.1 It is linked to a misbalance between perceptual cognitive processes such as catastrophising.2

Careful communication was key to managing the patient's expectations for whom a hard acrylic stabilisation splint was constructed and a referral made for the treatment of the cognitive, emotional and affective disorder components of the diagnosis.3 Psychological approaches such as cognitive behavioural therapy or mindfulness may be appropriate in such cases.2 The patient was very keen to have the crown adjusted, or an extraction, but we strongly advised against this as the repetition of occlusal adjustment or treatment can reinforce the patient's view that the occlusion is incorrect.2,3

How can we as dentists predictably provide the conformative approach as we are often taught not to regularly check the occlusion before a restoration, only afterwards?4 It is extremely important to consider this small, but very specific cohort of patients who may encounter difficulties adapting to any changes, no matter how minor. It may be a consideration to complete an occlusal examination prior to embarking on restorative work to ensure a conformative restorative approach is achieved, which is often viewed as the safest approach to prevent any occlusal disharmony or problems.