Sir, we read the paper by Byrne and Taylor with interest as this topic is our research concern.1

In our opinion, the patient's management process could be indicative of another condition called phantom bite syndrome (PBS) or occlusal dysesthesia though the detailed characteristics were unknown. PBS is an uncommon condition in which the patient is preoccupied with the dental occlusion and does not correspond to any physical alteration and causes significant functional impairment.2 Interestingly, in many cases of PBS, the first mild discomfort is often associated with certain dental treatments such as simple restoration or orthodontic treatment, before it becomes worse after further occlusal adjustment or extensive dental interventions.3 This, aligned with the patient's mental fixation on their teeth following direct restoration, although there is no clear description of whether the initial chief complaint was related to occlusal discomfort or not. Moreover, the patient described other somatic symptoms (eg overwhelming anxiety, claustrophobia, lack of sleep, subsequent alcohol use, a desire to harm themself) as consequences of occlusal alteration and therefore requested restoration removal. These clinical aspects were also listed as one of PBS's typical manifestations, in which the patients usually emphasise that 'their occlusal problems lead to concomitant somatic symptoms in other body parts' and 'all of their somatic dysfunctions would be cured if and only if their bites are corrected'.3 However, typical dental treatments normally make the PBS symptoms worse, even if they could achieve temporal improvement.2,4

In terms of comorbid psychiatric disorders, the authors suggested: 'whilst this patient had a history of depression and anxiety, their medical history was not unusual considering their dental presentation'. This statement might lead to an impression of severe psychological distress after dental intervention could be attributed to psychiatric disorders if any. However, this might not be the case, since psychological distress is remarkable even in PBS cases without any psychiatric history and could result in serious consequences on patients' life, even suicidal thoughts.3,4

PBS is rare but distinguishable, if ever encountered, and for typical patients dental treatment would not be helpful and should be avoided, since it often affects patients iatrogenically for the worse.3 As in our reported case, some patients could be very sensitive to their occlusal changes and show a variety of psychosomatic symptoms.5Therefore, we agree with the authors' conclusion highlighting that minimal intervention should be considered initially, not invasive irreversible treatment.