Sir, just occasionally I read an article that is 'ground breaking'. I am, indeed, both grateful to and appreciative of Messrs. Jagger and Korszun (BDJ 2004, 197: 241) for their paper. Certainly it does describe that nightmare scenario of continuing patient treatment with deteriorating appreciation. Both in terms of professional satisfaction and cost implications. A very worrying problem!

All three patients had symptoms suggestive of 'temporo-mandibular joint pain dysfunction' as such is mechanically caused by a tooth clenching habit. One of the products is fatigue in masticatory muscles and such results in failure of proprioceptive feedback.

Any patient who has a tooth clenching habit will admit that, on occasions, the mouth is 'uncomfortable'. Treatment modalities must therefore be directed towards the cause of such a habit, rather than merely treating the symptoms.

In this day and age we are looking at treatments, including temporomandibular joint surgery, occlusal splints and occlusal grinding. Not to mention managing traumatic pulpitis and periodontitis.

I wonder whether we could take a big leap forward, in refocusing on cause, rather than symptoms i.e. lack of proprioceptive feedback. Once we have awareness of the phenomenon, then I do believe that a great deal of investigative dental treatment would become unavoidable and 'phantom bite' explained.